SDOH Clinical Care
2.1.0 - STU 2.1 United States of America flag

SDOH Clinical Care, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-sdoh-clinicalcare/ and changes regularly. See the Directory of published versions

Resource Profile: SDOHCCGroup - Detailed Descriptions

Page standards status: Trial-use

Definitions for the SDOHCC-Group resource profile.

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

0. Group
Definition

For aggregation of individuals with a common set of characteristics (i.e., the same payer and and any condition in the specified SDOH categories) to enable organizations with the appropriate permissions to easily retrieve information related to the cohort of individuals for which they have a common responsibility.

ShortGroup of SDOH patients for a payer
2. Group.active
Control1..?
Fixed Valuetrue
4. Group.type
Definition

Identifies that this is a group of persons.

Shortperson
Requirements

For this IG use case, this will only be used for a group of persons.

Fixed Valueperson
6. Group.actual
Requirements

Refers only to a specific group of real individuals.

Fixed Valuetrue
8. Group.characteristic
Control2..?
SlicingThis element introduces a set of slices on Group.characteristic. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ code
  • 10. Group.characteristic:HasSDOHCondition
    Slice NameHasSDOHCondition
    Control1..1
    Must Supporttrue
    Requirements

    To identify members who have an active instance of a condition with any Condition.category in the value set referenced by Group.characteristic.value[x] (i.e., SDOH conditions).

    12. Group.characteristic:HasSDOHCondition.code
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
        "code" : "sdoh-condition-category"
      }]
    }
    14. Group.characteristic:HasSDOHCondition.value[x]
    TypeReference(ValueSet)
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Must Supporttrue
    Pattern Value{
      "reference" : "http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory"
    }
    16. Group.characteristic:HasSDOHCondition.exclude
    Must Supporttrue
    Fixed Valuefalse
    18. Group.characteristic:HasSDOHCondition.period
    Control0..0
    20. Group.characteristic:HasPayer
    Slice NameHasPayer
    Definition

    Identifies traits whose presence or absence is shared by members of the group.

    Control1..1
    Must Supporttrue
    Requirements

    To identify members who are covered by a payer referenced by Group.characteristic.value[x].

    22. Group.characteristic:HasPayer.code
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
        "code" : "payer-coverage"
      }]
    }
    24. Group.characteristic:HasPayer.value[x]
    TypeReference(US Core Organization Profile)
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Must Supporttrue
    26. Group.characteristic:HasPayer.exclude
    Must Supporttrue
    Fixed Valuefalse
    28. Group.characteristic:HasPayer.period
    Control0..0
    30. Group.member
    Must Supporttrue
    32. Group.member.entity
    Must Supporttrue

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

    0. Group
    Definition

    For aggregation of individuals with a common set of characteristics (i.e., the same payer and and any condition in the specified SDOH categories) to enable organizations with the appropriate permissions to easily retrieve information related to the cohort of individuals for which they have a common responsibility.


    Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization.

    ShortGroup of SDOH patients for a payerGroup of multiple entities
    Comments

    If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    grp-1: Can only have members if group is "actual" (member.empty() or (actual = true))
    grp-1: Can only have members if group is "actual" (member.empty() or (actual = true))
    2. Group.implicitRules
    Definition

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

    ShortA set of rules under which this content was created
    Comments

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

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

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

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

    ShortExtensions that cannot be ignored
    Comments

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

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

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

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. Group.active
    Definition

    Indicates whether the record for the group is available for use or is merely being retained for historical purposes.

    ShortWhether this group's record is in active use
    Control10..1
    Typeboolean
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Need to be able to mark a group record as not to be used because it was created in error or is otherwise no longer available (e.g. a herd that no longer exists).

    Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
    Fixed Valuetrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Group.type
    Definition

    Identifies that this is a group of persons.


    Identifies the broad classification of the kind of resources the group includes.

    Shortpersonperson | animal | practitioner | device | medication | substance
    Comments

    Group members SHALL be of the appropriate resource type (Patient for person or animal; or Practitioner, Device, Medication or Substance for the other types.).

    Control1..1
    BindingThe codes SHALL be taken from GroupTypehttp://hl7.org/fhir/ValueSet/group-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/group-type|4.0.1)

    Types of resources that are part of group.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    For this IG use case, this will only be used for a group of persons.


    Identifies what type of resources the group is made up of.

    Fixed Valueperson
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Group.actual
    Definition

    If true, indicates that the resource refers to a specific group of real individuals. If false, the group defines a set of intended individuals.

    ShortDescriptive or actual
    Control1..1
    This element is affected by the following invariants: grp-1
    Typeboolean
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Requirements

    Refers only to a specific group of real individuals.


