ADI Composition Header - PACIO Advance Healthcare Directive Interoperability Implementation Guide v2.0.0

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

Resource Profile: ADI Composition Header ( Abstract )

Official URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Composition-Header				Version: 2.0.0
Standards status: Trial-use				Computable Name: ADICompositionHeader
Other Identifiers: OID:2.16.840.1.113883.4.642.40.68.42.4

This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents.

This profile, largely based on the CCDA on FHIR US Realm Header profile, defines requirements that address specific exchange requirements for a composition containing a person's advance care plan information.

Conformance:

In the cases where the patient is not able to "write" the Personal ACP contents due to literacy constraints or physical disability, e.g. hemiplegia, the patient/subject is still considered author of the content, and a data enterer will fill the role of physically creating the document by entering the author’s requested information into the system used to create the document.

Advance Directive Information versionNumber represents a numeric value used to version successive replacement documents. Best practice for systems that support distributed document creation and updating is to populate the versionNumber with the timestamp created from the date/time when the version of the document is created in the system. Note: this may or may not be equivalent to the timestamp integer for Composition.date. the versionNumber timestamp always will be equivalent to the Bundle.timestamp for the document.

To better align with CDA, versionNumber should be a string label generated by converting the ClinicalDocument.effectiveTime (or Composition.date) to UTC time (-0000) and then using the YYYYMMDDhhmmss as the version.

Documents follow a pattern where the timestamp-label versionNumber will be equivalent to the timestamp of the Composition.date and the Bundle.timestamp. However, for unstructured historical documents uploaded into a system, the timestamp-label versionNumber will be equivalent to the timestamp of the the Bundle.timestamp, but the Composition.date will reflect the creation date of the original document.

Documents that are signed represent the signers using the attester element in the Composition. The attester.mode indicates the role of the signer.

personal - for the patient or patient's representative
official - for a witness
professional - for a notary
legal - for a signing physician

Usages:

Derived from this Profile: ADI Person-Authored Composition and ADI PMO Composition

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Description & Constraints Filter:

Composition C 0..* ClinicalDocumentComposition This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition
A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: clindoc-limit-participantType

Composition.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created

language

1..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Composition.text This element must be supported. 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

Composition.Slices for extension Content/Rules for all slices

Composition.Slices for extension.extension:R5-Composition-version 0..1 string R5: An explicitly assigned identifer of a variation of the content in the Composition (new)
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.version
Constraints: ext-1

Composition.Slices for extension.extension:data-enterer 0..1 (Complex) A Data Enterer represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/data-enterer-extension

Composition.Slices for extension.extension:informant 0..* (Complex) An Informant is an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/informant-extension

Composition.Slices for extension.extension:information-recipient 0..* (Complex) An Information Recipient is the intended recipient of the information at the time the document was created.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/information-recipient-extension

Composition.Slices for extension.extension:participant This element must be supported. 0..* (Complex) A Participant that is not a data-enter, information-recipient nor an informant
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension

Composition.Slices for extension.extension:consent 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension

Composition.Slices for extension.extension:basedOn 0..* Reference(Resource) The clinical action, such as a plan, proposal or order that is fulfilled by or precipitated this FHIR Clinical Document, such as a radiologists report of an x-ray.
URL: http://hl7.org/fhir/StructureDefinition/event-basedOn

Composition.Slices for extension.extension:change-made 0..1 (Complex) Note of changes made, calculating changes maybe required for safety as this extension may not contain all changes. Experimental, may overlap with other elements such as FHIR R6 note.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade

Composition.Slices for extension.extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension

Composition.Slices for extension.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

Composition.Slices for 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

Composition.Slices for 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

Composition.Slices for 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

Composition.Slices for extension.extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension

Composition.Slices for extension.extension:DocumentRevokeStatus This element must be supported. 0..1 code Revoke Status
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
Binding: ADI Document Revoke Status (required)

Composition.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Composition.identifier This element must be supported. This element is included in summaries. 1..1 Identifier Version-independent identifier for the Composition

Composition.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code preliminary | final | amended | entered-in-error
Binding: ADI Composition Status (required)

