MCC eCare Plan Implementation Guide
1.0.0 - STU1 United States of America flag

MCC eCare Plan Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-mcc/ and changes regularly. See the Directory of published versions

Resource Profile: MCCChronCondHealthConcern - Detailed Descriptions

Draft as of 2020-06-29

Definitions for the MCCChronCondHealthConcern resource profile.

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

0. Condition
2. Condition.extension
Must Supportfalse
LabelLabel
SlicingThis element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Condition.extension:Condition-dueTo
    Slice NameCondition-dueTo
    Control0..*
    TypeExtension(Condition Due To) (Extension Type: Choice of: CodeableConcept, Reference(Condition, Procedure, MedicationAdministration, Immunization, MedicationStatement))
    6. Condition.category
    ShortWithin the industry, Health Concerns may reside on the problem list along with Problems
    8. Condition.code
    ShortPlease see the MCC Chronic Condition and Health Concern Value Sets Library for value sets that are subsets of US Core Condition Code that can be used at Conditon.code element
    LabelLabel
    10. Condition.evidence
    ShortSupporting evidence for the presence of a chronic condition should be provided whenever possible.
    Must Supporttrue
    Labellabel on evidence
    12. Condition.evidence.detail
    ShortCondition.evidence allows asserting an encoded term code OR pointing to a profile where more detail is available. The use of referring to detail through referred profiles is encouraged.
    Control0..*
    Must Supportfalse
    Labellabel on detail
    SlicingThis element introduces a set of slices on Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ resolve()
    • Guidance on how to interpret the contents of this table can be found here

      0. Condition
      Definition

      -


      A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

      ShortDetailed information about conditions, problems or diagnoses
      Comments

      -

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
      con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
      con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
      dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
      con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
      con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
      2. Condition.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. Condition.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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
      Must Supportfalse
      Summaryfalse
      LabelLabel
      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())
      SlicingThis element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. Condition.extension:assertedDate
        Slice NameassertedDate
        Definition

        The date on which the existence of the Condition was first asserted or acknowledged.

        Short(USCDI) Date the condition was first asserted
        Comments

        The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.

        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Condition Asserted Date) (Extension Type: dateTime)
        Is Modifierfalse
        Must Supporttrue
        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())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. Condition.extension:Condition-dueTo
        Slice NameCondition-dueTo
        Definition

        Further conditions, problems, diagnoses, procedures or events or the substance that caused/triggered this Condition.

        ShortCauses for this Condition
        Comments

        Although a condition may be caused by a substance, this is not intended to be used to record allergies/adverse reactions to substances.

        Control0..*
        TypeExtension(Condition Due To) (Extension Type: Choice of: CodeableConcept, Reference(Condition, Procedure, MedicationAdministration, Immunization, MedicationStatement))
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        10. Condition.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())
        12. Condition.clinicalStatus
        Definition

        The clinical status of the condition.

        Short(USCDI) active | recurrence | relapse | inactive | remission | resolvedactive | recurrence | relapse | inactive | remission | resolved
        Comments

        The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

        Control0..1
        This element is affected by the following invariants: con-3, con-4, con-5
        BindingThe codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
        (required to http://hl7.org/fhir/ValueSet/condition-clinical)
        TypeCodeableConcept
        Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. Condition.verificationStatus
        Definition

        The verification status to support the clinical status of the condition.

        Short(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-errorunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
        Comments

        verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

        Control0..1
        This element is affected by the following invariants: con-3, con-5
        BindingThe codes SHALL be taken from ConditionVerificationStatushttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
        TypeCodeableConcept
        Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Condition.category
        Definition

        A category assigned to the condition.

        ShortWithin the industry, Health Concerns may reside on the problem list along with Problemsproblem-list-item | encounter-diagnosis
        Comments

        The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

        Control10..*
        BindingUnless not suitable, these codes SHALL be taken from ConditionCategoryCodeshttp://hl7.org/fhir/ValueSet/condition-category
        (extensible to http://hl7.org/fhir/ValueSet/condition-category)

        A category assigned to the condition.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 18. Condition.category:us-core
          Slice Nameus-core
          Definition

          A category assigned to the condition.

