Terminology Change Set Exchange
1.0.0 - STU1 International flag

Terminology Change Set Exchange, published by HL7 International / Terminology Infrastructure. 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/termchangeset-ig/ and changes regularly. See the Directory of published versions

Resource Profile: LOINCChangeSetFHIR46709 - Detailed Descriptions

Page standards status: Draft Maturity Level: 0

Definitions for the loinc-changeset-profile--fhir46709 resource profile.

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

0. CodeSystem
Definition

The CodeSystem resource is used to declare the existence of and describe a code system or code system supplement and its key properties, and optionally define a part or all of its content.

ShortDeclares the existence of and describes a code system or code system supplement
Control10..1*
Is Modifierfalse
Summaryfalse
Invariantscsd-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
csd-1: Within a code system definition, all the codes SHALL be unique (concept.code.combine($this.descendants().concept.code).isDistinct())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
csd-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
csd-1: Within a code system definition, all the codes SHALL be unique (concept.code.combine($this.descendants().concept.code).isDistinct())
2. CodeSystem.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. CodeSystem.extension:ExtendsCodeSystem
Slice NameExtendsCodeSystem
Definition

Extends CodeSystem contains a reference to a source terminology, for which a CodeSystem resource is intended to contain additional Concepts

ShortExtends CodeSystem
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Extends CodeSystem) (Extension Type: Reference(CodeSystem))
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())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. CodeSystem.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.


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())
8. CodeSystem.url
Definition

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


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

ShortCanonical identifier for this code system, represented as a URI (globally unique) (Coding.system). NOTE: Where not specified by an SDO-specific policy (such as SNOMED’s extension process), change sets associated with locally-maintained extensions should include a url clearly identifying the extension as published under the implementer’s authority, and not the SDO.
Comments

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

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.


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

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

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

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

A formal identifier that is used to identify this code system when it is represented in other formats, or referenced in a specification, model, design or an instance.

ShortAdditional identifier for the code system (business identifier)
Comments

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this code system outside of FHIR, where it is not possible to use the logical URI. Note that HL7 defines at least three identifiers for many of its code systems - the FHIR canonical URL, the OID and the V2 Table 0396 mnemonic code.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..1*
TypeIdentifier
Is Modifierfalse
Summarytrue
Requirements

Allows externally provided and/or usable business identifiers to be easily associated with the module.

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

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control0..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
(required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. CodeSystem.version
Definition

The identifier that is used to identify this version of the code system when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the code system author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. This is used in Coding.version.


The identifier that is used to identify this version of the code system when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the code system author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. This is used in Coding.version.

ShortBusiness version of the code system (Coding.version). NOTE: where not specified by an SDO-specific policy, it is recommended that implementers consider aligning to HL7 terminology versioning approach.
Comments

There may be different code system instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the code system with the format [url]|[version].

NoteThis is a business version Id, not a resource version Id (see discussion)
Control10..1
Typestring
Is Modifierfalse
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()))
16. CodeSystem.name
Definition

A natural language name identifying the code system. This name should be usable as an identifier for the module by machine processing applications such as code generation.

ShortName for this code system (computer friendly). Should clearly identify the CodeSystem as a Change Set and ideally convey both the source terminology from which it was derived and a notion of its contents.
Comments

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Control10..1
This element is affected by the following invariants: inv-0
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Support human navigation and code generation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. CodeSystem.title
Definition

A short, descriptive, user-friendly title for the code system.

ShortName for this code system (human friendly). Should clearly identify the CodeSystem as a Change Set and ideally convey both the source terminology from which it was derived and a notion of its contents.
Comments

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Control10..1
Typestring
Is Modifierfalse
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()))
20. CodeSystem.status
Definition

The date (and optionally time) when the code system resource was created or revised.

Shortdraft | active | retired | unknown
Comments

Allows filtering of code systems that are appropriate for use versus not.

Control1..1
BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

The lifecycle status of an artifact.

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
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()))
22. CodeSystem.experimental
Definition

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

ShortFor testing purposes, not real usage
Comments

Allows filtering of code systems that are appropriate for use versus not.

Control10..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Enables experimental content to be developed following the same lifecycle that would be used for a production-level code system.

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

The name of the organization or individual that published the code system.

