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

Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

Resource Profile: Guideline - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the guideline resource profile.

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

0. Composition
2. Composition.type
4. Composition.type.coding
Control1..1
Pattern Value{
  "system" : "https://fevir.net/resources/CodeSystem/179423",
  "code" : "Guideline",
  "display" : "Guideline"
}
6. Composition.section:recommendations
Slice Namerecommendations
Control0..1
Must Supporttrue
8. Composition.section:recommendations.code
10. Composition.section:recommendations.code.coding
Control1..1
Pattern Value{
  "system" : "https://fevir.net/resources/CodeSystem/179423",
  "code" : "recommendations",
  "display" : "Recommendations"
}
12. Composition.section:recommendations.entry
TypeReference(Recommendation)

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

0. Composition
Definition

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

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

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

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Composition.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

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

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

ShortContained, inline Resources
Comments

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

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

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

ShortHow to compare versions
Comments

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

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

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

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

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

ShortNatural language description of the artifact
Comments

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

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

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

ShortWhy this artifact is defined
Comments

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

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

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

ShortUse and/or publishing restrictions
Comments

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

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

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

ShortCopyright holder and year(s)
Comments

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

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

The date on which the 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
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
20. Composition.extension:lastReviewDate
Slice NamelastReviewDate
Definition

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

ShortWhen the 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
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
22. Composition.extension:effectivePeriod
Slice NameeffectivePeriod
Definition

The period during which the 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
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
24. Composition.modifierExtension
Definition

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

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

ShortExtensions that cannot be ignored
Comments

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

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

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

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

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

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

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

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

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

The workflow/clinical status of the composition.

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

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

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

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

ShortKind of composition (LOINC if possible)
Comments

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

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

Type of a composition.

TypeCodeableConcept
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

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

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

A reference to a code defined by a terminology system.

ShortCode defined by a terminology system
Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Control10..1*
TypeCoding
Is Modifierfalse
Summaryfalse
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Pattern Value{
  "system" : "https://fevir.net/resources/CodeSystem/179423",
  "code" : "Guideline",
  "display" : "Guideline"
}
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. Composition.subject
Definition

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

ShortWho and/or what the composition is about
Comments

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


For clinical documents, this is usually the patient.

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

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

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

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

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

Identifies who is responsible for the content.

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

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

ShortRelationships to other compositions/documents
Comments

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

"relatesTo": [{
  "type": "replaces",
  "resourceReference": {
    "identifier": { 
      "system": "...", 
      "value": "..."
    }
  } 
}]
Control0..*
TypeRelatedArtifact
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Composition.relatesTo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ label
  • 42. Composition.relatesTo:citeAs
    Slice NameciteAs
    Definition

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

    ShortRelationships to other compositions/documents
    Comments

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

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

    The type of relationship to the related artifact.

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

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

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

    The type of relationship to the related artifact.

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

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

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

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

    ShortRelationships to other compositions/documents
    Comments

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

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

    The type of relationship to the related artifact.

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

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

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

    The type of relationship to the related artifact.

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

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

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

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

    ShortRelationships to other compositions/documents
    Comments

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

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

    The type of relationship to the related artifact.

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

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

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

    The type of relationship to the related artifact.

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

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

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

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

    ShortRelationships to other compositions/documents
    Comments

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

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

    The type of relationship to the related artifact.

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

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

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

    The type of relationship to the related artifact.

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

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

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

    The root of the sections that make up the composition.

    ShortComposition is broken into sections
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantscmp-1: A section must contain at least one of text, entries, or sub-sections (text.exists() or entry.exists() or section.exists())
    cmp-2: A section can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Composition.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ code.coding
    • 68. 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()))
      70. 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()))
      72. Composition.section:summary
      Slice Namesummary
      Definition

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      The root of the sections that make up the composition.

