Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 ballot International flag

Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot3 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: M11ReportSection01 - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the m11-report-section-01 resource profile

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

0. Composition
Definition

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

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

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

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

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

ShortA set of rules under which this content was created
Comments

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

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

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

ShortContained, inline Resources
Comments

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

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

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

ShortHow to compare versions
Comments

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

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

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

ShortNatural language description of the artifact
Comments

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

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

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

ShortUse and/or publishing restrictions
Comments

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

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

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

ShortWhen resource approved by publisher
Comments

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

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

The date on which the asset content was last reviewed. Review happens periodically after that, but doesn't change the original approval date.

ShortLast review date for the resource
Comments

If specified, this is usually after the approval date.

Control0..1
TypeExtension(Resource Last Review Date) (Extension Type: date)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
22. Composition.extension:effectivePeriod
Slice NameeffectivePeriod
Definition

The period during which the resource content was or is planned to be effective.

ShortThe effective date range for the resource
Comments

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

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

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

ShortThe additional language
Control0..*
TypeExtension(Additional Language) (Extension Type: code)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
26. Composition.extension:extendedContactDetail
Slice NameextendedContactDetail
Definition

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

ShortContact details for the publisher
Comments

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

Control0..*
TypeExtension(Artifact Extended Contact Detail) (Extension Type: ExtendedContactDetail)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
28. Composition.extension:publicationDate
Slice NamepublicationDate
Definition

Specifies the publication date of the Resource.

ShortPublication date of Resource
Control0..1
TypeExtension(Publication Date) (Extension Type: date)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
30. Composition.extension:publicationStatus
Slice NamepublicationStatus
Definition

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

ShortPublication status
Control0..1
TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
32. 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()))
34. Composition.status
Definition

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

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

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

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

Control1..1
BindingThe codes SHALL be taken from CompositionStatushttp://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot3
(required to http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot3)

The workflow/clinical status of the composition.

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

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

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. 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|6.0.0-ballot3
(preferred to http://hl7.org/fhir/ValueSet/doc-typecodes|6.0.0-ballot3)

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()))
38. 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" : "http://loinc.org",
  "code" : "35528-9",
  "display" : "Clinical trial protocol Clinical trial protocol"
}
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. 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.

Pattern ValueCeSHarP Report
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. 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 ReferencedItemCategoryValueSethttp://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot3
(example to http://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot3)

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()))
SlicingThis element introduces a set of slices on Composition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ text
  • 44. Composition.category:summary
    Slice Namesummary
    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..1*
    BindingFor example codes, see ReferencedItemCategoryValueSethttp://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot3
    (example to http://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot3)

    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()))
    46. Composition.category:summary.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
      "code" : "C218514",
      "display" : "ICH M11 Protocol Section 1 PROTOCOL SUMMARY"
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. Composition.category:summary.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.

    Control10..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.

    Pattern Valuesection1-protocol-summary
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. 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()))
    52. Composition.author
    Definition

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

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

    Identifies who is responsible for the content.

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

    Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

    ShortRelationships to other compositions/documents
    Comments

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

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

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. Composition.relatesTo.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Composition.relatesTo:citeAs
      Slice NameciteAs
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..1*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      68. Composition.relatesTo:citeAs.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      70. Composition.relatesTo:citeAs.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      76. Composition.relatesTo:partOf
      Slice NamepartOf
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      78. Composition.relatesTo:partOf.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      80. Composition.relatesTo:partOf.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      86. Composition.relatesTo:derivedFrom
      Slice NamederivedFrom
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      88. Composition.relatesTo:derivedFrom.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      90. Composition.relatesTo:derivedFrom.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      96. Composition.relatesTo:specificationOf
      Slice NamespecificationOf
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      98. Composition.relatesTo:specificationOf.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      100. Composition.relatesTo:specificationOf.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      106. Composition.relatesTo:dependsOn
      Slice NamedependsOn
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      108. Composition.relatesTo:dependsOn.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      110. Composition.relatesTo:dependsOn.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

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

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      116. Composition.relatesTo:supportedWith
      Slice NamesupportedWith
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      118. Composition.relatesTo:supportedWith.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      120. Composition.relatesTo:supportedWith.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

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

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Pattern Valuesupported-with
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      124. Composition.relatesTo:supportedWith.target[x]
      Definition

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      126. Composition.relatesTo:similarTo
      Slice NamesimilarTo
      Definition

      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

      ShortRelationships to other compositions/documents
      Comments

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

      "relatesTo": [{
        "type": "replaces",
        "targetReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      128. Composition.relatesTo:similarTo.extension:classifier
      Slice Nameclassifier
      Definition

      Provides additional classifiers of the related artifact.

      ShortAdditional classifiers for RelatedArtifacts
      Control0..1
      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      130. Composition.relatesTo:similarTo.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()))
      132. Composition.relatesTo:similarTo.type
      Definition

      The type of relationship to the related artifact.

      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
      Control1..1
      BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

      The type of relationship to the related artifact.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Pattern Valuesimilar-to
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      134. Composition.relatesTo:similarTo.target[x]
      Definition

      The artifact that is related to this Composition Resource.

      ShortThe artifact that is related to this Composition
      Control1..1
      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      136. Composition.section
      Definition

      The root of the sections that make up the composition.

      ShortComposition is broken into sections
      Control10..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 no entries are included (emptyReason.empty() or entry.empty())
      ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
      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.text
      • 138. 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()))
        140. 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()))
        142. Composition.section:summary
        Slice Namesummary
        Definition

        The root of the sections that make up the composition.

        ShortComposition is broken into sections
        Control10..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 no entries are included (emptyReason.empty() or entry.empty())
        ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        144. 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()))
        146. 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
        Pattern ValueProtocol Summary
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        148. 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

        No text is intended here (heading only).


        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()))
        150. 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()))
        152. 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.

        Control30..*
        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()))
        SlicingThis element introduces a set of slices on Composition.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ code.text
        • 154. Composition.section:summary.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()))
          156. Composition.section:summary.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()))
          158. Composition.section:summary.section:protocolSynopsis
          Slice NameprotocolSynopsis
          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.

          Control10..1*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          160. Composition.section:summary.section:protocolSynopsis.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.


          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()))
          162. Composition.section:summary.section:protocolSynopsis.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
          Pattern ValueProtocol Synopsis
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          164. Composition.section:summary.section:protocolSynopsis.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

          No text is intended here (heading only).


          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()))
          166. Composition.section:summary.section:protocolSynopsis.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()))
          168. Composition.section:summary.section:protocolSynopsis.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.

          Control70..*
          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()))
          SlicingThis element introduces a set of slices on Composition.section.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ code.text
          • 170. Composition.section:summary.section:protocolSynopsis.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.


            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()))
            172. Composition.section:summary.section:protocolSynopsis.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()))
            174. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints
            Slice NameobjectivesEndpoints
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            176. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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.


            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()))
            178. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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
            Pattern ValuePrimary and Secondary Objectives and Estimands
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            180. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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

            Summarise the primary and secondary objectives and any associated estimands in natural, nontechnical (layperson) language. For trials intended to estimate a treatment effect or test a hypothesis related to a treatment effect, include the primary and secondary objectives and any associated estimands using a nontechnical summary describing the objective and treatment effect of interest (estimand). For other types of trials not intended to estimate a treatment effect or test a hypothesis related to a treatment effect, define trial objectives and describe additional information relevant to the clinical question(s) of interest (e.g., the endpoint(s) associated with each objective). For trials with numerous objectives in which the description of objectives will exceed half a page, consider including the most important objectives and estimands in the synopsis and refer to Section 3 Trial Objectives and Associated Estimands, which covers the objectives and estimands in technical detail. For considerations on estimands, refer to ICH E9(R1).


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

            Control10..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()))
            182. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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(Composition, Resource)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            184. Composition.section:summary.section:protocolSynopsis.section:overallDesign
            Slice NameoverallDesign
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            186. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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.