          Short(USCDI) problem-list-item | health-concernproblem-list-item | encounter-diagnosis
          Comments

          The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

          Control10..*
          BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from US Core Problem or Health Concernhttp://hl7.org/fhir/ValueSet/condition-category
          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern)

          Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


          A category assigned to the condition.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. Condition.category:screening-assessment
          Slice Namescreening-assessment
          Definition

          Categories that a provider may use in their workflow to classify that this Condition is related to a USCDI Health Status/Assessments Data Class.


          A category assigned to the condition.

          Short(USCDI) USCDI Health Status/Assessments Data Classproblem-list-item | encounter-diagnosis
          Comments

          The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

          Control0..*
          BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from US Core Screening Assessment Condition Categoryhttp://hl7.org/fhir/ValueSet/condition-category
          (required to http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-condition-category)

          Note that other codes are permitted, see Required Bindings When Slicing by Value Sets


          A category assigned to the condition.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Used for filtering condition

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Condition.code
          Definition

          Identification of the condition, problem or diagnosis.

          ShortPlease see the MCC Chronic Condition and Health Concern Value Sets Library for value sets that are subsets of US Core Condition Code that can be used at Conditon.code elementIdentification of the condition, problem or diagnosis
          Control10..1
          BindingUnless not suitable, these codes SHALL be taken from For example codes, see US Core Condition Codeshttp://hl7.org/fhir/ValueSet/condition-code
          (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)

          Valueset to describe the actual problem experienced by the patient


          Identification of the condition or diagnosis.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          0..1 to account for primarily narrative only resources.

          LabelLabel
          Alternate Namestype
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          24. Condition.subject
          Definition

          Indicates the patient or group who the condition record is associated with.

          Short(USCDI) Who has the condition?Who has the condition?
          Control1..1
          TypeReference(US Core Patient Profile, Patient, Group)
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Group is typically used for veterinary or public health use cases.

          Alternate Namespatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. Condition.onset[x]
          Definition

          Estimated or actual date or date-time the condition began, in the opinion of the clinician.

          Short(USCDI) Estimated or actual date, date-time, or ageEstimated or actual date, date-time, or age
          Comments

          Age is generally used when the patient reports an age at which the Condition began to occur.

          Control0..1
          TypeChoice of: dateTime, Age, Period, Range, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesdateTime
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          28. Condition.abatement[x]
          Definition

          The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

          Short(USCDI) When in resolution/remissionWhen in resolution/remission
          Comments

          There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

          Control0..1
          This element is affected by the following invariants: con-4
          TypeChoice of: dateTime, Age, Period, Range, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesdateTime
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. Condition.recordedDate
          Definition

          The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

          Short(USCDI) Date record was first recordedDate record was first recorded
          Control0..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. Condition.evidence
          Definition

          Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

          ShortSupporting evidence for the presence of a chronic condition should be provided whenever possible.
          Comments

          The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Labellabel on evidence
          Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          con-2: evidence SHALL have code or details (code.exists() or detail.exists())
          34. Condition.evidence.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())
          36. Condition.evidence.detail
          Definition

          Links to other relevant information, including pathology reports.

          ShortCondition.evidence allows asserting an encoded term code OR pointing to a profile where more detail is available. The use of referring to detail through referred profiles is encouraged.Supporting information found elsewhere
          Control0..*
          This element is affected by the following invariants: con-2
          TypeReference(Resource)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Labellabel on detail
          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 Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • profile @ resolve()
          • Guidance on how to interpret the contents of this table can be found here

            0. Condition
            Definition

            -

            ShortDetailed information about conditions, problems or diagnoses
            Comments

            -

            Control0..*
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
            con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
            con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
            dom-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())
            2. Condition.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. Condition.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. Condition.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. Condition.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. Condition.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. Condition.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. Condition.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            LabelLabel
            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())
            SlicingThis element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 16. Condition.extension:assertedDate
              Slice NameassertedDate
              Definition

              The date on which the existence of the Condition was first asserted or acknowledged.