Composition.status.Slices for extension Content/Rules for all slices

Composition.status.Slices for extension.extension:R5-Composition-status 0..1 code This allows for additional status values found in R5. However, exercise caution as the R4 Composition.status is required.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.status
Binding: R5CompositionStatusForR4 (0.1.0) (required): The workflow/clinical status of the composition.
Constraints: ext-1

Composition.type This element must be supported. This element is included in summaries. 1..1 CodeableConcept Kind of composition (LOINC if possible)
Binding: Advance Healthcare Directive Document Types Grouper (extensible)

Composition.Slices for category This element is included in summaries. 1..* CodeableConcept Categorization of Composition
Slice: Unordered, Open by value:$this
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

category:clinicalnotecategory

0..1

CodeableConcept

Category for Clinical Note
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "107903-7",
      "display" : "Clinical note"
    }
  ]
}

category:advanceDirectiveCategory

1..1

CodeableConcept

Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC

(extensible)

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "42348-3",
      "display" : "Advance healthcare directives"
    }
  ]
}

Composition.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the composition is about

Composition.encounter This element is included in summaries. 0..1 Reference(US Core Encounter Profile) Context of the Composition

Composition.date This element must be supported. This element is included in summaries. 1..1 dateTime Composition editing time

Composition.author This element must be supported. This element is included in summaries. 1..* Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) Who and/or what authored the composition

Composition.title This element must be supported. This element is included in summaries. 1..1 string Human Readable name/title

Composition.Slices for attester 0..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode

Composition.Slices for attester.attester:All Slices Content/Rules for all slices

Composition.Slices for attester.attester:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for attester.attester:All Slices.mode 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.

Composition.Slices for attester.attester:legal_attester 0..1 BackboneElement aka legal authenticator

Composition.Slices for attester.attester:legal_attester.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for attester.attester:legal_attester.mode 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: legal (extensions allowed)

Composition.Slices for attester.attester:professional_attester 0..* BackboneElement aka authenticator

Composition.Slices for attester.attester:professional_attester.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for attester.attester:professional_attester.mode 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: professional (extensions allowed)

Composition.custodian This element must be supported. This element is included in summaries. 1..1 Reference(US Core Organization Profile) Organization which maintains the composition

Composition.Slices for relatesTo 0..* BackboneElement Relationships to other compositions/documents
Slice: Unordered, Open by value:code, type:target

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

Composition.Slices for relatesTo.relatesTo:All Slices Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for relatesTo.relatesTo:All Slices.code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x].targetIdentifier Identifier

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x].targetReference Reference(Composition)

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x].target[x]:targetIdentifier 0..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being appended, or to some other identifier of a non FHIR document

Composition.Slices for relatesTo.relatesTo:replaced_document 0..* BackboneElement The document(s) being superceded

Composition.Slices for relatesTo.relatesTo:replaced_document.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for relatesTo.relatesTo:replaced_document.code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: replaces (extensions allowed)

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x] Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier 1..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being replaced, or to some other identifier of a non FHIR document

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.use This element is a modifier element. This element is included in summaries. 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.system This element is included in summaries. 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.value This element is included in summaries. 1..1 string The value that is unique
Example General: 123456

Composition.Slices for relatesTo.relatesTo:appended_document 0..* BackboneElement The document(s) being appended too

Composition.Slices for relatesTo.relatesTo:appended_document.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for relatesTo.relatesTo:appended_document.code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: appends (extensions allowed)

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x] Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier 1..1 Identifier Target of the relationship

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.use This element is a modifier element. This element is included in summaries. 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

Composition.Slices for section This element must be supported. C 1..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
Constraints: cmp-1, cmp-2

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

Composition.Slices for section.section:All Slices Content/Rules for all slices

Composition.Slices for section.section:All Slices.Slices for extension Content/Rules for all slices

Composition.Slices for section.section:All Slices.Slices for extension.extension:change-made 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade

Composition.Slices for section.section:All Slices.Slices for extension.extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension

Composition.Slices for section.section:All Slices.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for section.section:All Slices.title This element must be supported. 1..1 string Label for section (e.g. for ToC)

Composition.Slices for section.section:All Slices.code This element must be supported. 0..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

Composition.Slices for section.section:All Slices.text This element must be supported. C 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

Composition.Slices for section.section:advance_directive_source_form This element must be supported. C 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2