            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()))
            188. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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
            Pattern ValueOverall Design
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            190. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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

            Key aspects of the trial design include Intervention, Intervention Model, Control Type, Control Description, Intervention Assignment Method, Drug/Device Combination Product Indicator, Population Type, Population Diagnosis or Condition, Population Age (Minimum, Maximum), Site Distribution and Geographic Scope, Master Protocol, and Adaptive Trial Design. Entries should Reference Composition Resource or ResearchStudy Resource.


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

            Control10..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()))
            192. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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(Composition, ResearchStudy, Resource)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            194. Composition.section:summary.section:protocolSynopsis.section:numberOfArms
            Slice NamenumberOfArms
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            196. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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.


            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()))
            198. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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

            Enter the numeric value for the number of arms in the trial. For trials with a different number of arms in different periods, populate this field based on the total number of arms.


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

            Control10..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()))
            200. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
            202. Composition.section:summary.section:protocolSynopsis.section:blinding
            Slice Nameblinding
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            204. Composition.section:summary.section:protocolSynopsis.section:blinding.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.


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

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

            For designs in which these details may differ in one or more trial periods, answer according to the portion of the trial in which the highest number of blinded roles occurs. Additional details can be provided in Section 6.7.3 Measures to Maintain Blinding.


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

            Control10..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()))
            208. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
            210. Composition.section:summary.section:protocolSynopsis.section:blindedRoles
            Slice NameblindedRoles
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            212. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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.


            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:summary.section:protocolSynopsis.section:blindedRoles.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

            State 'The following roles indictated will not be made aware of the treatment group assignment during the trial:' [Blinded Roles] --OR-- 'Not applicable (No blinding)' indicates an open-label trial.


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

            Control10..1
            This element is affected by the following invariants: cmp-1
            TypeNarrative
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            216. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
            218. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants
            Slice NamenumberOfParticipants
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            220. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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.


            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()))
            222. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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

            State the expected number of participants to be assigned to trial intervention/enrolled. Indicate whether the number provided is the target or maximum number of individuals to be randomly assigned to trial intervention/enrolled. A [Target/ Maximum] of [[Enter Number of Participants]] participants will be [randomly assigned to trial intervention/enrolled].


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

            Control10..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:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
            226. Composition.section:summary.section:protocolSynopsis.section:duration
            Slice Nameduration
            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..1*
            TypeBackboneElement
            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:summary.section:protocolSynopsis.section:duration.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.


            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()))
            230. Composition.section:summary.section:protocolSynopsis.section:duration.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

            See Template instructions. Select one of the two options for total planned duration of trial intervention and trial participation for each participant. Note that the total duration of trial participation should include any washout and any follow-up periods in which the participant is not receiving trial intervention. When duration will vary, provide a short explanation (for example, “event-driven” or “adaptive design”.


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

            Control10..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()))
            232. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
            234. Composition.section:summary.section:protocolSynopsis.section:committees
            Slice Namecommittees
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            236. Composition.section:summary.section:protocolSynopsis.section:committees.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.


            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()))
            238. Composition.section:summary.section:protocolSynopsis.section:committees.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

            Indicate whether any committee(s) will be reviewing data while the trial is ongoing, and the type of committee. Common examples include Data Monitoring Committee, Dose Escalation Committee, or Endpoint Adjudication Committee; describe others, if applicable. List independent committees in the space indicated. Other committees may be included at the Sponsor’s discretion in the separate space provided. Committees listed here should be fully described in Section 11.4 Committees.


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

            Control10..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()))
            240. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
            242. Composition.section:summary.section:trialSchema
            Slice NametrialSchema
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            244. Composition.section:summary.section:trialSchema.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.


            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()))
            246. Composition.section:summary.section:trialSchema.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
            Pattern ValueTrial Schema
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            248. Composition.section:summary.section:trialSchema.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

            The purpose of this section is to provide a visual depiction of the trial design, orienting users of the protocol to the key features of the design. The schema depicts the trial arms, the flow of individual participant through the progression of trial period(s)/epochs (such as screening, washout/run-in, intervention, and key milestones [e.g., randomisation, cross-over, end of treatment, end of study, post-treatment follow-up]). For complex trials, additional schemas may be added to describe activities or trial periods in greater detail. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.


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

            Control10..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()))
            250. Composition.section:summary.section:trialSchema.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(SoaPlanDefinition, Resource)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            252. Composition.section:summary.section:scheduleOfActivities
            Slice NamescheduleOfActivities
            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.

            Control10..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            254. Composition.section:summary.section:scheduleOfActivities.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.


            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()))
            256. Composition.section:summary.section:scheduleOfActivities.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
            Pattern ValueSchedule of Activities
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            258. Composition.section:summary.section:scheduleOfActivities.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

            The schedule of activities must capture the procedures that will be accomplished at each trial visit, and all contact with participants, for example, telephone contacts. This includes any tests that are used for eligibility, participant randomisation or stratification, or decisions on trial intervention discontinuation. Allowable windows should be stated for all visits and procedures. A tabular format is recommended. When applicable for studies with extensive sampling (e.g., serial PK sampling) a separate table may be added. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.


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

            Control10..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()))
            260. Composition.section:summary.section:scheduleOfActivities.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(SoaPlanDefinition, 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 foundhere

            0. Composition
            2. Composition.type
            4. Composition.type.coding
            Control1..1
            Pattern Value{
              "system" : "http://loinc.org",
              "code" : "35528-9",
              "display" : "Clinical trial protocol Clinical trial protocol"
            }
            6. Composition.type.text
            Pattern ValueCeSHarP Report
            8. Composition.category
            SlicingThis element introduces a set of slices on Composition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ text
            • 10. Composition.category:summary
              Slice Namesummary
              Control0..1
              12. Composition.category:summary.coding
              Control1..1
              Pattern Value{
                "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                "code" : "C218514",
                "display" : "ICH M11 Protocol Section 1 PROTOCOL SUMMARY"
              }
              14. Composition.category:summary.text
              Control1..?
              Pattern Valuesection1-protocol-summary
              16. Composition.section
              Control1..1
              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.text
              • 18. Composition.section:summary
                Slice Namesummary
                Control1..1
                Must Supporttrue
                20. Composition.section:summary.title
                Pattern ValueProtocol Summary
                22. Composition.section:summary.code
                24. Composition.section:summary.code.coding
                Control1..1
                Pattern Value{
                  "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                  "code" : "C218514",
                  "display" : "ICH M11 Protocol Section 1 PROTOCOL SUMMARY"
                }
                26. Composition.section:summary.code.text
                Control1..?
                Pattern Valuesection1-protocol-summary
                28. Composition.section:summary.text
                Comments

                No text is intended here (heading only).

                30. Composition.section:summary.section
                Control3..?
                SlicingThis element introduces a set of slices on Composition.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ code.text
                • 32. Composition.section:summary.section:protocolSynopsis
                  Slice NameprotocolSynopsis
                  Control1..1
                  TypeBackboneElement
                  Must Supporttrue
                  34. Composition.section:summary.section:protocolSynopsis.title
                  Pattern ValueProtocol Synopsis
                  36. Composition.section:summary.section:protocolSynopsis.code
                  38. Composition.section:summary.section:protocolSynopsis.code.coding
                  Control1..1
                  Pattern Value{
                    "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                    "code" : "C218515",
                    "display" : "ICH M11 Protocol Section 1.1 Protocol Synopsis"
                  }
                  40. Composition.section:summary.section:protocolSynopsis.code.text
                  Control1..?
                  Pattern Valuesection1.1-protocol-synopsis
                  42. Composition.section:summary.section:protocolSynopsis.text
                  Comments

                  No text is intended here (heading only).