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

      0. Composition
      Definition

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

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

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

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. Composition.id
      Definition

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

      ShortLogical id of this artifact
      Comments

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

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

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

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

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

      ShortA set of rules under which this content was created
      Comments

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

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

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

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

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

      IETF language tag for a human language

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

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

      ShortText summary of the resource, for human interpretation
      Comments

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

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

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

      ShortContained, inline Resources
      Comments

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

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

      An Extension

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

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

        ShortHow to compare versions
        Comments

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

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

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

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

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

        ShortNatural language description of the artifact
        Comments

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

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

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

        ShortWhy this artifact is defined
        Comments

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

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

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

        ShortUse and/or publishing restrictions
        Comments

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

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

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

        ShortCopyright holder and year(s)
        Comments

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

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

        The date on which the 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
        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
        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
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        34. Composition.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored
        Comments

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

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

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

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

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

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

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

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

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

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

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

        ShortVersion-independent identifier for the Composition
        Comments

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

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

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

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

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

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

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

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

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

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

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

        The workflow/clinical status of the composition.

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

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

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

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

        ShortKind of composition (LOINC if possible)
        Comments

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

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

        Type of a composition.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

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

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

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

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

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

        ShortAdditional content defined by implementations
        Comments

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

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

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control1..1
          TypeCoding
          Is Modifierfalse
          Summaryfalse
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Pattern Value{
            "system" : "https://fevir.net/resources/CodeSystem/179423",
            "code" : "Guideline",
            "display" : "Guideline"
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Composition.type.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

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

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          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, 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 (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 Evidence Report Contributor Role Value Set
          (preferred to http://hl7.org/fhir/uv/ebm/ValueSet/evidence-report-contributor-role)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Requirements

          Indicates the level of authority of the attestation.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          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 that already exist.

          ShortRelationships to other compositions/documents
          Comments

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

          "relatesTo": [{
            "type": "replaces",
            "resourceReference": {
              "identifier": { 
                "system": "...", 
                "value": "..."
              }
            } 
          }]
          
          Control0..*
          TypeRelatedArtifact
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Composition.relatesTo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ label
          • 90. Composition.relatesTo:citeAs
            Slice NameciteAs
            Definition

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

            ShortRelationships to other compositions/documents
            Comments

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

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

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

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

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

            ShortAdditional content defined by implementations
            Comments

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

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

              The type of relationship to the related artifact.

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

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

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

              The type of relationship to the related artifact.

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

              Provides additional classifiers of the related artifact.

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

              Additional classifiers for the related artifact.

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

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

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

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

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

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

              ShortBibliographic citation for the artifact
              Comments

              Additional structured information about citations should be captured as extensions.

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

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

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

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

              ShortWhat artifact is being referenced
              Comments

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

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

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

              ShortWhat artifact, if not a conformance resource
              Comments

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

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

              The publication status of the artifact being referred to.

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

              Publication status of an artifact being referred to.

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

              The date of publication of the artifact being referred to.

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

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

              ShortRelationships to other compositions/documents
              Comments

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

              "relatesTo": [{
                "type": "replaces",
                "resourceReference": {
                  "identifier": { 
                    "system": "...", 
                    "value": "..."
                  }
                } 
              }]
              
              Control0..*
              TypeRelatedArtifact
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              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
              Typeid
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              120. Composition.relatesTo:partOf.extension
              Definition

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

              ShortAdditional content defined by implementations
              Comments

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

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

                The type of relationship to the related artifact.

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

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

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

                The type of relationship to the related artifact.

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

                Provides additional classifiers of the related artifact.

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

                Additional classifiers for the related artifact.

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

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

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

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

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

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

                ShortBibliographic citation for the artifact
                Comments

                Additional structured information about citations should be captured as extensions.

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

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

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

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

                ShortWhat artifact is being referenced
                Comments

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

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

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

                ShortWhat artifact, if not a conformance resource
                Comments

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

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

                The publication status of the artifact being referred to.

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

                Publication status of an artifact being referred to.

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

                The date of publication of the artifact being referred to.

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

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

                ShortRelationships to other compositions/documents
                Comments

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

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

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

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

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

                ShortAdditional content defined by implementations
                Comments

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

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

                  The type of relationship to the related artifact.

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

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

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

                  The type of relationship to the related artifact.

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

                  Provides additional classifiers of the related artifact.

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

                  Additional classifiers for the related artifact.

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

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

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

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

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

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

                  ShortBibliographic citation for the artifact
                  Comments

                  Additional structured information about citations should be captured as extensions.