Composition.Slices for section.section:advance_directive_source_form.Slices for extension Content/Rules for all slices

Composition.Slices for section.section:advance_directive_source_form.Slices for extension.extension:change-made 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade

Composition.Slices for section.section:advance_directive_source_form.Slices for extension.extension:ADISourceFormJurisdiction This element must be supported. 0..1 CodeableConcept Jurisdiction
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension
Binding: UspsTwoLetterAlphabeticCodes (2.0.0) (extensible)

Composition.Slices for section.section:advance_directive_source_form.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

Composition.Slices for section.section:advance_directive_source_form.title This element must be supported. 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:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs",
      "code" : "advance_directive_source_form"
    }
  ]
}

Composition.Slices for section.section:advance_directive_source_form.text This element must be supported. C 0..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

Composition.Slices for section.section:advance_directive_source_form.entry C 0..* Reference(ADI Source Form) A reference to data that supports this section

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Composition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Composition.status	Base	required	ADI Composition Status	📦2.0.0	This IG
Composition.type	Base	extensible	Advance Healthcare Directive Document Types Grouper	⏿20250407	tx.fhir.org
Composition.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
Composition.category:clinicalnotecategory	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
Composition.category:advanceDirectiveCategory	Base	extensible	Advance Healthcare Directive Categories LOINC	⏿20260912	tx.fhir.org
Composition.attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.attester:legal_attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.attester:professional_attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.relatesTo.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:replaced_document.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:replaced_document.target[x]:targetIdentifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Composition.relatesTo:appended_document.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:appended_document.target[x]:targetIdentifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Composition.section.code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:advance_directive_source_form.code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
clindoc-limit-participantType	error	Composition	The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element.	extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1	error	Composition.section, Composition.section:advance_directive_source_form	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:advance_directive_source_form	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	Composition.extension:R5-Composition-version, Composition.extension:data-enterer, Composition.extension:informant, Composition.extension:information-recipient, Composition.extension:participant, Composition.extension:consent, Composition.extension:basedOn, Composition.extension:change-made, Composition.extension:ExpirationDateExtension, Composition.extension:DataEntererExtension, Composition.extension:InformantExtension, Composition.extension:ParticipantExtension, Composition.extension:PerformerExtension, Composition.extension:ClauseExtension, Composition.extension:DocumentRevokeStatus, Composition.modifierExtension, Composition.status.extension:R5-Composition-status, Composition.attester.modifierExtension, Composition.attester:legal_attester.modifierExtension, Composition.attester:professional_attester.modifierExtension, Composition.relatesTo.modifierExtension, Composition.relatesTo:replaced_document.modifierExtension, Composition.relatesTo:appended_document.modifierExtension, Composition.section.extension:change-made, Composition.section.extension:ClauseExtension, Composition.section.modifierExtension, Composition.section:advance_directive_source_form.extension:change-made, Composition.section:advance_directive_source_form.extension:ADISourceFormJurisdiction, Composition.section:advance_directive_source_form.modifierExtension	Must have either extensions or value[x], not both	`extension.exists() != value.exists()`