              Short(USCDI) Date the condition was first asserted
              Comments

              The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Condition Asserted Date) (Extension Type: dateTime)
              Is Modifierfalse
              Must Supporttrue
              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. Condition.extension:Condition-dueTo
              Slice NameCondition-dueTo
              Definition

              Further conditions, problems, diagnoses, procedures or events or the substance that caused/triggered this Condition.

              ShortCauses for this Condition
              Comments

              Although a condition may be caused by a substance, this is not intended to be used to record allergies/adverse reactions to substances.

              Control0..*
              TypeExtension(Condition Due To) (Extension Type: Choice of: CodeableConcept, Reference(Condition, Procedure, MedicationAdministration, Immunization, MedicationStatement))
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              20. Condition.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())
              22. Condition.identifier
              Definition

              Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

              ShortExternal Ids for this condition
              Comments

              This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

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

              Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. Condition.clinicalStatus
              Definition

              The clinical status of the condition.

              Short(USCDI) active | recurrence | relapse | inactive | remission | resolved
              Comments

              The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

              Control0..1
              This element is affected by the following invariants: con-3, con-4, con-5
              BindingThe codes SHALL be taken from ConditionClinicalStatusCodes
              (required to http://hl7.org/fhir/ValueSet/condition-clinical)
              TypeCodeableConcept
              Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Condition.verificationStatus
              Definition

              The verification status to support the clinical status of the condition.

              Short(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
              Comments

              verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

              Control0..1
              This element is affected by the following invariants: con-3, con-5
              BindingThe codes SHALL be taken from ConditionVerificationStatus
              (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
              TypeCodeableConcept
              Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
              Must Supporttrue
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. Condition.category
              Definition

              A category assigned to the condition.

              ShortWithin the industry, Health Concerns may reside on the problem list along with Problems
              Comments

              The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

              Control1..*
              BindingUnless not suitable, these codes SHALL be taken from ConditionCategoryCodes
              (extensible to http://hl7.org/fhir/ValueSet/condition-category)

              A category assigned to the condition.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • pattern @ $this
              • 30. Condition.category:us-core
                Slice Nameus-core
                Definition

                A category assigned to the condition.

                Short(USCDI) problem-list-item | health-concern
                Comments

                The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

                Control1..*
                BindingThe codes SHALL be taken from US Core Problem or Health Concern
                (required to http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern)

                Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                32. Condition.category:screening-assessment
                Slice Namescreening-assessment
                Definition

                Categories that a provider may use in their workflow to classify that this Condition is related to a USCDI Health Status/Assessments Data Class.

                Short(USCDI) USCDI Health Status/Assessments Data Class
                Comments

                The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

                Control0..*
                BindingThe codes SHALL be taken from US Core Screening Assessment Condition Category
                (required to http://hl7.org/fhir/us/core/ValueSet/us-core-screening-assessment-condition-category)

                Note that other codes are permitted, see Required Bindings When Slicing by Value Sets

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Used for filtering condition

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

                A subjective assessment of the severity of the condition as evaluated by the clinician.

                ShortSubjective severity of condition
                Comments

                Coding of the severity with a terminology is preferred, where possible.

                Control0..1
                BindingThe codes SHOULD be taken from Condition/DiagnosisSeverity
                (preferred to http://hl7.org/fhir/ValueSet/condition-severity)

                A subjective assessment of the severity of the condition as evaluated by the clinician.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. Condition.code
                Definition

                Identification of the condition, problem or diagnosis.

                ShortPlease see the MCC Chronic Condition and Health Concern Value Sets Library for value sets that are subsets of US Core Condition Code that can be used at Conditon.code element
                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from US Core Condition Codes
                (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)

                Valueset to describe the actual problem experienced by the patient

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                0..1 to account for primarily narrative only resources.

                LabelLabel
                Alternate Namestype
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. Condition.bodySite
                Definition

                The anatomical location where this condition manifests itself.