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

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

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

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

                  ShortWhat artifact is being referenced
                  Comments

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

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

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

                  ShortWhat artifact, if not a conformance resource
                  Comments

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

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

                  The publication status of the artifact being referred to.

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

                  Publication status of an artifact being referred to.

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

                  The date of publication of the artifact being referred to.

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

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

                  ShortRelationships to other compositions/documents
                  Comments

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

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

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

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

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

                  ShortAdditional content defined by implementations
                  Comments

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

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

                    The type of relationship to the related artifact.

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

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

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

                    The type of relationship to the related artifact.

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

                    Provides additional classifiers of the related artifact.

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

                    Additional classifiers for the related artifact.

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

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

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

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

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

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

                    ShortBibliographic citation for the artifact
                    Comments

                    Additional structured information about citations should be captured as extensions.

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

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

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

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

                    ShortWhat artifact is being referenced
                    Comments

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

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

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

                    ShortWhat artifact, if not a conformance resource
                    Comments

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

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

                    The publication status of the artifact being referred to.

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

                    Publication status of an artifact being referred to.

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

                    The date of publication of the artifact being referred to.

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

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

                    ShortThe clinical service(s) being documented
                    Comments

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

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Requirements

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

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    196. 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
                    198. 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()))
                    200. 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()))
                    202. 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()))
                    204. 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()))
                    206. Composition.section
                    Definition

                    The root of the sections that make up the composition.

                    ShortComposition is broken into sections
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantscmp-1: A section must contain at least one of text, entries, or sub-sections (text.exists() or entry.exists() or section.exists())
                    cmp-2: A section can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
                    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Composition.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ code.coding
                    • 208. 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
                      210. 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()))
                      212. 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()))
                      214. 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()))
                      216. 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()))
                      218. Composition.section.author
                      Definition

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

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

                      Identifies who is responsible for the content.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      220. 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()))
                      222. 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()))
                      224. 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()))
                      226. 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()))
                      228. 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()))
                      230. 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()))
                      232. Composition.section:summary
                      Slice Namesummary
                      Definition

                      The root of the sections that make up the composition.

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

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

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

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

                      ShortAdditional content defined by implementations
                      Comments

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

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

                        A reference to a code defined by a terminology system.

                        ShortCode defined by a terminology system
                        Comments

                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                        Control1..1
                        TypeCoding
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Allows for alternative encodings within a code system, and translations to other code systems.

                        Pattern Value{
                          "system" : "https://fevir.net/resources/CodeSystem/179423",
                          "code" : "summary",
                          "display" : "Summary"
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        250. Composition.section:summary.code.text
                        Definition

                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                        ShortPlain text representation of the concept
                        Comments

                        Very often the text is the same as a displayName of one of the codings.

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

                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                        Identifies who is responsible for the content.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        254. Composition.section:summary.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()))
                        256. Composition.section:summary.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()))
                        258. Composition.section:summary.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()))
                        260. Composition.section:summary.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()))
                        262. Composition.section:summary.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()))
                        264. Composition.section:summary.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()))
                        266. Composition.section:introduction
                        Slice Nameintroduction
                        Definition

                        The root of the sections that make up the composition.

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

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

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

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

                        ShortAdditional content defined by implementations
                        Comments

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

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

                          A reference to a code defined by a terminology system.

                          ShortCode defined by a terminology system
                          Comments

                          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                          Control1..1
                          TypeCoding
                          Is Modifierfalse
                          Summaryfalse
                          Requirements

                          Allows for alternative encodings within a code system, and translations to other code systems.

                          Pattern Value{
                            "system" : "https://fevir.net/resources/CodeSystem/179423",
                            "code" : "introduction",
                            "display" : "Introduction"
                          }
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          284. Composition.section:introduction.code.text
                          Definition

                          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                          ShortPlain text representation of the concept
                          Comments

                          Very often the text is the same as a displayName of one of the codings.

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

                          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                          Identifies who is responsible for the content.

                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          288. Composition.section:introduction.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()))
                          290. Composition.section:introduction.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()))
                          292. Composition.section:introduction.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()))
                          294. Composition.section:introduction.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()))
                          296. Composition.section:introduction.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()))
                          298. Composition.section:introduction.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()))
                          300. Composition.section:discussion
                          Slice Namediscussion
                          Definition

                          The root of the sections that make up the composition.

