This profile defines the requirements for communicating a Personal Advance Care Plan (PACP) using a Composition Resource. It is used to create a person-generated document which is authored by the subject of the document (the patient). It contains information about the person's goals, preferences, and priorities (GPPs) for care and treatment under certain future conditions.

It is possible for a PACP composition to only contain textual information and not have any encoded entries. In this case, an implementer may populate the section.text element in place of a resource reference in the section.entry element.

For a Patient-authored composition, the attester is set to personal.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
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Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension		0..1	dateTime	ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction		0..*	CodeableConcept	US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant-extension
extension:PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester	S	1..*	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: personal
party		0..1	Reference(US Core Patient Profile | RelatedPerson)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
Slices for extension				Content/Rules for all slices
extension:ADIDocumentReferenceExtension	S	0..*	Reference(ADI Document Reference)	ADI Document Reference Extension URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-reference-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
section:healthcare_agent	SC	1..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations Constraints: cmp-1, cmp-2, HCA-section-entries
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition	C	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI PtAuthored Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience	C	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI PtAuthored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death	C	0..1	BackboneElement	Goals, preferences, and priorities upon death Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI PtAuthored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
section:minimal_source_form	C	0..1	BackboneElement	Minimal source form Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
section:additional_documentation	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	C	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information	C	0..1	BackboneElement	Administrative information associated with this personal advance care plan Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS From this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 From https://vsac.nlm.nih.gov
Composition.category	example	Pattern Value: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
Composition.attester.mode	required	Pattern Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
Composition.section:healthcare_agent.code	example	Pattern Value: LOINC Code 81335-2 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADINoHealthcareAgentIncludedReasonVS From this IG
Composition.section:gpp_for_certain_health_condition.code	example	Pattern Value: LOINC Code 81336-0 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:gpp_personal_care_experience.code	example	Pattern Value: LOINC Code 81338-6 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:gpp_upon_death.code	example	Pattern Value: LOINC Code 81337-8 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:minimal_source_form.code	example	Pattern Value: minimal_source_form http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:additional_documentation.code	example	Pattern Value: LOINC Code 77599-9 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:witness_and_notary.code	example	Pattern Value: LOINC Code 81339-4 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:administrative_information.code	example	Pattern Value: LOINC Code 81381-6 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type : section.code = type
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
cmp-1	error	Composition.section, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from ADICompositionHeader

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
author		1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
attester	S	1..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal | professional | legal | official Required Pattern: personal
party		0..1	Reference(US Core Patient Profile | RelatedPerson)	Who attested the composition
Slices for section		1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
text	S	1..1	Narrative	Text summary of the section, for human interpretation
section:healthcare_agent	SC	1..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations Constraints: HCA-section-entries
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
entry		0..*	Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant)	A reference to data that supports this section
emptyReason		0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition		0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
entry		0..*	Reference(ADI PtAuthored Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience		0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
entry		0..*	Reference(ADI PtAuthored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death		0..1	BackboneElement	Goals, preferences, and priorities upon death
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry		0..*	Reference(ADI PtAuthored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
section:minimal_source_form		0..1	BackboneElement	Minimal source form
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
entry		0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
section:additional_documentation		0..1	BackboneElement	Observations regarding the existence of other advance directive related information
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry		0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary		0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry		0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information		0..1	BackboneElement	Administrative information associated with this personal advance care plan
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADINoHealthcareAgentIncludedReasonVS From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type : section.code = type
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension		0..1	dateTime	ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction		0..*	CodeableConcept	US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant-extension
extension:PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester	S	1..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: personal
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(US Core Patient Profile | RelatedPerson)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ADIDocumentReferenceExtension	S	0..*	Reference(ADI Document Reference)	ADI Document Reference Extension URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-reference-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
period	Σ	0..1	Period	The period covered by the documentation
Slices for detail	Σ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator	Σ	0..1	Reference(ADI Facilitator)	ADI Facilitator
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:healthcare_agent	SC	1..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations Constraints: cmp-1, cmp-2, HCA-section-entries
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section	C	0..*	See section (Composition)	Nested Section
section:gpp_for_certain_health_condition	C	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI PtAuthored Care Plan)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_personal_care_experience	C	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI PtAuthored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_upon_death	C	0..1	BackboneElement	Goals, preferences, and priorities upon death Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI PtAuthored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:minimal_source_form	C	0..1	BackboneElement	Minimal source form Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:additional_documentation	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:witness_and_notary	C	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:administrative_information	C	0..1	BackboneElement	Administrative information associated with this personal advance care plan Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS From this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 From https://vsac.nlm.nih.gov
Composition.category	example	Pattern Value: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
Composition.attester.mode	required	Pattern Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
Composition.event.code	example	Pattern Value: acp-services("Advance care planning services") http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:healthcare_agent.code	example	Pattern Value: LOINC Code 81335-2 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:healthcare_agent.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:healthcare_agent.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADINoHealthcareAgentIncludedReasonVS From this IG
Composition.section:gpp_for_certain_health_condition.code	example	Pattern Value: LOINC Code 81336-0 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:gpp_for_certain_health_condition.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:gpp_for_certain_health_condition.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:gpp_for_certain_health_condition.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:gpp_personal_care_experience.code	example	Pattern Value: LOINC Code 81338-6 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:gpp_personal_care_experience.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:gpp_personal_care_experience.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:gpp_personal_care_experience.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:gpp_upon_death.code	example	Pattern Value: LOINC Code 81337-8 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:gpp_upon_death.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:gpp_upon_death.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:gpp_upon_death.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:minimal_source_form.code	example	Pattern Value: minimal_source_form http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:minimal_source_form.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:minimal_source_form.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:minimal_source_form.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:additional_documentation.code	example	Pattern Value: LOINC Code 77599-9 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:additional_documentation.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:additional_documentation.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:additional_documentation.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:witness_and_notary.code	example	Pattern Value: LOINC Code 81339-4 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:witness_and_notary.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:witness_and_notary.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:witness_and_notary.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:administrative_information.code	example	Pattern Value: LOINC Code 81381-6 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:administrative_information.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:administrative_information.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:administrative_information.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type : section.code = type
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
cmp-1	error	Composition.section, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()