                  44. Composition.section:summary.section:protocolSynopsis.section
                  Control7..?
                  SlicingThis element introduces a set of slices on Composition.section.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ code.text
                  • 46. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints
                    Slice NameobjectivesEndpoints
                    Control1..1
                    TypeBackboneElement
                    Must Supporttrue
                    48. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.title
                    Pattern ValuePrimary and Secondary Objectives and Estimands
                    50. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.code
                    52. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.code.coding
                    Control1..1
                    Pattern Value{
                      "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                      "code" : "C218516",
                      "display" : "ICH M11 Protocol Section 1.1.1 Primary and Secondary Objectives and Estimands"
                    }
                    54. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.code.text
                    Control1..?
                    Pattern Valuesection1.1.1-objectives-estimands
                    56. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.text
                    Comments

                    Summarise the primary and secondary objectives and any associated estimands in natural, nontechnical (layperson) language. For trials intended to estimate a treatment effect or test a hypothesis related to a treatment effect, include the primary and secondary objectives and any associated estimands using a nontechnical summary describing the objective and treatment effect of interest (estimand). For other types of trials not intended to estimate a treatment effect or test a hypothesis related to a treatment effect, define trial objectives and describe additional information relevant to the clinical question(s) of interest (e.g., the endpoint(s) associated with each objective). For trials with numerous objectives in which the description of objectives will exceed half a page, consider including the most important objectives and estimands in the synopsis and refer to Section 3 Trial Objectives and Associated Estimands, which covers the objectives and estimands in technical detail. For considerations on estimands, refer to ICH E9(R1).

                    Control1..?
                    58. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.entry
                    TypeReference(Composition)
                    60. Composition.section:summary.section:protocolSynopsis.section:overallDesign
                    Slice NameoverallDesign
                    Control1..1
                    TypeBackboneElement
                    62. Composition.section:summary.section:protocolSynopsis.section:overallDesign.title
                    Pattern ValueOverall Design
                    64. Composition.section:summary.section:protocolSynopsis.section:overallDesign.code
                    66. Composition.section:summary.section:protocolSynopsis.section:overallDesign.code.coding
                    Control1..1
                    Pattern Value{
                      "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                      "code" : "C218517",
                      "display" : "ICH M11 Protocol Section 1.1.2 Overall Design"
                    }
                    68. Composition.section:summary.section:protocolSynopsis.section:overallDesign.code.text
                    Control1..?
                    Pattern Valuesection1.1.2-overall-design
                    70. Composition.section:summary.section:protocolSynopsis.section:overallDesign.text
                    Comments

                    Key aspects of the trial design include Intervention, Intervention Model, Control Type, Control Description, Intervention Assignment Method, Drug/Device Combination Product Indicator, Population Type, Population Diagnosis or Condition, Population Age (Minimum, Maximum), Site Distribution and Geographic Scope, Master Protocol, and Adaptive Trial Design. Entries should Reference Composition Resource or ResearchStudy Resource.

                    Control1..?
                    72. Composition.section:summary.section:protocolSynopsis.section:overallDesign.entry
                    TypeReference(Composition, ResearchStudy)
                    74. Composition.section:summary.section:protocolSynopsis.section:numberOfArms
                    Slice NamenumberOfArms
                    Control1..1
                    TypeBackboneElement
                    76. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.code
                    78. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.code.text
                    Control1..?
                    Pattern ValueNumber of Arms
                    80. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.text
                    Comments

                    Enter the numeric value for the number of arms in the trial. For trials with a different number of arms in different periods, populate this field based on the total number of arms.

                    Control1..?
                    82. Composition.section:summary.section:protocolSynopsis.section:blinding
                    Slice Nameblinding
                    Control1..1
                    TypeBackboneElement
                    84. Composition.section:summary.section:protocolSynopsis.section:blinding.code
                    86. Composition.section:summary.section:protocolSynopsis.section:blinding.code.text
                    Control1..?
                    Pattern ValueTrial Blind Schema
                    88. Composition.section:summary.section:protocolSynopsis.section:blinding.text
                    Comments

                    For designs in which these details may differ in one or more trial periods, answer according to the portion of the trial in which the highest number of blinded roles occurs. Additional details can be provided in Section 6.7.3 Measures to Maintain Blinding.

                    Control1..?
                    90. Composition.section:summary.section:protocolSynopsis.section:blindedRoles
                    Slice NameblindedRoles
                    Control1..1
                    TypeBackboneElement
                    92. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.code
                    94. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.code.text
                    Control1..?
                    Pattern ValueBlinded Roles
                    96. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.text
                    Comments

                    State 'The following roles indictated will not be made aware of the treatment group assignment during the trial:' [Blinded Roles] --OR-- 'Not applicable (No blinding)' indicates an open-label trial.

                    Control1..?
                    98. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants
                    Slice NamenumberOfParticipants
                    Control1..1
                    TypeBackboneElement
                    100. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.code
                    102. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.code.text
                    Control1..?
                    Pattern ValueNumber of Participants
                    104. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.text
                    Comments

                    State the expected number of participants to be assigned to trial intervention/enrolled. Indicate whether the number provided is the target or maximum number of individuals to be randomly assigned to trial intervention/enrolled. A [Target/ Maximum] of [[Enter Number of Participants]] participants will be [randomly assigned to trial intervention/enrolled].

                    Control1..?
                    106. Composition.section:summary.section:protocolSynopsis.section:duration
                    Slice Nameduration
                    Control0..1
                    TypeBackboneElement
                    108. Composition.section:summary.section:protocolSynopsis.section:duration.code
                    110. Composition.section:summary.section:protocolSynopsis.section:duration.code.text
                    Control1..?
                    Pattern ValueDuration
                    112. Composition.section:summary.section:protocolSynopsis.section:duration.text
                    Comments

                    See Template instructions. Select one of the two options for total planned duration of trial intervention and trial participation for each participant. Note that the total duration of trial participation should include any washout and any follow-up periods in which the participant is not receiving trial intervention. When duration will vary, provide a short explanation (for example, “event-driven” or “adaptive design”.

                    Control1..?
                    114. Composition.section:summary.section:protocolSynopsis.section:committees
                    Slice Namecommittees
                    Control1..1
                    TypeBackboneElement
                    116. Composition.section:summary.section:protocolSynopsis.section:committees.code
                    118. Composition.section:summary.section:protocolSynopsis.section:committees.code.text
                    Control1..?
                    Pattern ValueCommittees
                    120. Composition.section:summary.section:protocolSynopsis.section:committees.text
                    Comments

                    Indicate whether any committee(s) will be reviewing data while the trial is ongoing, and the type of committee. Common examples include Data Monitoring Committee, Dose Escalation Committee, or Endpoint Adjudication Committee; describe others, if applicable. List independent committees in the space indicated. Other committees may be included at the Sponsor’s discretion in the separate space provided. Committees listed here should be fully described in Section 11.4 Committees.

                    Control1..?
                    122. Composition.section:summary.section:trialSchema
                    Slice NametrialSchema
                    Control1..1
                    TypeBackboneElement
                    Must Supporttrue
                    124. Composition.section:summary.section:trialSchema.title
                    Pattern ValueTrial Schema
                    126. Composition.section:summary.section:trialSchema.code
                    128. Composition.section:summary.section:trialSchema.code.coding
                    Control1..1
                    Pattern Value{
                      "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                      "code" : "C218518",
                      "display" : "ICH M11 Protocol Section 1.2 Trial Schema"
                    }
                    130. Composition.section:summary.section:trialSchema.code.text
                    Control1..?
                    Pattern Valuesection1.2-trial-schema
                    132. Composition.section:summary.section:trialSchema.text
                    Comments

                    The purpose of this section is to provide a visual depiction of the trial design, orienting users of the protocol to the key features of the design. The schema depicts the trial arms, the flow of individual participant through the progression of trial period(s)/epochs (such as screening, washout/run-in, intervention, and key milestones [e.g., randomisation, cross-over, end of treatment, end of study, post-treatment follow-up]). For complex trials, additional schemas may be added to describe activities or trial periods in greater detail. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.

                    Control1..?
                    134. Composition.section:summary.section:trialSchema.entry
                    TypeReference(SoaPlanDefinition)
                    136. Composition.section:summary.section:scheduleOfActivities
                    Slice NamescheduleOfActivities
                    Control1..1
                    TypeBackboneElement
                    Must Supporttrue
                    138. Composition.section:summary.section:scheduleOfActivities.title
                    Pattern ValueSchedule of Activities
                    140. Composition.section:summary.section:scheduleOfActivities.code
                    142. Composition.section:summary.section:scheduleOfActivities.code.coding
                    Control1..1
                    Pattern Value{
                      "system" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                      "code" : "C218519",
                      "display" : "ICH M11 Protocol Section 1.3 Schedule of Activities"
                    }
                    144. Composition.section:summary.section:scheduleOfActivities.code.text
                    Control1..?
                    Pattern Valuesection1.3-schedule-of-activities
                    146. Composition.section:summary.section:scheduleOfActivities.text
                    Comments

                    The schedule of activities must capture the procedures that will be accomplished at each trial visit, and all contact with participants, for example, telephone contacts. This includes any tests that are used for eligibility, participant randomisation or stratification, or decisions on trial intervention discontinuation. Allowable windows should be stated for all visits and procedures. A tabular format is recommended. When applicable for studies with extensive sampling (e.g., serial PK sampling) a separate table may be added. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.