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

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

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

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

                          ShortAdditional content defined by implementations
                          Comments

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

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

                            A reference to a code defined by a terminology system.

                            ShortCode defined by a terminology system
                            Comments

                            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                            Control1..1
                            TypeCoding
                            Is Modifierfalse
                            Summaryfalse
                            Requirements

                            Allows for alternative encodings within a code system, and translations to other code systems.

                            Pattern Value{
                              "system" : "https://fevir.net/resources/CodeSystem/179423",
                              "code" : "discussion",
                              "display" : "Discussion"
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            318. Composition.section:discussion.code.text
                            Definition

                            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                            ShortPlain text representation of the concept
                            Comments

                            Very often the text is the same as a displayName of one of the codings.

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

                            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                            Identifies who is responsible for the content.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            322. Composition.section:discussion.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()))
                            324. Composition.section:discussion.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()))
                            326. Composition.section:discussion.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()))
                            328. Composition.section:discussion.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()))
                            330. Composition.section:discussion.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()))
                            332. Composition.section:discussion.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()))
                            334. Composition.section:methods
                            Slice Namemethods
                            Definition

                            The root of the sections that make up the composition.

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

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

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

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

                            ShortAdditional content defined by implementations
                            Comments

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

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

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                              Control1..1
                              TypeCoding
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Allows for alternative encodings within a code system, and translations to other code systems.

                              Pattern Value{
                                "system" : "https://fevir.net/resources/CodeSystem/179423",
                                "code" : "methods",
                                "display" : "Methods"
                              }
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              352. Composition.section:methods.code.text
                              Definition

                              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                              ShortPlain text representation of the concept
                              Comments

                              Very often the text is the same as a displayName of one of the codings.

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

                              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                              Identifies who is responsible for the content.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              356. Composition.section:methods.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()))
                              358. Composition.section:methods.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()))
                              360. Composition.section:methods.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()))
                              362. Composition.section:methods.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()))
                              364. Composition.section:methods.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()))
                              366. Composition.section:methods.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()))
                              368. Composition.section:references
                              Slice Namereferences
                              Definition

                              The root of the sections that make up the composition.

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

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

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

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

                              ShortAdditional content defined by implementations
                              Comments

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

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

                                A reference to a code defined by a terminology system.

                                ShortCode defined by a terminology system
                                Comments

                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                Control1..1
                                TypeCoding
                                Is Modifierfalse
                                Summaryfalse
                                Requirements

                                Allows for alternative encodings within a code system, and translations to other code systems.

                                Pattern Value{
                                  "system" : "https://fevir.net/resources/CodeSystem/179423",
                                  "code" : "references",
                                  "display" : "References"
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                386. Composition.section:references.code.text
                                Definition

                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                ShortPlain text representation of the concept
                                Comments

                                Very often the text is the same as a displayName of one of the codings.

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

                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                                Identifies who is responsible for the content.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                390. Composition.section:references.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()))
                                392. Composition.section:references.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()))
                                394. Composition.section:references.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()))
                                396. Composition.section:references.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(Citation)
                                Is Modifierfalse
                                Must Supportfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                398. Composition.section:references.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()))
                                400. Composition.section:references.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()))
                                402. Composition.section:competingInterests
                                Slice NamecompetingInterests
                                Definition

                                The root of the sections that make up the composition.

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

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

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

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

                                ShortAdditional content defined by implementations
                                Comments

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

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

                                  A reference to a code defined by a terminology system.

                                  ShortCode defined by a terminology system
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control1..1
                                  TypeCoding
                                  Is Modifierfalse
                                  Summaryfalse
                                  Requirements

                                  Allows for alternative encodings within a code system, and translations to other code systems.

                                  Pattern Value{
                                    "system" : "https://fevir.net/resources/CodeSystem/179423",
                                    "code" : "competing-interests",
                                    "display" : "Competing Interests"
                                  }
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  420. Composition.section:competingInterests.code.text
                                  Definition

                                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                  ShortPlain text representation of the concept
                                  Comments

                                  Very often the text is the same as a displayName of one of the codings.