This structure is derived from ClinicalDocumentComposition

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Composition			ClinicalDocumentComposition	This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition
Composition.language	This element must be supported.	1..1	code	Language of the resource content
Composition.Slices for extension				Content/Rules for all slices
Composition.Slices for extension.extension:ExpirationDateExtension		0..1	dateTime	ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
Composition.Slices for extension.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
Composition.Slices for 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
Composition.Slices for 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
Composition.Slices for 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
Composition.Slices for extension.extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Composition.Slices for extension.extension:DocumentRevokeStatus	This element must be supported.	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
Composition.identifier	This element must be supported.	1..1	Identifier	Version-independent identifier for the Composition
Composition.status		1..1	code	preliminary \| final \| amended \| entered-in-error Binding: ADI Composition Status (required)
Composition.type		1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Document Types Grouper (extensible)
Composition.category		1..*	CodeableConcept	Categorization of Composition
Composition.Slices for category				Content/Rules for all slices
Composition.Slices for category.category:advanceDirectiveCategory	This element must be supported.	1..1	CodeableConcept	Categorization of Composition Binding: Advance Healthcare Directive Categories LOINC (extensible) Required Pattern: `{ "coding" : [ { "system" : "http://loinc.org", "code" : "42348-3", "display" : "Advance healthcare directives" } ] }`
Composition.subject		1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
Composition.encounter		0..1	Reference(US Core Encounter Profile)	Context of the Composition
Composition.author		1..*	Reference(US Core Practitioner Profile \| US Core PractitionerRole Profile \| PractitionerRole \| US Core Patient Profile \| Device \| RelatedPerson)	Who and/or what authored the composition
Composition.confidentiality		0..0		As defined by affinity domain
Composition.custodian		1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Composition.event
Composition.event.code		0..*	CodeableConcept	Code(s) that apply to the event being documented Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs", "code" : "acp-services", "display" : "Advance care planning services" } ] }`
Composition.event.Slices for detail		0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve() Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Composition.event.Slices for detail.detail:adiFacilitator		0..1	Reference(ADI Facilitator)	ADI Facilitator
Composition.Slices for section		1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Composition.Slices for section.section:All Slices				Content/Rules for all slices
Composition.Slices for section.section:All Slices.Slices for extension				Content/Rules for all slices
Composition.Slices for section.section:All Slices.Slices for extension.extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Composition.Slices for section.section:All Slices.text		1..1	Narrative	Text summary of the section, for human interpretation
Composition.Slices for section.section:advance_directive_source_form	This element must be supported.	1..1	BackboneElement	Advance directive source form
Composition.Slices for section.section:advance_directive_source_form.Slices for extension				Content/Rules for all slices
Composition.Slices for section.section:advance_directive_source_form.Slices for extension.extension:ADISourceFormJurisdiction	This element must be supported.	0..1	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: UspsTwoLetterAlphabeticCodes (2.0.0) (extensible)
Composition.Slices for section.section:advance_directive_source_form.code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs", "code" : "advance_directive_source_form" } ] }`
Composition.Slices for section.section:advance_directive_source_form.entry		0..*	Reference(ADI Source Form)	A reference to data that supports this section
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Composition.status	Base	required	ADI Composition Status	📦2.0.0	This IG
Composition.type	Base	extensible	Advance Healthcare Directive Document Types Grouper	⏿20250407	tx.fhir.org
Composition.category:advanceDirectiveCategory	Base	extensible	Advance Healthcare Directive Categories LOINC	⏿20260912	tx.fhir.org

Description & Constraints Filter:

Composition.id This element is included in summaries. 0..1 id Logical id of this artifact

Composition.meta This element is included in summaries. 0..1 Meta Metadata about the resource

Composition.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created

language

1..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Composition.contained 0..* Resource Contained, inline Resources

Composition.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Composition.Slices for extension.extension:consent 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension

Composition.Slices for extension.extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension

Composition.Slices for extension.extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension

Composition.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Composition.identifier This element must be supported. This element is included in summaries. 1..1 Identifier Version-independent identifier for the Composition

Composition.status.id 0..1 string xml:id (or equivalent in JSON)

Composition.status.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Composition.status.value 0..1 string Primitive value for code

category:clinicalnotecategory

0..1

CodeableConcept

Category for Clinical Note
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "107903-7",
      "display" : "Clinical note"
    }
  ]
}

category:advanceDirectiveCategory

1..1

CodeableConcept

Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC

(extensible)

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "42348-3",
      "display" : "Advance healthcare directives"
    }
  ]
}

Composition.subject This element must be supported. This element is included in summaries. 1..1 Reference(US Core Patient Profile) Who and/or what the composition is about

Composition.encounter This element is included in summaries. 0..1 Reference(US Core Encounter Profile) Context of the Composition

Composition.date This element must be supported. This element is included in summaries. 1..1 dateTime Composition editing time

Composition.title This element must be supported. This element is included in summaries. 1..1 string Human Readable name/title

Composition.Slices for attester 0..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode

Composition.Slices for attester.attester:All Slices Content/Rules for all slices

Composition.Slices for attester.attester:All Slices.id 0..1 string Unique id for inter-element referencing

Composition.Slices for attester.attester:All Slices.extension 0..* Extension Additional content defined by implementations

Composition.Slices for attester.attester:All Slices.time 0..1 dateTime When the composition was attested