                ShortAnatomical location, if relevant
                Comments

                Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                Control0..*
                BindingFor example codes, see SNOMEDCTBodyStructures
                (example to http://hl7.org/fhir/ValueSet/body-site)

                Codes describing anatomical locations. May include laterality.

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

                Indicates the patient or group who the condition record is associated with.

                Short(USCDI) Who has the condition?
                Control1..1
                TypeReference(US Core Patient Profile)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Group is typically used for veterinary or public health use cases.

                Alternate Namespatient
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. Condition.encounter
                Definition

                The Encounter during which this Condition was created or to which the creation of this record is tightly associated.

                ShortEncounter created as part of
                Comments

                This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

                Control0..1
                TypeReference(Encounter)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. Condition.onset[x]
                Definition

                Estimated or actual date or date-time the condition began, in the opinion of the clinician.

                Short(USCDI) Estimated or actual date, date-time, or age
                Comments

                Age is generally used when the patient reports an age at which the Condition began to occur.

                Control0..1
                TypeChoice of: dateTime, Age, Period, Range, string
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Must Support TypesdateTime
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. Condition.abatement[x]
                Definition

                The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

                Short(USCDI) When in resolution/remission
                Comments

                There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

                Control0..1
                This element is affected by the following invariants: con-4
                TypeChoice of: dateTime, Age, Period, Range, string
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Must Support TypesdateTime
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. Condition.recordedDate
                Definition

                The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

                Short(USCDI) Date record was first recorded
                Control0..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. Condition.recorder
                Definition

                Individual who recorded the record and takes responsibility for its content.

                ShortWho recorded the condition
                Control0..1
                TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. Condition.asserter
                Definition

                Individual who is making the condition statement.

                ShortPerson who asserts this condition
                Control0..1
                TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. Condition.stage
                Definition

                Clinical stage or grade of a condition. May include formal severity assessments.

                ShortStage/grade, usually assessed formally
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. Condition.stage.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
                58. Condition.stage.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())
                60. Condition.stage.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())
                62. Condition.stage.summary
                Definition

                A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

                ShortSimple summary (disease specific)
                Control0..1
                This element is affected by the following invariants: con-1
                BindingFor example codes, see ConditionStage
                (example to http://hl7.org/fhir/ValueSet/condition-stage)

                Codes describing condition stages (e.g. Cancer stages).

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. Condition.stage.assessment
                Definition

                Reference to a formal record of the evidence on which the staging assessment is based.

                ShortFormal record of assessment
                Control0..*
                This element is affected by the following invariants: con-1
                TypeReference(ClinicalImpression, DiagnosticReport, Observation)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                66. Condition.stage.type
                Definition

                The kind of staging, such as pathological or clinical staging.

                ShortKind of staging
                Control0..1
                BindingFor example codes, see ConditionStageType
                (example to http://hl7.org/fhir/ValueSet/condition-stage-type)

                Codes describing the kind of condition staging (e.g. clinical or pathological).

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. Condition.evidence
                Definition

                Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

                ShortSupporting evidence for the presence of a chronic condition should be provided whenever possible.
                Comments

                The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Labellabel on evidence
                Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. Condition.evidence.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
                72. Condition.evidence.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())
                74. Condition.evidence.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())
                76. Condition.evidence.code
                Definition

                A manifestation or symptom that led to the recording of this condition.

                ShortManifestation/symptom
                Control0..*
                This element is affected by the following invariants: con-2
                BindingFor example codes, see ManifestationAndSymptomCodes
                (example to http://hl7.org/fhir/ValueSet/manifestation-or-symptom)

                Codes that describe the manifestation or symptoms of a condition.

                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                78. Condition.evidence.detail
                Definition

                Links to other relevant information, including pathology reports.

                ShortCondition.evidence allows asserting an encoded term code OR pointing to a profile where more detail is available. The use of referring to detail through referred profiles is encouraged.
                Control0..*
                This element is affected by the following invariants: con-2
                TypeReference(Resource)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Labellabel on detail
                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 Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • profile @ resolve()
                • 80. Condition.note
                  Definition

                  Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

                  ShortAdditional information about the Condition
                  Control0..*
                  TypeAnnotation
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))