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

                                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                                  Identifies who is responsible for the content.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  424. Composition.section:competingInterests.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()))
                                  426. Composition.section:competingInterests.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()))
                                  428. Composition.section:competingInterests.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()))
                                  430. Composition.section:competingInterests.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()))
                                  432. Composition.section:competingInterests.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()))
                                  434. Composition.section:competingInterests.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()))
                                  436. Composition.section:acknowledgements
                                  Slice Nameacknowledgements
                                  Definition

                                  The root of the sections that make up the composition.

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

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

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

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

                                  ShortAdditional content defined by implementations
                                  Comments

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

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

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

                                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                    Control1..1
                                    TypeCoding
                                    Is Modifierfalse
                                    Summaryfalse
                                    Requirements

                                    Allows for alternative encodings within a code system, and translations to other code systems.

                                    Pattern Value{
                                      "system" : "https://fevir.net/resources/CodeSystem/179423",
                                      "code" : "acknowledgements",
                                      "display" : "Acknowledgements"
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    454. Composition.section:acknowledgements.code.text
                                    Definition

                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                    ShortPlain text representation of the concept
                                    Comments

                                    Very often the text is the same as a displayName of one of the codings.

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

                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                                    Identifies who is responsible for the content.

                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    458. Composition.section:acknowledgements.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()))
                                    460. Composition.section:acknowledgements.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()))
                                    462. Composition.section:acknowledgements.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()))
                                    464. Composition.section:acknowledgements.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()))
                                    466. Composition.section:acknowledgements.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()))
                                    468. Composition.section:acknowledgements.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()))
                                    470. Composition.section:appendices
                                    Slice Nameappendices
                                    Definition

                                    The root of the sections that make up the composition.

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

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

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

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

                                    ShortAdditional content defined by implementations
                                    Comments

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

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

                                      A reference to a code defined by a terminology system.

                                      ShortCode defined by a terminology system
                                      Comments

                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                      Control1..1
                                      TypeCoding
                                      Is Modifierfalse
                                      Summaryfalse
                                      Requirements

                                      Allows for alternative encodings within a code system, and translations to other code systems.

                                      Pattern Value{
                                        "system" : "https://fevir.net/resources/CodeSystem/179423",
                                        "code" : "appendices",
                                        "display" : "Appendices"
                                      }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      488. Composition.section:appendices.code.text
                                      Definition

                                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                      ShortPlain text representation of the concept
                                      Comments

                                      Very often the text is the same as a displayName of one of the codings.

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

                                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                                      Identifies who is responsible for the content.

                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      492. Composition.section:appendices.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()))
                                      494. Composition.section:appendices.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()))
                                      496. Composition.section:appendices.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()))
                                      498. Composition.section:appendices.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()))
                                      500. Composition.section:appendices.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()))
                                      502. Composition.section:appendices.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()))
                                      504. Composition.section:recommendations
                                      Slice Namerecommendations
                                      Definition

                                      The root of the sections that make up the composition.

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

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

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

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

                                      ShortAdditional content defined by implementations
                                      Comments

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

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

                                        A reference to a code defined by a terminology system.

                                        ShortCode defined by a terminology system
                                        Comments

                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                        Control1..1
                                        TypeCoding
                                        Is Modifierfalse
                                        Summaryfalse
                                        Requirements

                                        Allows for alternative encodings within a code system, and translations to other code systems.

                                        Pattern Value{
                                          "system" : "https://fevir.net/resources/CodeSystem/179423",
                                          "code" : "recommendations",
                                          "display" : "Recommendations"
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        522. Composition.section:recommendations.code.text
                                        Definition

                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                        ShortPlain text representation of the concept
                                        Comments

                                        Very often the text is the same as a displayName of one of the codings.

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

                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

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

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

                                        Identifies who is responsible for the content.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        526. Composition.section:recommendations.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()))
                                        528. Composition.section:recommendations.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()))
                                        530. Composition.section:recommendations.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()))
                                        532. Composition.section:recommendations.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(Recommendation)
                                        Is Modifierfalse
                                        Must Supportfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        534. Composition.section:recommendations.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()))
                                        536. Composition.section:recommendations.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()))