ShortName of the publisher (organization or individual)
Comments

Usually an organization but may be an individual. The publisher (or steward) of the code system is the organization or individual primarily responsible for the maintenance and upkeep of the code system. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the code system. This item SHOULD be populated unless the information is available from context.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Helps establish the "authority/credibility" of the code system. May also allow for contact.

Alternate Namessteward
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. CodeSystem.description
Definition

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

ShortNatural language description of the code system. Should provide a robust inventory of the contents of the Change Set
Comments

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

Control10..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Alternate NamesScope, Purpose, scope
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. CodeSystem.copyright
Definition

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

ShortUse and/or publishing restrictions
Comments

... Sometimes, the copyright differs between the code system and the codes that are included. The copyright statement should clearly differentiate between these when required.

Control10..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Consumers must be able to determine any legal restrictions on the use of the code system and/or its content.

Alternate NamesLicense, Restrictions
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. CodeSystem.caseSensitive
Definition

If code comparison is case sensitive when codes within this system are compared to each other.

ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, caseSensitive should not be included.If code comparison is case sensitive
Comments

If this value is missing, then it is not specified whether a code system is case sensitive or not. When the rule is not known, Postel's law should be followed: produce codes with the correct case, and accept codes in any case. This element is primarily provided to support validation software.

Control0..01
Typeboolean
Is Modifierfalse
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()))
32. CodeSystem.hierarchyMeaning
Definition

The meaning of the hierarchy of concepts as represented in this resource.

ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, hierarchyMeaning should not be included.grouped-by | is-a | part-of | classified-with
Comments

Note that other representations might have a different hierarchy or none at all, and represent the information using properties.

Control0..01
BindingThe codes SHALL be taken from CodeSystemHierarchyMeaninghttp://hl7.org/fhir/ValueSet/codesystem-hierarchy-meaning|4.0.1
(required to http://hl7.org/fhir/ValueSet/codesystem-hierarchy-meaning|4.0.1)

The meaning of the hierarchy of concepts in a code system.

Typecode
Is Modifierfalse
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()))
34. CodeSystem.compositional
Definition

The code system defines a compositional (post-coordination) grammar.

ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, compositional should not be included.If code system defines a compositional grammar
Comments

Note that the code system resource does not define what the compositional grammar is, only whether or not there is one.

Control0..01
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate Namesgrammar
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. CodeSystem.content
Definition

This codes system profile contains only those concepts included in an incremental Change Set for a terminology


The extent of the content of the code system (the concepts and codes it defines) are represented in this resource instance.

ShortChange Set CodeSystem resources are most appropriately described as a FRAGMENTnot-present | example | fragment | complete | supplement
Control1..1
BindingThe codes SHALL be taken from CodeSystemContentModehttp://hl7.org/fhir/ValueSet/codesystem-content-mode|4.0.1
(required to http://hl7.org/fhir/ValueSet/codesystem-content-mode|4.0.1)

The extent of the content of the code system (the concepts and codes it defines) are represented in a code system resource.

Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Fixed Valuefragment
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. CodeSystem.supplements
Definition

The canonical URL of the code system that this code system supplement is adding designations and properties to.

ShortThe source terminology from which the Change Set was derived should be conveyed via a Provenance resource, not CodeSystem.supplementsCanonical URL of Code System this adds designations and properties to
Comments

The most common use of a code system supplement is to add additional language support.

Control0..01
Typecanonical(CodeSystem)
Is Modifierfalse
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()))
40. CodeSystem.property
Definition

A property defines additional semantic detail for each concept included in the change set


A property defines an additional slot through which additional information can be provided about a concept.

ShortAdditional information supplied about each concept. Property values should follow the guidance available in the terminology-specific links in the 'Use with HL7 Standards' column within the [HL7 Terminology External Code Systems page](https://terminology.hl7.org/external_terminologies.html).
Comments

All properties referenced in the definitions of concepts within the change set must be defined first as a CodeSystem.property

Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. CodeSystem.property.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.


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())
44. CodeSystem.property.code
Definition

A code that is used to identify the property. The code is used internally (in CodeSystem.concept.property.code) and also externally, such as in property filters.

ShortIdentifies the property on the concepts, and when referred to in operations
Control1..1
BindingUnless not suitable, these codes SHALL be taken from For codes, see LOINC Property ValueSet
(extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/loinc-property-vs)
Typecode
Is Modifierfalse
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()))
46. CodeSystem.property.description
Definition

A description of the property- why it is defined, and how its value might be used.