    There are use-cases for groups that define specific collections of individuals, and other groups that define "types" of intended individuals. The requirements for both kinds of groups are similar, so we use a single resource, distinguished by this flag.

    Fixed Valuetrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Group.characteristic
    Definition

    Identifies traits whose presence r absence is shared by members of the group.

    ShortInclude / Exclude group members by Trait
    Comments

    All the identified characteristics must be true for an entity to a member of the group.

    Control20..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Requirements

    Needs to be a generic mechanism for identifying what individuals can be part of a group.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Group.characteristic. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • pattern @ code
    • 14. Group.characteristic.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. Group.characteristic.code
      Definition

      A code that identifies the kind of trait being asserted.

      ShortKind of characteristic
      Control1..1
      Binding

      List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Requirements

      Need a formal way of identifying the characteristic being described.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Group.characteristic.value[x]
      Definition

      The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

      ShortValue held by characteristic
      Comments

      For Range, it means members of the group have a value that falls somewhere within the specified range.

      Control1..1
      Binding

      Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.

      TypeChoice of: CodeableConcept, boolean, Quantity, Range, Reference
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      The value of the characteristic is what determines group membership.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Group.characteristic.exclude
      Definition

      If true, indicates the characteristic is one that is NOT held by members of the group.

      ShortGroup includes or excludes
      Comments

      This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

      Control1..1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Requirements

      Sometimes group membership is determined by characteristics not possessed.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Group.characteristic:HasSDOHCondition
      Slice NameHasSDOHCondition
      Definition

      Identifies traits whose presence r absence is shared by members of the group.

      ShortInclude / Exclude group members by Trait
      Comments

      All the identified characteristics must be true for an entity to a member of the group.

      Control10..1*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      To identify members who have an active instance of a condition with any Condition.category in the value set referenced by Group.characteristic.value[x] (i.e., SDOH conditions).


      Needs to be a generic mechanism for identifying what individuals can be part of a group.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Group.characteristic:HasSDOHCondition.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. Group.characteristic:HasSDOHCondition.code
      Definition

      A code that identifies the kind of trait being asserted.

      ShortKind of characteristic
      Control1..1
      Binding

      List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need a formal way of identifying the characteristic being described.

      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "sdoh-condition-category"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Group.characteristic:HasSDOHCondition.value[x]
      Definition

      The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

      ShortValue held by characteristic
      Comments

      For Range, it means members of the group have a value that falls somewhere within the specified range.

      Control1..1
      TypeReference(ValueSet), boolean, Quantity, Range, CodeableConcept
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      The value of the characteristic is what determines group membership.

      Pattern Value{
        "reference" : "http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory"
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Group.characteristic:HasSDOHCondition.exclude
      Definition

      If true, indicates the characteristic is one that is NOT held by members of the group.

      ShortGroup includes or excludes
      Comments

      This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

      Control1..1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Sometimes group membership is determined by characteristics not possessed.

      Fixed Valuefalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Group.characteristic:HasSDOHCondition.period
      Definition

      The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

      ShortPeriod over which characteristic is tested
      Control0..01
      TypePeriod
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Group.characteristic:HasPayer
      Slice NameHasPayer
      Definition

      Identifies traits whose presence or absence is shared by members of the group.


      Identifies traits whose presence r absence is shared by members of the group.

      ShortInclude / Exclude group members by Trait
      Comments

      All the identified characteristics must be true for an entity to a member of the group.

      Control10..1*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      To identify members who are covered by a payer referenced by Group.characteristic.value[x].


      Needs to be a generic mechanism for identifying what individuals can be part of a group.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Group.characteristic:HasPayer.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      38. Group.characteristic:HasPayer.code
      Definition

      A code that identifies the kind of trait being asserted.

      ShortKind of characteristic
      Control1..1
      Binding

      List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Need a formal way of identifying the characteristic being described.

      Pattern Value{
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
          "code" : "payer-coverage"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Group.characteristic:HasPayer.value[x]
      Definition

      The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

      ShortValue held by characteristic
      Comments

      For Range, it means members of the group have a value that falls somewhere within the specified range.

      Control1..1
      TypeReference(US Core Organization Profile), boolean, Quantity, Range, CodeableConcept
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      The value of the characteristic is what determines group membership.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Group.characteristic:HasPayer.exclude
      Definition

      If true, indicates the characteristic is one that is NOT held by members of the group.

      ShortGroup includes or excludes
      Comments

      This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

      Control1..1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Sometimes group membership is determined by characteristics not possessed.

      Fixed Valuefalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. Group.characteristic:HasPayer.period
      Definition

      The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

      ShortPeriod over which characteristic is tested
      Control0..01
      TypePeriod
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Group.member
      Definition

      Identifies the resource instances that are members of the group.