                    Control1..?
                    148. Composition.section:summary.section:scheduleOfActivities.entry
                    TypeReference(SoaPlanDefinition)

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

                    0. Composition
                    Definition

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

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

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

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

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

                    ShortLogical id of this artifact
                    Comments

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

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

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

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

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

                    ShortA set of rules under which this content was created
                    Comments

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

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

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

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

                    Control0..1
                    BindingThe codes SHALL be taken from AllLanguages
                    (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot3)

                    IETF language tag for a human language

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

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

                    ShortText summary of the resource, for human interpretation
                    Comments

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

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

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

                    ShortContained, inline Resources
                    Comments

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

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

                    An Extension

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

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

                      ShortHow to compare versions
                      Comments

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

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

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

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

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

                      ShortNatural language description of the artifact
                      Comments

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

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

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

                      ShortWhy this artifact is defined
                      Comments

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

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

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

                      ShortUse and/or publishing restrictions
                      Comments

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

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

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

                      ShortCopyright holder and year(s)
                      Comments

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

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

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

                      ShortWhen resource approved by publisher
                      Comments

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

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

                      The date on which the asset content was last reviewed. Review happens periodically after that, but doesn't change the original approval date.

                      ShortLast review date for the resource
                      Comments

                      If specified, this is usually after the approval date.

                      Control0..1
                      TypeExtension(Resource Last Review Date) (Extension Type: date)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      32. Composition.extension:effectivePeriod
                      Slice NameeffectivePeriod
                      Definition

                      The period during which the resource content was or is planned to be effective.

                      ShortThe effective date range for the resource
                      Comments

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

                      Control0..1
                      TypeExtension(Resource Effective Period) (Extension Type: Period)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      34. Composition.extension:additionalLanguage
                      Slice NameadditionalLanguage
                      Definition

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

                      ShortThe additional language
                      Control0..*
                      TypeExtension(Additional Language) (Extension Type: code)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      36. Composition.extension:extendedContactDetail
                      Slice NameextendedContactDetail
                      Definition

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

                      ShortContact details for the publisher
                      Comments

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

                      Control0..*
                      TypeExtension(Artifact Extended Contact Detail) (Extension Type: ExtendedContactDetail)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      38. Composition.extension:publicationDate
                      Slice NamepublicationDate
                      Definition

                      Specifies the publication date of the Resource.

                      ShortPublication date of Resource
                      Control0..1
                      TypeExtension(Publication Date) (Extension Type: date)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      40. Composition.extension:publicationStatus
                      Slice NamepublicationStatus
                      Definition

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

                      ShortPublication status
                      Control0..1
                      TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      42. Composition.modifierExtension
                      Definition

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

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

                      ShortExtensions that cannot be ignored
                      Comments

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

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

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

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

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

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

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

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

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

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

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

                      ShortVersion-independent identifier for the Composition
                      Comments

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

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

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

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

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

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

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

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

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

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

                      Control1..1
                      BindingThe codes SHALL be taken from CompositionStatus
                      (required to http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot3)

                      The workflow/clinical status of the composition.

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

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

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

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

                      ShortKind of composition (LOINC if possible)
                      Comments

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

                      Control1..1
                      BindingThe codes SHOULD be taken from FHIRDocumentTypeCodes
                      (preferred to http://hl7.org/fhir/ValueSet/doc-typecodes|6.0.0-ballot3)

                      Type of a composition.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Requirements

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

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      54. Composition.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
                      56. 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
                      • 58. 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" : "http://loinc.org",
                          "code" : "35528-9",
                          "display" : "Clinical trial protocol Clinical trial protocol"
                        }
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        60. 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.

                        Pattern ValueCeSHarP Report
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        62. 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|6.0.0-ballot3)

                        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()))
                        SlicingThis element introduces a set of slices on Composition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ text
                        • 64. Composition.category:summary
                          Slice Namesummary
                          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..1
                          BindingFor example codes, see ReferencedItemCategoryValueSet
                          (example to http://hl7.org/fhir/ValueSet/referenced-item-category|6.0.0-ballot3)

                          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()))
                          66. Composition.category: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
                          Typeid
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          68. Composition.category: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()))
                          SlicingThis element introduces a set of slices on Composition.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 70. Composition.category:summary.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                              "code" : "C218514",
                              "display" : "ICH M11 Protocol Section 1 PROTOCOL SUMMARY"
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            72. Composition.category:summary.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.

                            Control1..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.

                            Pattern Valuesection1-protocol-summary
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            74. Composition.subject
                            Definition

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

                            ShortWho and/or what the composition is about
                            Comments

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

                            Control0..*
                            TypeReference(Resource)
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

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

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            76. 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()))
                            78. 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()))
                            80. 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()))
                            82. Composition.author
                            Definition

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

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

                            Identifies who is responsible for the content.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            84. 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()))
                            86. 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()))
                            88. 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()))
                            90. Composition.attester
                            Definition

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

                            ShortAttests to accuracy of composition
                            Comments

                            Only list each attester once.

                            Control0..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Requirements

                            Identifies responsibility for the accuracy of the composition content.

                            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                            92. 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
                            94. 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()))
                            96. 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()))
                            98. Composition.attester.mode
                            Definition

                            The type of attestation the authenticator offers.

                            Shortreviewer | editor | endorser | informant | recorder
                            Control1..1
                            BindingThe codes SHOULD be taken from Contributor Role
                            (preferred to http://terminology.hl7.org/ValueSet/contributor-role)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Requirements

                            Indicates the level of authority of the attestation.

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            100. 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()))
                            102. 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()))
                            104. 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()))
                            106. Composition.relatesTo
                            Definition

                            Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                            ShortRelationships to other compositions/documents
                            Comments

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

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

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

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

                              An Extension

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

                                Provides additional classifiers of the related artifact.

                                ShortAdditional classifiers for RelatedArtifacts
                                Control0..1
                                TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                114. Composition.relatesTo.modifierExtension
                                Definition

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

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

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

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

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

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

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

                                The type of relationship to the related artifact.

                                Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                Control1..1
                                BindingThe codes SHALL be taken from ArtifactRelationshipType
                                (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                The type of relationship to the related artifact.

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

                                The artifact that is related to this Composition Resource.

                                ShortThe artifact that is related to this Composition
                                Control1..1
                                TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supportfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                120. Composition.relatesTo:citeAs
                                Slice NameciteAs
                                Definition

                                Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                ShortRelationships to other compositions/documents
                                Comments

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

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

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

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

                                An Extension

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

                                  Provides additional classifiers of the related artifact.

                                  ShortAdditional classifiers for RelatedArtifacts
                                  Control0..1
                                  TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  128. Composition.relatesTo:citeAs.modifierExtension
                                  Definition

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

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

                                  ShortExtensions that cannot be ignored even if unrecognized
                                  Comments

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

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

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

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

                                  The type of relationship to the related artifact.

                                  Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                  Control1..1
                                  BindingThe codes SHALL be taken from ArtifactRelationshipType
                                  (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                  The type of relationship to the related artifact.

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

                                  The artifact that is related to this Composition Resource.

                                  ShortThe artifact that is related to this Composition
                                  Control1..1
                                  TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supportfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  134. Composition.relatesTo:partOf
                                  Slice NamepartOf
                                  Definition

                                  Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                  ShortRelationships to other compositions/documents
                                  Comments

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

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

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

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

                                  An Extension

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

                                    Provides additional classifiers of the related artifact.

                                    ShortAdditional classifiers for RelatedArtifacts
                                    Control0..1
                                    TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    142. Composition.relatesTo:partOf.modifierExtension
                                    Definition

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

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

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

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

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

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

                                    The type of relationship to the related artifact.