Composition.Slices for attester.attester:All Slices.party 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the composition

Composition.Slices for attester.attester:legal_attester 0..1 BackboneElement aka legal authenticator

Composition.Slices for attester.attester:legal_attester.id 0..1 string Unique id for inter-element referencing

Composition.Slices for attester.attester:legal_attester.extension 0..* Extension Additional content defined by implementations

Composition.Slices for attester.attester:legal_attester.time 0..1 dateTime When the composition was attested

Composition.Slices for attester.attester:legal_attester.party 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the composition

Composition.Slices for attester.attester:professional_attester 0..* BackboneElement aka authenticator

Composition.Slices for attester.attester:professional_attester.id 0..1 string Unique id for inter-element referencing

Composition.Slices for attester.attester:professional_attester.extension 0..* Extension Additional content defined by implementations

Composition.Slices for attester.attester:professional_attester.time 0..1 dateTime When the composition was attested

Composition.Slices for attester.attester:professional_attester.party 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) Who attested the composition

Composition.custodian This element must be supported. This element is included in summaries. 1..1 Reference(US Core Organization Profile) Organization which maintains the composition

Composition.Slices for relatesTo.relatesTo:All Slices Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:All Slices.id 0..1 string Unique id for inter-element referencing

Composition.Slices for relatesTo.relatesTo:All Slices.extension 0..* Extension Additional content defined by implementations

Composition.Slices for relatesTo.relatesTo:All Slices.code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x].targetIdentifier Identifier

Composition.Slices for relatesTo.relatesTo:All Slices.Slices for target[x].targetReference Reference(Composition)

Composition.Slices for relatesTo.relatesTo:replaced_document 0..* BackboneElement The document(s) being superceded

Composition.Slices for relatesTo.relatesTo:replaced_document.id 0..1 string Unique id for inter-element referencing

Composition.Slices for relatesTo.relatesTo:replaced_document.extension 0..* Extension Additional content defined by implementations

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x] Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.id 0..1 string Unique id for inter-element referencing

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use

Composition.Slices for relatesTo.relatesTo:replaced_document.Slices for target[x].target[x]:targetIdentifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)

Composition.Slices for relatesTo.relatesTo:appended_document 0..* BackboneElement The document(s) being appended too

Composition.Slices for relatesTo.relatesTo:appended_document.id 0..1 string Unique id for inter-element referencing

Composition.Slices for relatesTo.relatesTo:appended_document.extension 0..* Extension Additional content defined by implementations

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x] Content/Rules for all slices

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier 1..1 Identifier Target of the relationship

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.id 0..1 string Unique id for inter-element referencing

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.type This element is included in summaries. 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.system This element is included in summaries. 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.value This element is included in summaries. 0..1 string The value that is unique
Example General: 123456

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.period This element is included in summaries. 0..1 Period Time period when id is/was valid for use

Composition.Slices for relatesTo.relatesTo:appended_document.Slices for target[x].target[x]:targetIdentifier.assigner This element is included in summaries. 0..1 Reference(Organization) Organization that issued id (may be just text)

Composition.event This element is included in summaries. 0..* BackboneElement The clinical service(s) being documented

Composition.event.id 0..1 string Unique id for inter-element referencing

Composition.event.extension 0..* Extension Additional content defined by implementations

Composition.event.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized

code

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:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs",
      "code" : "acp-services",
      "display" : "Advance care planning services"
    }
  ]
}

Composition.event.period This element is included in summaries. 0..1 Period The period covered by the documentation

Composition.event.Slices for detail This element is included in summaries. 0..* Reference(Resource) The event(s) being documented
Slice: Unordered, Open by profile:resolve()

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them

Composition.event.Slices for detail.detail:adiFacilitator This element is included in summaries. 0..1 Reference(ADI Facilitator) ADI Facilitator

Composition.Slices for section.section:All Slices Content/Rules for all slices

Composition.Slices for section.section:All Slices.id 0..1 string Unique id for inter-element referencing

Composition.Slices for section.section:All Slices.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Composition.Slices for section.section:All Slices.Slices for extension.extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension

Composition.Slices for section.section:All Slices.title This element must be supported. 1..1 string Label for section (e.g. for ToC)