      ShortWho or what is in group
      Control0..*
      This element is affected by the following invariants: grp-1
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Often the only thing of interest about a group is "who's in it".

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. Group.member.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

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

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

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      50. Group.member.entity
      Definition

      A reference to the entity that is a member of the group. Must be consistent with Group.type. If the entity is another group, then the type must be the same.

      ShortReference to the group member
      Control1..1
      TypeReference(Patient, Practitioner, PractitionerRole, Device, Medication, Substance, Group)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

      0. Group
      Definition

      For aggregation of individuals with a common set of characteristics (i.e., the same payer and and any condition in the specified SDOH categories) to enable organizations with the appropriate permissions to easily retrieve information related to the cohort of individuals for which they have a common responsibility.

      ShortGroup of SDOH patients for a payer
      Comments

      If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics.

      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      grp-1: Can only have members if group is "actual" (member.empty() or (actual = true))
      2. Group.id
      Definition

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

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. Group.meta
      Definition

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

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

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

      ShortA set of rules under which this content was created
      Comments

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

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

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

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

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

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

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

      ShortText summary of the resource, for human interpretation
      Comments

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

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Group.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

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

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Group.extension
      Definition

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

      ShortAdditional content defined by implementations
      Comments

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

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. Group.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored
      Comments

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

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

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

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. Group.identifier
      Definition

      A unique business identifier for this group.

      ShortUnique id
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows the group to be referenced from external specifications.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Group.active
      Definition

      Indicates whether the record for the group is available for use or is merely being retained for historical purposes.

      ShortWhether this group's record is in active use
      Control1..1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Need to be able to mark a group record as not to be used because it was created in error or is otherwise no longer available (e.g. a herd that no longer exists).

      Meaning if MissingThis resource is generally assumed to be active if no value is provided for the active element
      Fixed Valuetrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Group.type
      Definition

      Identifies that this is a group of persons.

      Shortperson
      Comments

      Group members SHALL be of the appropriate resource type (Patient for person or animal; or Practitioner, Device, Medication or Substance for the other types.).

      Control1..1
      BindingThe codes SHALL be taken from GroupType
      (required to http://hl7.org/fhir/ValueSet/group-type|4.0.1)

      Types of resources that are part of group.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      For this IG use case, this will only be used for a group of persons.

      Fixed Valueperson
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Group.actual
      Definition

      If true, indicates that the resource refers to a specific group of real individuals. If false, the group defines a set of intended individuals.

      ShortDescriptive or actual
      Control1..1
      This element is affected by the following invariants: grp-1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Refers only to a specific group of real individuals.

      Fixed Valuetrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Group.code
      Definition

      Provides a specific type of resource the group includes; e.g. "cow", "syringe", etc.

      ShortKind of Group members
      Comments

      This would generally be omitted for Person resources.

      Control0..1
      Binding

      Kind of particular resource; e.g. cow, syringe, lake, etc.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Group.name
      Definition

      A label assigned to the group for human identification and communication.

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

      Used to identify the group in human communication.

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

      A count of the number of resource instances that are part of the group.

      ShortNumber of members
      Comments

      Note that the quantity may be less than the number of members if some of the members are not active.

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

      Group size is a common defining characteristic.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Group.managingEntity
      Definition

      Entity responsible for defining and maintaining Group characteristics and/or registered members.

      ShortEntity that is the custodian of the Group's definition
      Comments

      This does not strictly align with ownership of a herd or flock, but may suffice to represent that relationship in simple cases. More complex cases will require an extension.

      Control0..1
      TypeReference(Organization, RelatedPerson, Practitioner, PractitionerRole)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Group.characteristic
      Definition

      Identifies traits whose presence r absence is shared by members of the group.

      ShortInclude / Exclude group members by Trait
      Comments

      All the identified characteristics must be true for an entity to a member of the group.

      Control2..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Requirements

      Needs to be a generic mechanism for identifying what individuals can be part of a group.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Group.characteristic. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • pattern @ code
      • 36. Group.characteristic.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        38. Group.characteristic.extension
        Definition

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        40. Group.characteristic.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        42. Group.characteristic.code
        Definition

        A code that identifies the kind of trait being asserted.

        ShortKind of characteristic
        Control1..1
        Binding

        List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need a formal way of identifying the characteristic being described.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Group.characteristic.value[x]
        Definition

        The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

        ShortValue held by characteristic
        Comments

        For Range, it means members of the group have a value that falls somewhere within the specified range.

        Control1..1
        Binding

        Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.

        TypeChoice of: CodeableConcept, boolean, Quantity, Range, Reference
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        The value of the characteristic is what determines group membership.

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

        If true, indicates the characteristic is one that is NOT held by members of the group.