ShortWhy the property is defined, and/or what it conveys
Control0..1
Typestring
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()))
48. CodeSystem.property.type
Definition

The type of the property value. Properties of type "code" contain a code defined by the code system (e.g. a reference to anotherr defined concept).


The type of the property value. Properties of type "code" contain a code defined by the code system (e.g. a reference to another defined concept).

Shortcode | Coding | string | integer | boolean | dateTimecode | Coding | string | integer | boolean | dateTime | decimal
Control1..1
BindingThe codes SHALL be taken from PropertyTypehttp://hl7.org/fhir/ValueSet/concept-property-type|4.0.1
(required to http://hl7.org/fhir/ValueSet/concept-property-type|4.0.1)

The type of a property value.

Typecode
Is Modifierfalse
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()))
50. CodeSystem.concept
Definition

Concepts that are in the code system. The concept definitions are inherently hierarchical, but the definitions must be consulted to determine what the meaning of the hierarchical relationships are.


Concepts that are in the code system. The concept definitions are inherently hierarchical, but the definitions must be consulted to determine what the meanings of the hierarchical relationships are.

ShortConcepts in the change set for the code systemConcepts in the code system
Comments

For a change set, concepts must be defined and included in the CodeSystem instance


If this is empty, it means that the code system resource does not represent the content of the code system.

Control10..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. CodeSystem.concept.extension:OWLExpression
Slice NameOWLExpression
Definition

OWL Expression representing the logical definition of a concept

ShortOWL Expression
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(OWL Expression) (Extension Type: string)
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())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
54. CodeSystem.concept.extension:changeType
Slice NamechangeType
Definition

Coded value indicating the nature of a change made to the parent element

ShortChange Type
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Change Type) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
56. CodeSystem.concept.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.


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. CodeSystem.concept.code
Definition

A code - a text symbol - that uniquely identifies the concept within the code system.

ShortCode that identifies concept
Control1..1
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()))
60. CodeSystem.concept.display
Definition

A human readable string that is the recommended default way to present this concept to a user.

ShortText to display to the user
Comments

This contains the LOINC Long Name.

Control10..1
Typestring
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()))
62. CodeSystem.concept.definition
Definition

The formal definition of the concept. The code system resource does not make formal definitions required, because of the prevalence of legacy systems. However, they are highly recommended, as without them there is no formal meaning associated with the concept.

ShortFormal definition
Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. CodeSystem.concept.property
Definition

A property value for this concept.

ShortProperty value for the concept
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. CodeSystem.concept.property.extension:DefiningRelationshipType
Slice NameDefiningRelationshipType
Definition

Indicator to distinguish between axioms explicitly stated vs. inferred by a reasoner or other logical processes

ShortDefining Relationship Type
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Defining Relationship Type) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
68. CodeSystem.concept.property.extension:elProfileSetOperator
Slice NameelProfileSetOperator
Definition

EL++ profile to describe the axiom as being part of the Necessary vs. Sufficient set for defining the concept

ShortEL Profile Set Operator
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(EL Profile Set Operator) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
70. CodeSystem.concept.property.extension:roleGroup
Slice NameroleGroup
Definition

Where multiple property groupings are assigned for a particular concept, this identifies the group to which this property belongs. See also SNOMED concept 609096000 Role group (attribute)

ShortSNOMED Role Group
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(SNOMED Role Group) (Extension Type: integer)
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())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
72. CodeSystem.concept.property.extension:changeType
Slice NamechangeType
Definition

Coded value indicating the nature of a change made to the parent element

ShortChange Type
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Change Type) (Extension Type: CodeableConcept)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
74. CodeSystem.concept.property.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.


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. CodeSystem.concept.property.code
Definition

A code that is a reference to CodeSystem.property.code.

ShortReference to CodeSystem.property.code
Control1..1
BindingUnless not suitable, these codes SHALL be taken from For codes, see SNOMED Property ValueSet
(extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/snomed-property-vs)
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()))
78. CodeSystem.concept.property.value[x]
Definition

The value of this property.

ShortValue of the property for this concept
Control1..1
TypeChoice of: code, Coding, string, integer, boolean, dateTime, decimal
[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
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. CodeSystem.concept.concept
Definition

Defines children of a concept to produce a hierarchy of concepts. The nature of the relationships is variable (is-a/contains/categorizes) - see hierarchyMeaning.