Composition.Slices for section.section:All Slices.focus 0..1 Reference(Resource) Who/what the section is about, when it is not about the subject of composition

Composition.Slices for section.section:All Slices.mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

Composition.Slices for section.section:All Slices.orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

Composition.Slices for section.section:All Slices.entry C 0..* Reference(Resource) A reference to data that supports this section

Composition.Slices for section.section:All Slices.emptyReason C 0..1 CodeableConcept Why the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

Composition.Slices for section.section:All Slices.section C 0..* See section (Composition) Nested Section

Composition.Slices for section.section:advance_directive_source_form This element must be supported. C 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2

Composition.Slices for section.section:advance_directive_source_form.id 0..1 string Unique id for inter-element referencing

Composition.Slices for section.section:advance_directive_source_form.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Composition.Slices for section.section:advance_directive_source_form.Slices for extension Content/Rules for all slices

Composition.Slices for section.section:advance_directive_source_form.title This element must be supported. 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:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs",
      "code" : "advance_directive_source_form"
    }
  ]
}

Composition.Slices for section.section:advance_directive_source_form.focus 0..1 Reference(Resource) Who/what the section is about, when it is not about the subject of composition

Composition.Slices for section.section:advance_directive_source_form.mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

Composition.Slices for section.section:advance_directive_source_form.orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

Composition.Slices for section.section:advance_directive_source_form.entry C 0..* Reference(ADI Source Form) A reference to data that supports this section

Composition.Slices for section.section:advance_directive_source_form.emptyReason C 0..1 CodeableConcept Why the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

Composition.Slices for section.section:advance_directive_source_form.section C 0..* See section (Composition) Nested Section

Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Composition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Composition.status	Base	required	ADI Composition Status	📦2.0.0	This IG
Composition.type	Base	extensible	Advance Healthcare Directive Document Types Grouper	⏿20250407	tx.fhir.org
Composition.category	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
Composition.category:clinicalnotecategory	Base	example	Document Class Value Set	📍4.0.1	FHIR Std.
Composition.category:advanceDirectiveCategory	Base	extensible	Advance Healthcare Directive Categories LOINC	⏿20260912	tx.fhir.org
Composition.attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.attester:legal_attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.attester:professional_attester.mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.relatesTo.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:replaced_document.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:replaced_document.target[x]:targetIdentifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Composition.relatesTo:replaced_document.target[x]:targetIdentifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Composition.relatesTo:appended_document.code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.relatesTo:appended_document.target[x]:targetIdentifier.use	Base	required	IdentifierUse	📍4.0.1	FHIR Std.
Composition.relatesTo:appended_document.target[x]:targetIdentifier.type	Base	extensible	IdentifierType	📍4.0.1	FHIR Std.
Composition.event.code	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.4
Composition.section.code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section.mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section.orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section.emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:advance_directive_source_form.code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:advance_directive_source_form.mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:advance_directive_source_form.orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:advance_directive_source_form.emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
clindoc-limit-participantType	error	Composition	The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element.	extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1	error	Composition.section, Composition.section:advance_directive_source_form	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:advance_directive_source_form	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 ClinicalDocumentComposition

Summary

Mandatory: 8 elements
Must-Support: 6 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

The element 1 is sliced based on the value of Composition.event.detail
The element 1 is sliced based on the value of Composition.section

Key Elements View

Description & Constraints Filter:

Composition.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created

language

1..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

Composition.Slices for extension Content/Rules for all slices

Composition.Slices for extension.extension:consent 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension

Composition.Slices for extension.extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension

Composition.Slices for extension.extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension

Composition.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored

Composition.identifier This element must be supported. This element is included in summaries. 1..1 Identifier Version-independent identifier for the Composition

Composition.status.Slices for extension Content/Rules for all slices

category:clinicalnotecategory

0..1

CodeableConcept

Category for Clinical Note
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "107903-7",
      "display" : "Clinical note"
    }
  ]
}

category:advanceDirectiveCategory

1..1

CodeableConcept

Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC

(extensible)

Required Pattern:

{
  "coding" : [
    {
      "system" : "http://loinc.org",
      "code" : "42348-3",
      "display" : "Advance healthcare directives"
    }
  ]
}