        ShortGroup includes or excludes
        Comments

        This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

        Control1..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Sometimes group membership is determined by characteristics not possessed.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Group.characteristic.period
        Definition

        The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

        ShortPeriod over which characteristic is tested
        Control0..1
        TypePeriod
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Group.characteristic:HasSDOHCondition
        Slice NameHasSDOHCondition
        Definition

        Identifies traits whose presence r absence is shared by members of the group.

        ShortInclude / Exclude group members by Trait
        Comments

        All the identified characteristics must be true for an entity to a member of the group.

        Control1..1
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        To identify members who have an active instance of a condition with any Condition.category in the value set referenced by Group.characteristic.value[x] (i.e., SDOH conditions).

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

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        54. Group.characteristic:HasSDOHCondition.extension
        Definition

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        56. Group.characteristic:HasSDOHCondition.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        58. Group.characteristic:HasSDOHCondition.code
        Definition

        A code that identifies the kind of trait being asserted.

        ShortKind of characteristic
        Control1..1
        Binding

        List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Need a formal way of identifying the characteristic being described.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
            "code" : "sdoh-condition-category"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Group.characteristic:HasSDOHCondition.value[x]
        Definition

        The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

        ShortValue held by characteristic
        Comments

        For Range, it means members of the group have a value that falls somewhere within the specified range.

        Control1..1
        TypeReference(ValueSet)
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        The value of the characteristic is what determines group membership.

        Pattern Value{
          "reference" : "http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory"
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Group.characteristic:HasSDOHCondition.exclude
        Definition

        If true, indicates the characteristic is one that is NOT held by members of the group.

        ShortGroup includes or excludes
        Comments

        This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

        Control1..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Requirements

        Sometimes group membership is determined by characteristics not possessed.

        Fixed Valuefalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. Group.characteristic:HasSDOHCondition.period
        Definition

        The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

        ShortPeriod over which characteristic is tested
        Control0..0
        TypePeriod
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        66. Group.characteristic:HasPayer
        Slice NameHasPayer
        Definition

        Identifies traits whose presence or absence is shared by members of the group.

        ShortInclude / Exclude group members by Trait
        Comments

        All the identified characteristics must be true for an entity to a member of the group.

        Control1..1
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        To identify members who are covered by a payer referenced by Group.characteristic.value[x].

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        68. Group.characteristic:HasPayer.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        70. Group.characteristic:HasPayer.extension
        Definition

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        72. Group.characteristic:HasPayer.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        74. Group.characteristic:HasPayer.code
        Definition

        A code that identifies the kind of trait being asserted.

        ShortKind of characteristic
        Control1..1
        Binding

        List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Need a formal way of identifying the characteristic being described.

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes",
            "code" : "payer-coverage"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. Group.characteristic:HasPayer.value[x]
        Definition

        The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

        ShortValue held by characteristic
        Comments

        For Range, it means members of the group have a value that falls somewhere within the specified range.

        Control1..1
        TypeReference(US Core Organization Profile)
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        The value of the characteristic is what determines group membership.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. Group.characteristic:HasPayer.exclude
        Definition

        If true, indicates the characteristic is one that is NOT held by members of the group.

        ShortGroup includes or excludes
        Comments

        This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

        Control1..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Requirements

        Sometimes group membership is determined by characteristics not possessed.

        Fixed Valuefalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        80. Group.characteristic:HasPayer.period
        Definition

        The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

        ShortPeriod over which characteristic is tested
        Control0..0
        TypePeriod
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        82. Group.member
        Definition

        Identifies the resource instances that are members of the group.

        ShortWho or what is in group
        Control0..*
        This element is affected by the following invariants: grp-1
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Often the only thing of interest about a group is "who's in it".

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. Group.member.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        86. Group.member.extension
        Definition

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        88. Group.member.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        90. Group.member.entity
        Definition

        A reference to the entity that is a member of the group. Must be consistent with Group.type. If the entity is another group, then the type must be the same.

        ShortReference to the group member
        Control1..1
        TypeReference(Patient, Practitioner, PractitionerRole, Device, Medication, Substance, Group)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        92. Group.member.period
        Definition

        The period that the member was in the group, if known.

        ShortPeriod member belonged to the group
        Control0..1
        TypePeriod
        Is Modifierfalse
        Summaryfalse
        Requirements

        Need to track who was in a group at a particular time.

        Meaning if MissingThe member is in the group at this time
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. Group.member.inactive
        Definition

        A flag to indicate that the member is no longer in the group, but previously may have been a member.

        ShortIf member is no longer in group
        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Sometimes you don't know when someone stopped being in a group, but not when.

        Meaning if MissingMembers are considered active unless explicitly specified otherwise
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))