ShortChild Concepts (is-a/contains/categorizes)
Comments

For CodeSystem Change Sets, relationships to child concepts should be done through concept.property values, not concept.concept elements

Control0..0*
TypeSeettp://hl7.org/fhir/StructureDefinition/CodeSystem#CodeSystem.concept
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

0. CodeSystem
2. CodeSystem.property
4. CodeSystem.property.code
BindingUnless not suitable, these codes SHALL be taken from LOINC Property ValueSet
(extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/loinc-property-vs)
6. CodeSystem.concept
8. CodeSystem.concept.display
ShortText to display to the user
Comments

This contains the LOINC Long Name.

10. CodeSystem.concept.property
12. CodeSystem.concept.property.code
BindingUnless not suitable, these codes SHALL be taken from SNOMED Property ValueSet
(extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/snomed-property-vs)

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

0. CodeSystem
Definition

The CodeSystem resource is used to declare the existence of and describe a code system or code system supplement and its key properties, and optionally define a part or all of its content.

ShortDeclares the existence of and describes a code system or code system supplement
Control1..1
Is Modifierfalse
Summaryfalse
Invariantscsd-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
csd-1: Within a code system definition, all the codes SHALL be unique (concept.code.combine($this.descendants().concept.code).isDistinct())
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. CodeSystem.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. CodeSystem.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. CodeSystem.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. CodeSystem.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. CodeSystem.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. CodeSystem.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. CodeSystem.extension
Definition

An Extension

ShortExtension
Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on CodeSystem.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. CodeSystem.extension:ExtendsCodeSystem
    Slice NameExtendsCodeSystem
    Definition

    Extends CodeSystem contains a reference to a source terminology, for which a CodeSystem resource is intended to contain additional Concepts

    ShortExtends CodeSystem
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Extends CodeSystem) (Extension Type: Reference(CodeSystem))
    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())
    18. CodeSystem.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())
    20. CodeSystem.url
    Definition

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

    ShortCanonical identifier for this code system, represented as a URI (globally unique) (Coding.system). NOTE: Where not specified by an SDO-specific policy (such as SNOMED’s extension process), change sets associated with locally-maintained extensions should include a url clearly identifying the extension as published under the implementer’s authority, and not the SDO.
    Comments

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

    The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

    In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

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

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

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

    A formal identifier that is used to identify this code system when it is represented in other formats, or referenced in a specification, model, design or an instance.

    ShortAdditional identifier for the code system (business identifier)
    Comments

    Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this code system outside of FHIR, where it is not possible to use the logical URI. Note that HL7 defines at least three identifiers for many of its code systems - the FHIR canonical URL, the OID and the V2 Table 0396 mnemonic code.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..1
    TypeIdentifier
    Is Modifierfalse
    Summarytrue
    Requirements

    Allows externally provided and/or usable business identifiers to be easily associated with the module.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. CodeSystem.identifier.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
    26. CodeSystem.identifier.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())
    SlicingThis element introduces a set of slices on CodeSystem.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 28. CodeSystem.identifier.use
      Definition

      The purpose of this identifier.

      Shortusual | official | temp | secondary | old (If known)
      Comments

      Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

      Control0..1
      BindingThe codes SHALL be taken from IdentifierUse
      (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

      Identifies the purpose for this identifier, if known .

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

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

      A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

      ShortDescription of identifier
      Comments

      This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

      A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows users to make use of identifiers when the identifier system is not known.

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

      Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

      ShortThe namespace for the identifier value
      Comments

      Identifier.system is always case sensitive.

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

      There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

      ExampleGeneral: http://www.acme.com/identifiers/patient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. CodeSystem.identifier.value
      Definition

      The portion of the identifier typically relevant to the user and which is unique within the context of the system.

      ShortThe value that is unique
      Comments

      If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      ExampleGeneral: 123456
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. CodeSystem.identifier.period
      Definition

      Time period during which identifier is/was valid for use.

      ShortTime period when id is/was valid for use
      Control0..1
      TypePeriod
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. CodeSystem.identifier.assigner
      Definition

      Organization that issued/manages the identifier.

      ShortOrganization that issued id (may be just text)
      Comments

      The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

      Control0..1
      TypeReference(Organization)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. CodeSystem.version
      Definition

      The identifier that is used to identify this version of the code system when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the code system author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. This is used in Coding.version.