                                    Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                    Control1..1
                                    BindingThe codes SHALL be taken from ArtifactRelationshipType
                                    (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                    The type of relationship to the related artifact.

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

                                    The artifact that is related to this Composition Resource.

                                    ShortThe artifact that is related to this Composition
                                    Control1..1
                                    TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supportfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    148. Composition.relatesTo:derivedFrom
                                    Slice NamederivedFrom
                                    Definition

                                    Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                    ShortRelationships to other compositions/documents
                                    Comments

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

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

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

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

                                    An Extension

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

                                      Provides additional classifiers of the related artifact.

                                      ShortAdditional classifiers for RelatedArtifacts
                                      Control0..1
                                      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                      Is Modifierfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      156. Composition.relatesTo:derivedFrom.modifierExtension
                                      Definition

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

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

                                      ShortExtensions that cannot be ignored even if unrecognized
                                      Comments

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

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

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

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

                                      The type of relationship to the related artifact.

                                      Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                      Control1..1
                                      BindingThe codes SHALL be taken from ArtifactRelationshipType
                                      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                      The type of relationship to the related artifact.

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

                                      The artifact that is related to this Composition Resource.

                                      ShortThe artifact that is related to this Composition
                                      Control1..1
                                      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Is Modifierfalse
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Must Supportfalse
                                      Summaryfalse
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      162. Composition.relatesTo:specificationOf
                                      Slice NamespecificationOf
                                      Definition

                                      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                      ShortRelationships to other compositions/documents
                                      Comments

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

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

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

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

                                      An Extension

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

                                        Provides additional classifiers of the related artifact.

                                        ShortAdditional classifiers for RelatedArtifacts
                                        Control0..1
                                        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        170. Composition.relatesTo:specificationOf.modifierExtension
                                        Definition

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

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

                                        ShortExtensions that cannot be ignored even if unrecognized
                                        Comments

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

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

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

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

                                        The type of relationship to the related artifact.

                                        Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                        Control1..1
                                        BindingThe codes SHALL be taken from ArtifactRelationshipType
                                        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                        The type of relationship to the related artifact.

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

                                        The artifact that is related to this Composition Resource.

                                        ShortThe artifact that is related to this Composition
                                        Control1..1
                                        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supportfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        176. Composition.relatesTo:dependsOn
                                        Slice NamedependsOn
                                        Definition

                                        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                        ShortRelationships to other compositions/documents
                                        Comments

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

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

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

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

                                        An Extension

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

                                          Provides additional classifiers of the related artifact.

                                          ShortAdditional classifiers for RelatedArtifacts
                                          Control0..1
                                          TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          184. Composition.relatesTo:dependsOn.modifierExtension
                                          Definition

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

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

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

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

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

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

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

                                          The type of relationship to the related artifact.

                                          Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                          Control1..1
                                          BindingThe codes SHALL be taken from ArtifactRelationshipType
                                          (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                          The type of relationship to the related artifact.

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

                                          The artifact that is related to this Composition Resource.

                                          ShortThe artifact that is related to this Composition
                                          Control1..1
                                          TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supportfalse
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          190. Composition.relatesTo:supportedWith
                                          Slice NamesupportedWith
                                          Definition

                                          Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                          ShortRelationships to other compositions/documents
                                          Comments

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

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

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

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

                                          An Extension

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

                                            Provides additional classifiers of the related artifact.

                                            ShortAdditional classifiers for RelatedArtifacts
                                            Control0..1
                                            TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            198. Composition.relatesTo:supportedWith.modifierExtension
                                            Definition

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

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

                                            ShortExtensions that cannot be ignored even if unrecognized
                                            Comments

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

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

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

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

                                            The type of relationship to the related artifact.

                                            Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                            Control1..1
                                            BindingThe codes SHALL be taken from ArtifactRelationshipType
                                            (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                            The type of relationship to the related artifact.

                                            Typecode
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supportfalse
                                            Summaryfalse
                                            Pattern Valuesupported-with
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            202. Composition.relatesTo:supportedWith.target[x]
                                            Definition

                                            The artifact that is related to this Composition Resource.

                                            ShortThe artifact that is related to this Composition
                                            Control1..1
                                            TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supportfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            204. Composition.relatesTo:similarTo
                                            Slice NamesimilarTo
                                            Definition

                                            Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) that already exist.

                                            ShortRelationships to other compositions/documents
                                            Comments

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

                                            "relatesTo": [{
                                              "type": "replaces",
                                              "targetReference": {
                                                "identifier": { 
                                                  "system": "...", 
                                                  "value": "..."
                                                }
                                              } 
                                            }]
                                            
                                            Control0..*
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supportfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                            206. Composition.relatesTo:similarTo.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
                                            208. Composition.relatesTo:similarTo.extension
                                            Definition

                                            An Extension

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

                                              Provides additional classifiers of the related artifact.

                                              ShortAdditional classifiers for RelatedArtifacts
                                              Control0..1
                                              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              212. Composition.relatesTo:similarTo.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.relatesTo:similarTo.type
                                              Definition

                                              The type of relationship to the related artifact.

                                              Shortdocumentation | justification | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | specification-of | created-with | cite-as | summarizes
                                              Control1..1
                                              BindingThe codes SHALL be taken from ArtifactRelationshipType
                                              (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                              The type of relationship to the related artifact.

                                              Typecode
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summaryfalse
                                              Pattern Valuesimilar-to
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              216. Composition.relatesTo:similarTo.target[x]
                                              Definition

                                              The artifact that is related to this Composition Resource.

                                              ShortThe artifact that is related to this Composition
                                              Control1..1
                                              TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Is Modifierfalse
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Must Supportfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              218. Composition.event
                                              Definition

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

                                              ShortThe clinical service(s) being documented
                                              Comments

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

                                              Control0..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supportfalse
                                              Summarytrue
                                              Requirements

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

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

                                              The root of the sections that make up the composition.

                                              ShortComposition is broken into sections
                                              Control1..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 no entries are included (emptyReason.empty() or entry.empty())
                                              ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                              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.text
                                              • 232. 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
                                                234. 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()))
                                                236. 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()))
                                                238. 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()))
                                                240. 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()))
                                                242. Composition.section.author
                                                Definition

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

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

                                                ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                Control0..*
                                                TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                Is Modifierfalse
                                                Must Supportfalse
                                                Summaryfalse
                                                Requirements

                                                Identifies who is responsible for the content.

                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                244. 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()))
                                                246. 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()))
                                                248. 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|6.0.0-ballot3)

                                                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()))
                                                250. 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()))
                                                252. 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|6.0.0-ballot3)

                                                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()))
                                                254. 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()))
                                                256. Composition.section:summary
                                                Slice Namesummary
                                                Definition

                                                The root of the sections that make up the composition.

                                                ShortComposition is broken into sections
                                                Control1..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 no entries are included (emptyReason.empty() or entry.empty())
                                                ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                                258. 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
                                                260. 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()))
                                                262. 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()))
                                                264. 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
                                                Pattern ValueProtocol Summary
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                266. 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()))
                                                268. 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
                                                270. 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
                                                • 272. 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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                    "code" : "C218514",
                                                    "display" : "ICH M11 Protocol Section 1 PROTOCOL SUMMARY"
                                                  }
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  274. 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.

                                                  Control1..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.

                                                  Pattern Valuesection1-protocol-summary
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  276. Composition.section:summary.author
                                                  Definition

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

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

                                                  ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                  Control0..*
                                                  TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                  Is Modifierfalse
                                                  Must Supportfalse
                                                  Summaryfalse
                                                  Requirements

                                                  Identifies who is responsible for the content.

                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  278. 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()))
                                                  280. 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

                                                  No text is intended here (heading only).

                                                  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()))
                                                  282. 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|6.0.0-ballot3)

                                                  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()))
                                                  284. 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()))
                                                  286. 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|6.0.0-ballot3)

                                                  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()))
                                                  288. 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.