      ShortBusiness version of the code system (Coding.version). NOTE: where not specified by an SDO-specific policy, it is recommended that implementers consider aligning to HL7 terminology versioning approach.
      Comments

      There may be different code system instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the code system with the format [url]|[version].

      NoteThis is a business version Id, not a resource version Id (see discussion)
      Control1..1
      Typestring
      Is Modifierfalse
      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()))
      42. CodeSystem.name
      Definition

      A natural language name identifying the code system. This name should be usable as an identifier for the module by machine processing applications such as code generation.

      ShortName for this code system (computer friendly). Should clearly identify the CodeSystem as a Change Set and ideally convey both the source terminology from which it was derived and a notion of its contents.
      Comments

      The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

      Control1..1
      This element is affected by the following invariants: inv-0
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Support human navigation and code generation.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. CodeSystem.title
      Definition

      A short, descriptive, user-friendly title for the code system.

      ShortName for this code system (human friendly). Should clearly identify the CodeSystem as a Change Set and ideally convey both the source terminology from which it was derived and a notion of its contents.
      Comments

      This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

      Control1..1
      Typestring
      Is Modifierfalse
      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()))
      46. CodeSystem.status
      Definition

      The date (and optionally time) when the code system resource was created or revised.

      Shortdraft | active | retired | unknown
      Comments

      Allows filtering of code systems that are appropriate for use versus not.

      Control1..1
      BindingThe codes SHALL be taken from PublicationStatus
      (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

      The lifecycle status of an artifact.

      Typecode
      Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
      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()))
      48. CodeSystem.experimental
      Definition

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

      ShortFor testing purposes, not real usage
      Comments

      Allows filtering of code systems that are appropriate for use versus not.

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

      Enables experimental content to be developed following the same lifecycle that would be used for a production-level code system.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. CodeSystem.date
      Definition

      The date (and optionally time) when the code system was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the code system changes.

      ShortDate last changed
      Comments

      Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the code system. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Alternate NamesRevision Date
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. CodeSystem.publisher
      Definition

      The name of the organization or individual that published the code system.

      ShortName of the publisher (organization or individual)
      Comments

      Usually an organization but may be an individual. The publisher (or steward) of the code system is the organization or individual primarily responsible for the maintenance and upkeep of the code system. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the code system. This item SHOULD be populated unless the information is available from context.

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

      Helps establish the "authority/credibility" of the code system. May also allow for contact.

      Alternate Namessteward
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. CodeSystem.contact
      Definition

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

      ShortContact details for the publisher
      Comments

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

      Control0..*
      TypeContactDetail
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. CodeSystem.description
      Definition

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

      ShortNatural language description of the code system. Should provide a robust inventory of the contents of the Change Set
      Comments

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

      Control1..1
      Typemarkdown
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Alternate NamesScope, Purpose, scope
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. CodeSystem.useContext
      Definition

      The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate code system instances.

      ShortThe context that the content is intended to support
      Comments

      When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

      Control0..*
      TypeUsageContext
      Is Modifierfalse
      Summarytrue
      Requirements

      Assist in searching for appropriate content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. CodeSystem.jurisdiction
      Definition

      A legal or geographic region in which the code system is intended to be used.

      ShortIntended jurisdiction for code system (if applicable)
      Comments

      It may be possible for the code system to be used in jurisdictions other than those for which it was originally designed or intended.

      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSet
      (extensible to http://hl7.org/fhir/ValueSet/jurisdiction)

      Countries and regions within which this artifact is targeted for use.

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

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

      ShortWhy this code system is defined
      Comments

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

      Control0..1
      Typemarkdown
      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()))
      64. CodeSystem.copyright
      Definition

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

      ShortUse and/or publishing restrictions
      Comments

      ... Sometimes, the copyright differs between the code system and the codes that are included. The copyright statement should clearly differentiate between these when required.

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

      Consumers must be able to determine any legal restrictions on the use of the code system and/or its content.

      Alternate NamesLicense, Restrictions
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. CodeSystem.caseSensitive
      Definition

      If code comparison is case sensitive when codes within this system are compared to each other.

      ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, caseSensitive should not be included.
      Comments

      If this value is missing, then it is not specified whether a code system is case sensitive or not. When the rule is not known, Postel's law should be followed: produce codes with the correct case, and accept codes in any case. This element is primarily provided to support validation software.

      Control0..0
      Typeboolean
      Is Modifierfalse
      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()))
      68. CodeSystem.valueSet
      Definition

      Canonical reference to the value set that contains the entire code system.

      ShortCanonical reference to the value set with entire code system
      Comments

      The definition of the value set SHALL include all codes from this code system and only codes from this code system, and it SHALL be immutable.

      Control0..1
      Typecanonical(ValueSet)
      Is Modifierfalse
      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()))
      70. CodeSystem.hierarchyMeaning
      Definition

      The meaning of the hierarchy of concepts as represented in this resource.

      ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, hierarchyMeaning should not be included.
      Comments

      Note that other representations might have a different hierarchy or none at all, and represent the information using properties.

      Control0..0
      BindingThe codes SHALL be taken from CodeSystemHierarchyMeaning
      (required to http://hl7.org/fhir/ValueSet/codesystem-hierarchy-meaning|4.0.1)

      The meaning of the hierarchy of concepts in a code system.

      Typecode
      Is Modifierfalse
      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()))
      72. CodeSystem.compositional
      Definition

      The code system defines a compositional (post-coordination) grammar.

      ShortNOTE: As a CodeSystem Change Set should not be fundamentally altering the design and operation of the terminology as a whole therefore, compositional should not be included.
      Comments

      Note that the code system resource does not define what the compositional grammar is, only whether or not there is one.

      Control0..0
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Alternate Namesgrammar
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      74. CodeSystem.versionNeeded
      Definition

      This flag is used to signify that the code system does not commit to concept permanence across versions. If true, a version must be specified when referencing this code system.

      ShortIf definitions are not stable
      Comments

      Best practice is that code systems do not redefine concepts, or that if concepts are redefined, a new code system definition is created. But this is not always possible, so some code systems may be defined as 'versionNeeded'.

      Most code systems occasionally refine the displays defined for concepts between versions. Contexts in which the concept display values are validated may require that the version be specified for some code systems irrespective of the value of this property.

      Control0..1
      Typeboolean
      Is Modifierfalse
      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()))
      76. CodeSystem.content
      Definition

      This codes system profile contains only those concepts included in an incremental Change Set for a terminology

      ShortChange Set CodeSystem resources are most appropriately described as a FRAGMENT
      Control1..1
      BindingThe codes SHALL be taken from CodeSystemContentMode
      (required to http://hl7.org/fhir/ValueSet/codesystem-content-mode|4.0.1)

      The extent of the content of the code system (the concepts and codes it defines) are represented in a code system resource.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Fixed Valuefragment
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. CodeSystem.supplements
      Definition

      The canonical URL of the code system that this code system supplement is adding designations and properties to.

      ShortThe source terminology from which the Change Set was derived should be conveyed via a Provenance resource, not CodeSystem.supplements
      Comments

      The most common use of a code system supplement is to add additional language support.

      Control0..0
      Typecanonical(CodeSystem)
      Is Modifierfalse
      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()))
      80. CodeSystem.count
      Definition

      The total number of concepts defined by the code system. Where the code system has a compositional grammar, the basis of this count is defined by the system steward.

      ShortTotal concepts in the code system
      Comments

      The count of concepts defined in this resource cannot be more than this value but may be less for several reasons - see the content element.

      Control0..1
      TypeunsignedInt
      Is Modifierfalse
      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()))
      82. CodeSystem.filter
      Definition

      A filter that can be used in a value set compose statement when selecting concepts using a filter.

      ShortFilter that can be used in a value set
      Comments

      Note that filters defined in code systems usually require custom code on the part of any terminology engine that will make them available for use in value set filters. For this reason, they are generally only seen in high value published terminologies.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      84. CodeSystem.filter.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. CodeSystem.filter.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. CodeSystem.filter.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. CodeSystem.filter.code
      Definition

      The code that identifies this filter when it is used as a filter in ValueSet.compose.include.filter.

      ShortCode that identifies the filter
      Control1..1
      Typecode
      Is Modifierfalse
      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()))
      92. CodeSystem.filter.description
      Definition

      A description of how or why the filter is used.

      ShortHow or why the filter is used
      Control0..1
      Typestring
      Is Modifierfalse
      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()))
      94. CodeSystem.filter.operator
      Definition

      A list of operators that can be used with the filter.