                                                  Control3..*
                                                  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()))
                                                  SlicingThis element introduces a set of slices on Composition.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ code.text
                                                  • 290. Composition.section:summary.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
                                                    292. Composition.section:summary.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()))
                                                    294. Composition.section:summary.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()))
                                                    296. Composition.section:summary.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()))
                                                    298. Composition.section:summary.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()))
                                                    300. Composition.section:summary.section.author
                                                    Definition

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

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

                                                    ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                    Control0..*
                                                    TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                    Is Modifierfalse
                                                    Must Supportfalse
                                                    Summaryfalse
                                                    Requirements

                                                    Identifies who is responsible for the content.

                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    302. Composition.section:summary.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()))
                                                    304. Composition.section:summary.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()))
                                                    306. Composition.section:summary.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|6.0.0-ballot3)

                                                    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()))
                                                    308. Composition.section:summary.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()))
                                                    310. Composition.section:summary.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|6.0.0-ballot3)

                                                    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()))
                                                    312. Composition.section:summary.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()))
                                                    314. Composition.section:summary.section:protocolSynopsis
                                                    Slice NameprotocolSynopsis
                                                    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.

                                                    Control1..1
                                                    TypeBackboneElement
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    316. Composition.section:summary.section:protocolSynopsis.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
                                                    318. Composition.section:summary.section:protocolSynopsis.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()))
                                                    320. Composition.section:summary.section:protocolSynopsis.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()))
                                                    322. Composition.section:summary.section:protocolSynopsis.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
                                                    Pattern ValueProtocol Synopsis
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    324. Composition.section:summary.section:protocolSynopsis.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
                                                    BindingFor example codes, see DocumentSectionCodes
                                                    (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                    Classification of a section of a composition/document.

                                                    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()))
                                                    326. Composition.section:summary.section:protocolSynopsis.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
                                                    328. Composition.section:summary.section:protocolSynopsis.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.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 330. Composition.section:summary.section:protocolSynopsis.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                        "code" : "C218515",
                                                        "display" : "ICH M11 Protocol Section 1.1 Protocol Synopsis"
                                                      }
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      332. Composition.section:summary.section:protocolSynopsis.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.

                                                      Control1..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.

                                                      Pattern Valuesection1.1-protocol-synopsis
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      334. Composition.section:summary.section:protocolSynopsis.author
                                                      Definition

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

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

                                                      ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                      Control0..*
                                                      TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                      Is Modifierfalse
                                                      Must Supportfalse
                                                      Summaryfalse
                                                      Requirements

                                                      Identifies who is responsible for the content.

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

                                                      No text is intended here (heading only).

                                                      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()))
                                                      340. Composition.section:summary.section:protocolSynopsis.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|6.0.0-ballot3)

                                                      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()))
                                                      342. Composition.section:summary.section:protocolSynopsis.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()))
                                                      344. Composition.section:summary.section:protocolSynopsis.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|6.0.0-ballot3)

                                                      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()))
                                                      346. Composition.section:summary.section:protocolSynopsis.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.

                                                      Control7..*
                                                      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()))
                                                      SlicingThis element introduces a set of slices on Composition.section.section.section. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ code.text
                                                      • 348. Composition.section:summary.section:protocolSynopsis.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
                                                        350. Composition.section:summary.section:protocolSynopsis.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()))
                                                        352. Composition.section:summary.section:protocolSynopsis.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()))
                                                        354. Composition.section:summary.section:protocolSynopsis.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()))
                                                        356. Composition.section:summary.section:protocolSynopsis.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
                                                        BindingFor example codes, see DocumentSectionCodes
                                                        (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                        Classification of a section of a composition/document.

                                                        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()))
                                                        358. Composition.section:summary.section:protocolSynopsis.section.author
                                                        Definition

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

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

                                                        ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                        Control0..*
                                                        TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                        Is Modifierfalse
                                                        Must Supportfalse
                                                        Summaryfalse
                                                        Requirements

                                                        Identifies who is responsible for the content.

                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        360. Composition.section:summary.section:protocolSynopsis.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()))
                                                        362. Composition.section:summary.section:protocolSynopsis.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()))
                                                        364. Composition.section:summary.section:protocolSynopsis.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|6.0.0-ballot3)

                                                        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()))
                                                        366. Composition.section:summary.section:protocolSynopsis.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()))
                                                        368. Composition.section:summary.section:protocolSynopsis.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|6.0.0-ballot3)

                                                        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()))
                                                        370. Composition.section:summary.section:protocolSynopsis.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()))
                                                        372. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints
                                                        Slice NameobjectivesEndpoints
                                                        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.

                                                        Control1..1
                                                        TypeBackboneElement
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        374. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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
                                                        376. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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()))
                                                        378. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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()))
                                                        380. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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
                                                        Pattern ValuePrimary and Secondary Objectives and Estimands
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        382. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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
                                                        BindingFor example codes, see DocumentSectionCodes
                                                        (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                        Classification of a section of a composition/document.

                                                        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()))
                                                        384. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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
                                                        386. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ url
                                                        • 388. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                            "code" : "C218516",
                                                            "display" : "ICH M11 Protocol Section 1.1.1 Primary and Secondary Objectives and Estimands"
                                                          }
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          390. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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.

                                                          Control1..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.

                                                          Pattern Valuesection1.1.1-objectives-estimands
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          392. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.author
                                                          Definition

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

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

                                                          ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                          Control0..*
                                                          TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Requirements

                                                          Identifies who is responsible for the content.

                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          394. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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()))
                                                          396. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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

                                                          Summarise the primary and secondary objectives and any associated estimands in natural, nontechnical (layperson) language. For trials intended to estimate a treatment effect or test a hypothesis related to a treatment effect, include the primary and secondary objectives and any associated estimands using a nontechnical summary describing the objective and treatment effect of interest (estimand). For other types of trials not intended to estimate a treatment effect or test a hypothesis related to a treatment effect, define trial objectives and describe additional information relevant to the clinical question(s) of interest (e.g., the endpoint(s) associated with each objective). For trials with numerous objectives in which the description of objectives will exceed half a page, consider including the most important objectives and estimands in the synopsis and refer to Section 3 Trial Objectives and Associated Estimands, which covers the objectives and estimands in technical detail. For considerations on estimands, refer to ICH E9(R1).

                                                          Control1..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()))
                                                          398. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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|6.0.0-ballot3)

                                                          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()))
                                                          400. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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(Composition)
                                                          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:summary.section:protocolSynopsis.section:objectivesEndpoints.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|6.0.0-ballot3)

                                                          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()))
                                                          404. Composition.section:summary.section:protocolSynopsis.section:objectivesEndpoints.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()))
                                                          406. Composition.section:summary.section:protocolSynopsis.section:overallDesign
                                                          Slice NameoverallDesign
                                                          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.

                                                          Control1..1
                                                          TypeBackboneElement
                                                          Is Modifierfalse
                                                          Must Supportfalse
                                                          Summaryfalse
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          408. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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
                                                          410. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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()))
                                                          412. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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()))
                                                          414. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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
                                                          Pattern ValueOverall Design
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                          416. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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
                                                          BindingFor example codes, see DocumentSectionCodes
                                                          (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                          Classification of a section of a composition/document.

                                                          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()))
                                                          418. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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
                                                          420. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 422. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                              "code" : "C218517",
                                                              "display" : "ICH M11 Protocol Section 1.1.2 Overall Design"
                                                            }
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            424. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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.

                                                            Control1..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.

                                                            Pattern Valuesection1.1.2-overall-design
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            426. Composition.section:summary.section:protocolSynopsis.section:overallDesign.author
                                                            Definition

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

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

                                                            ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                            Control0..*
                                                            TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                            Is Modifierfalse
                                                            Must Supportfalse
                                                            Summaryfalse
                                                            Requirements

                                                            Identifies who is responsible for the content.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            428. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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()))
                                                            430. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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

                                                            Key aspects of the trial design include Intervention, Intervention Model, Control Type, Control Description, Intervention Assignment Method, Drug/Device Combination Product Indicator, Population Type, Population Diagnosis or Condition, Population Age (Minimum, Maximum), Site Distribution and Geographic Scope, Master Protocol, and Adaptive Trial Design. Entries should Reference Composition Resource or ResearchStudy Resource.

                                                            Control1..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()))
                                                            432. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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|6.0.0-ballot3)

                                                            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()))
                                                            434. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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(Composition, ResearchStudy)
                                                            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:summary.section:protocolSynopsis.section:overallDesign.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|6.0.0-ballot3)

                                                            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()))
                                                            438. Composition.section:summary.section:protocolSynopsis.section:overallDesign.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()))
                                                            440. Composition.section:summary.section:protocolSynopsis.section:numberOfArms
                                                            Slice NamenumberOfArms
                                                            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.

                                                            Control1..1
                                                            TypeBackboneElement
                                                            Is Modifierfalse
                                                            Must Supportfalse
                                                            Summaryfalse
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            442. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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
                                                            444. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                            446. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                            448. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                            450. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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
                                                            BindingFor example codes, see DocumentSectionCodes
                                                            (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                            Classification of a section of a composition/document.

                                                            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()))
                                                            452. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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
                                                            454. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 456. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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.

                                                              Control0..*
                                                              TypeCoding
                                                              Is Modifierfalse
                                                              Summaryfalse
                                                              Requirements

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

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

                                                              Control1..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.

                                                              Pattern ValueNumber of Arms
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              460. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.author
                                                              Definition

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

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

                                                              ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                              Control0..*
                                                              TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Requirements

                                                              Identifies who is responsible for the content.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              462. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                              464. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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

                                                              Enter the numeric value for the number of arms in the trial. For trials with a different number of arms in different periods, populate this field based on the total number of arms.

                                                              Control1..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()))
                                                              466. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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|6.0.0-ballot3)

                                                              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()))
                                                              468. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                              470. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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|6.0.0-ballot3)

                                                              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()))
                                                              472. Composition.section:summary.section:protocolSynopsis.section:numberOfArms.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()))
                                                              474. Composition.section:summary.section:protocolSynopsis.section:blinding
                                                              Slice Nameblinding
                                                              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.

                                                              Control1..1
                                                              TypeBackboneElement
                                                              Is Modifierfalse
                                                              Must Supportfalse
                                                              Summaryfalse
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              476. Composition.section:summary.section:protocolSynopsis.section:blinding.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
                                                              478. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                              480. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                              482. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                              484. Composition.section:summary.section:protocolSynopsis.section:blinding.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
                                                              BindingFor example codes, see DocumentSectionCodes
                                                              (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                              Classification of a section of a composition/document.

                                                              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()))
                                                              486. Composition.section:summary.section:protocolSynopsis.section:blinding.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
                                                              488. Composition.section:summary.section:protocolSynopsis.section:blinding.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 490. Composition.section:summary.section:protocolSynopsis.section:blinding.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.

                                                                Control0..*
                                                                TypeCoding
                                                                Is Modifierfalse
                                                                Summaryfalse
                                                                Requirements

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

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

                                                                Control1..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.

                                                                Pattern ValueTrial Blind Schema
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                494. Composition.section:summary.section:protocolSynopsis.section:blinding.author
                                                                Definition

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

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

                                                                ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                Control0..*
                                                                TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                Is Modifierfalse
                                                                Must Supportfalse
                                                                Summaryfalse
                                                                Requirements

                                                                Identifies who is responsible for the content.

                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                496. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                                498. Composition.section:summary.section:protocolSynopsis.section:blinding.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

                                                                For designs in which these details may differ in one or more trial periods, answer according to the portion of the trial in which the highest number of blinded roles occurs. Additional details can be provided in Section 6.7.3 Measures to Maintain Blinding.

                                                                Control1..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()))
                                                                500. Composition.section:summary.section:protocolSynopsis.section:blinding.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|6.0.0-ballot3)

                                                                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()))
                                                                502. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                                504. Composition.section:summary.section:protocolSynopsis.section:blinding.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|6.0.0-ballot3)

                                                                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()))
                                                                506. Composition.section:summary.section:protocolSynopsis.section:blinding.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()))
                                                                508. Composition.section:summary.section:protocolSynopsis.section:blindedRoles
                                                                Slice NameblindedRoles
                                                                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.

                                                                Control1..1
                                                                TypeBackboneElement
                                                                Is Modifierfalse
                                                                Must Supportfalse
                                                                Summaryfalse
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                510. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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
                                                                512. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                514. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                516. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                518. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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
                                                                BindingFor example codes, see DocumentSectionCodes
                                                                (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                Classification of a section of a composition/document.

                                                                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()))
                                                                520. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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
                                                                522. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                • value @ url
                                                                • 524. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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.

                                                                  Control0..*
                                                                  TypeCoding
                                                                  Is Modifierfalse
                                                                  Summaryfalse
                                                                  Requirements

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

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

                                                                  Control1..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.

                                                                  Pattern ValueBlinded Roles
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  528. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.author
                                                                  Definition

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

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

                                                                  ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                  Control0..*
                                                                  TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Requirements

                                                                  Identifies who is responsible for the content.

                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  530. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                  532. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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

                                                                  State 'The following roles indictated will not be made aware of the treatment group assignment during the trial:' [Blinded Roles] --OR-- 'Not applicable (No blinding)' indicates an open-label trial.

                                                                  Control1..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()))
                                                                  534. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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|6.0.0-ballot3)

                                                                  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()))
                                                                  536. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                  538. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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|6.0.0-ballot3)

                                                                  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()))
                                                                  540. Composition.section:summary.section:protocolSynopsis.section:blindedRoles.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()))
                                                                  542. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants
                                                                  Slice NamenumberOfParticipants
                                                                  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.

                                                                  Control1..1
                                                                  TypeBackboneElement
                                                                  Is Modifierfalse
                                                                  Must Supportfalse
                                                                  Summaryfalse
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  544. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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
                                                                  546. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                  548. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                  550. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                  552. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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
                                                                  BindingFor example codes, see DocumentSectionCodes
                                                                  (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                  Classification of a section of a composition/document.

                                                                  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()))
                                                                  554. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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
                                                                  556. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 558. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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.

                                                                    Control0..*
                                                                    TypeCoding
                                                                    Is Modifierfalse
                                                                    Summaryfalse
                                                                    Requirements

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

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

                                                                    Control1..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.

                                                                    Pattern ValueNumber of Participants
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    562. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.author
                                                                    Definition

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

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

                                                                    ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                    Control0..*
                                                                    TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                    Is Modifierfalse
                                                                    Must Supportfalse
                                                                    Summaryfalse
                                                                    Requirements

                                                                    Identifies who is responsible for the content.

                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    564. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                    566. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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

                                                                    State the expected number of participants to be assigned to trial intervention/enrolled. Indicate whether the number provided is the target or maximum number of individuals to be randomly assigned to trial intervention/enrolled. A [Target/ Maximum] of [[Enter Number of Participants]] participants will be [randomly assigned to trial intervention/enrolled].

                                                                    Control1..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()))
                                                                    568. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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|6.0.0-ballot3)

                                                                    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()))
                                                                    570. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                    572. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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|6.0.0-ballot3)

                                                                    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()))
                                                                    574. Composition.section:summary.section:protocolSynopsis.section:numberOfParticipants.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()))
                                                                    576. Composition.section:summary.section:protocolSynopsis.section:duration
                                                                    Slice Nameduration
                                                                    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..1
                                                                    TypeBackboneElement
                                                                    Is Modifierfalse
                                                                    Must Supportfalse
                                                                    Summaryfalse
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    578. Composition.section:summary.section:protocolSynopsis.section:duration.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
                                                                    580. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                    582. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                    584. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                    586. Composition.section:summary.section:protocolSynopsis.section:duration.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
                                                                    BindingFor example codes, see DocumentSectionCodes
                                                                    (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                    Classification of a section of a composition/document.

                                                                    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()))
                                                                    588. Composition.section:summary.section:protocolSynopsis.section:duration.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
                                                                    590. Composition.section:summary.section:protocolSynopsis.section:duration.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ url
                                                                    • 592. Composition.section:summary.section:protocolSynopsis.section:duration.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.

                                                                      Control0..*
                                                                      TypeCoding
                                                                      Is Modifierfalse
                                                                      Summaryfalse
                                                                      Requirements

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

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

                                                                      Control1..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.

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

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

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

                                                                      ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                      Control0..*
                                                                      TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Requirements

                                                                      Identifies who is responsible for the content.

                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      598. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                      600. Composition.section:summary.section:protocolSynopsis.section:duration.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

                                                                      See Template instructions. Select one of the two options for total planned duration of trial intervention and trial participation for each participant. Note that the total duration of trial participation should include any washout and any follow-up periods in which the participant is not receiving trial intervention. When duration will vary, provide a short explanation (for example, “event-driven” or “adaptive design”.

                                                                      Control1..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()))
                                                                      602. Composition.section:summary.section:protocolSynopsis.section:duration.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|6.0.0-ballot3)

                                                                      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()))
                                                                      604. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                      606. Composition.section:summary.section:protocolSynopsis.section:duration.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|6.0.0-ballot3)

                                                                      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()))
                                                                      608. Composition.section:summary.section:protocolSynopsis.section:duration.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()))
                                                                      610. Composition.section:summary.section:protocolSynopsis.section:committees
                                                                      Slice Namecommittees
                                                                      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.

                                                                      Control1..1
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Must Supportfalse
                                                                      Summaryfalse
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      612. Composition.section:summary.section:protocolSynopsis.section:committees.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
                                                                      614. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                      616. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                      618. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                      620. Composition.section:summary.section:protocolSynopsis.section:committees.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
                                                                      BindingFor example codes, see DocumentSectionCodes
                                                                      (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                      Classification of a section of a composition/document.

                                                                      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()))
                                                                      622. Composition.section:summary.section:protocolSynopsis.section:committees.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
                                                                      624. Composition.section:summary.section:protocolSynopsis.section:committees.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.section.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 626. Composition.section:summary.section:protocolSynopsis.section:committees.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.

                                                                        Control0..*
                                                                        TypeCoding
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Requirements

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

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

                                                                        Control1..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.

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

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

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

                                                                        ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                        Control0..*
                                                                        TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                        Is Modifierfalse
                                                                        Must Supportfalse
                                                                        Summaryfalse
                                                                        Requirements

                                                                        Identifies who is responsible for the content.

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        632. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                        634. Composition.section:summary.section:protocolSynopsis.section:committees.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

                                                                        Indicate whether any committee(s) will be reviewing data while the trial is ongoing, and the type of committee. Common examples include Data Monitoring Committee, Dose Escalation Committee, or Endpoint Adjudication Committee; describe others, if applicable. List independent committees in the space indicated. Other committees may be included at the Sponsor’s discretion in the separate space provided. Committees listed here should be fully described in Section 11.4 Committees.

                                                                        Control1..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()))
                                                                        636. Composition.section:summary.section:protocolSynopsis.section:committees.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|6.0.0-ballot3)

                                                                        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()))
                                                                        638. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                        640. Composition.section:summary.section:protocolSynopsis.section:committees.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|6.0.0-ballot3)

                                                                        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()))
                                                                        642. Composition.section:summary.section:protocolSynopsis.section:committees.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()))
                                                                        644. Composition.section:summary.section:trialSchema
                                                                        Slice NametrialSchema
                                                                        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.

                                                                        Control1..1
                                                                        TypeBackboneElement
                                                                        Is Modifierfalse
                                                                        Must Supporttrue
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        646. Composition.section:summary.section:trialSchema.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
                                                                        648. Composition.section:summary.section:trialSchema.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()))
                                                                        650. Composition.section:summary.section:trialSchema.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()))
                                                                        652. Composition.section:summary.section:trialSchema.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
                                                                        Pattern ValueTrial Schema
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        654. Composition.section:summary.section:trialSchema.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
                                                                        BindingFor example codes, see DocumentSectionCodes
                                                                        (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                        Classification of a section of a composition/document.

                                                                        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()))
                                                                        656. Composition.section:summary.section:trialSchema.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
                                                                        658. Composition.section:summary.section:trialSchema.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.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 660. Composition.section:summary.section:trialSchema.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                                            "code" : "C218518",
                                                                            "display" : "ICH M11 Protocol Section 1.2 Trial Schema"
                                                                          }
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          662. Composition.section:summary.section:trialSchema.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.

                                                                          Control1..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.

                                                                          Pattern Valuesection1.2-trial-schema
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          664. Composition.section:summary.section:trialSchema.author
                                                                          Definition

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

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

                                                                          ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                          Control0..*
                                                                          TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                          Is Modifierfalse
                                                                          Must Supportfalse
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Identifies who is responsible for the content.

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

                                                                          The purpose of this section is to provide a visual depiction of the trial design, orienting users of the protocol to the key features of the design. The schema depicts the trial arms, the flow of individual participant through the progression of trial period(s)/epochs (such as screening, washout/run-in, intervention, and key milestones [e.g., randomisation, cross-over, end of treatment, end of study, post-treatment follow-up]). For complex trials, additional schemas may be added to describe activities or trial periods in greater detail. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.

                                                                          Control1..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()))
                                                                          670. Composition.section:summary.section:trialSchema.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|6.0.0-ballot3)

                                                                          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()))
                                                                          672. Composition.section:summary.section:trialSchema.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(SoaPlanDefinition)
                                                                          Is Modifierfalse
                                                                          Must Supportfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          674. Composition.section:summary.section:trialSchema.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|6.0.0-ballot3)

                                                                          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()))
                                                                          676. Composition.section:summary.section:trialSchema.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()))
                                                                          678. Composition.section:summary.section:scheduleOfActivities
                                                                          Slice NamescheduleOfActivities
                                                                          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.

                                                                          Control1..1
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          680. Composition.section:summary.section:scheduleOfActivities.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
                                                                          682. Composition.section:summary.section:scheduleOfActivities.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()))
                                                                          684. Composition.section:summary.section:scheduleOfActivities.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()))
                                                                          686. Composition.section:summary.section:scheduleOfActivities.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
                                                                          Pattern ValueSchedule of Activities
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          688. Composition.section:summary.section:scheduleOfActivities.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
                                                                          BindingFor example codes, see DocumentSectionCodes
                                                                          (example to http://hl7.org/fhir/ValueSet/doc-section-codes|6.0.0-ballot3)

                                                                          Classification of a section of a composition/document.

                                                                          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()))
                                                                          690. Composition.section:summary.section:scheduleOfActivities.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
                                                                          692. Composition.section:summary.section:scheduleOfActivities.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.section.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                                          • value @ url
                                                                          • 694. Composition.section:summary.section:scheduleOfActivities.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" : "http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl",
                                                                              "code" : "C218519",
                                                                              "display" : "ICH M11 Protocol Section 1.3 Schedule of Activities"
                                                                            }
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            696. Composition.section:summary.section:scheduleOfActivities.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.

                                                                            Control1..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.

                                                                            Pattern Valuesection1.3-schedule-of-activities
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            698. Composition.section:summary.section:scheduleOfActivities.author
                                                                            Definition

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

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

                                                                            ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                                                            Control0..*
                                                                            TypeReference(Practitioner, PractitionerRole, CareTeam, Device, Patient, RelatedPerson, Organization)
                                                                            Is Modifierfalse
                                                                            Must Supportfalse
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Identifies who is responsible for the content.

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

                                                                            The schedule of activities must capture the procedures that will be accomplished at each trial visit, and all contact with participants, for example, telephone contacts. This includes any tests that are used for eligibility, participant randomisation or stratification, or decisions on trial intervention discontinuation. Allowable windows should be stated for all visits and procedures. A tabular format is recommended. When applicable for studies with extensive sampling (e.g., serial PK sampling) a separate table may be added. Entries should Reference SoaPlanDefinition Profile of PlanDefinition Resource.

                                                                            Control1..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()))
                                                                            704. Composition.section:summary.section:scheduleOfActivities.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|6.0.0-ballot3)

                                                                            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()))
                                                                            706. Composition.section:summary.section:scheduleOfActivities.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(SoaPlanDefinition)
                                                                            Is Modifierfalse
                                                                            Must Supportfalse
                                                                            Summaryfalse
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            708. Composition.section:summary.section:scheduleOfActivities.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|6.0.0-ballot3)

                                                                            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()))
                                                                            710. Composition.section:summary.section:scheduleOfActivities.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()))