      Short= | is-a | descendent-of | is-not-a | regex | in | not-in | generalizes | exists
      Control1..*
      BindingThe codes SHALL be taken from FilterOperator
      (required to http://hl7.org/fhir/ValueSet/filter-operator|4.0.1)

      The kind of operation to perform as a part of a property based filter.

      Typecode
      Is Modifierfalse
      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()))
      96. CodeSystem.filter.value
      Definition

      A description of what the value for the filter should be.

      ShortWhat to use for the value
      Control1..1
      Typestring
      Is Modifierfalse
      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()))
      98. CodeSystem.property
      Definition

      A property defines additional semantic detail for each concept included in the change set

      ShortAdditional information supplied about each concept. Property values should follow the guidance available in the terminology-specific links in the 'Use with HL7 Standards' column within the [HL7 Terminology External Code Systems page](https://terminology.hl7.org/external_terminologies.html).
      Comments

      All properties referenced in the definitions of concepts within the change set must be defined first as a CodeSystem.property

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      100. CodeSystem.property.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
      102. CodeSystem.property.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())
      104. CodeSystem.property.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())
      106. CodeSystem.property.code
      Definition

      A code that is used to identify the property. The code is used internally (in CodeSystem.concept.property.code) and also externally, such as in property filters.

      ShortIdentifies the property on the concepts, and when referred to in operations
      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from LOINC Property ValueSet
      (extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/loinc-property-vs)
      Typecode
      Is Modifierfalse
      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()))
      108. CodeSystem.property.uri
      Definition

      Reference to the formal meaning of the property. One possible source of meaning is the Concept Properties code system.

      ShortFormal identifier for the property
      Control0..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      110. CodeSystem.property.description
      Definition

      A description of the property- why it is defined, and how its value might be used.

      ShortWhy the property is defined, and/or what it conveys
      Control0..1
      Typestring
      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()))
      112. CodeSystem.property.type
      Definition

      The type of the property value. Properties of type "code" contain a code defined by the code system (e.g. a reference to anotherr defined concept).

      Shortcode | Coding | string | integer | boolean | dateTime
      Control1..1
      BindingThe codes SHALL be taken from PropertyType
      (required to http://hl7.org/fhir/ValueSet/concept-property-type|4.0.1)

      The type of a property value.

      Typecode
      Is Modifierfalse
      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()))
      114. CodeSystem.concept
      Definition

      Concepts that are in the code system. The concept definitions are inherently hierarchical, but the definitions must be consulted to determine what the meaning of the hierarchical relationships are.

      ShortConcepts in the change set for the code system
      Comments

      For a change set, concepts must be defined and included in the CodeSystem instance

      Control1..*
      TypeBackboneElement
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      116. CodeSystem.concept.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 internal identifier maintained by the entity distributing the change set for the concept represented by the terminology-specific concept.code
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      118. CodeSystem.concept.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on CodeSystem.concept.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 120. CodeSystem.concept.extension:OWLExpression
        Slice NameOWLExpression
        Definition

        OWL Expression representing the logical definition of a concept

        ShortOWL Expression
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(OWL Expression) (Extension Type: string)
        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())
        122. CodeSystem.concept.extension:changeType
        Slice NamechangeType
        Definition

        Coded value indicating the nature of a change made to the parent element

        ShortChange Type
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Change Type) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        124. CodeSystem.concept.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())
        126. CodeSystem.concept.code
        Definition

        A code - a text symbol - that uniquely identifies the concept within the code system.

        ShortCode that identifies concept
        Control1..1
        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()))
        128. CodeSystem.concept.display
        Definition

        A human readable string that is the recommended default way to present this concept to a user.

        ShortText to display to the user
        Comments

        This contains the LOINC Long Name.

        Control1..1
        Typestring
        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()))
        130. CodeSystem.concept.definition
        Definition

        The formal definition of the concept. The code system resource does not make formal definitions required, because of the prevalence of legacy systems. However, they are highly recommended, as without them there is no formal meaning associated with the concept.

        ShortFormal definition
        Control1..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        132. CodeSystem.concept.designation
        Definition

        Additional representations for the concept - other languages, aliases, specialized purposes, used for particular purposes, etc.

        ShortAdditional representations for the concept
        Comments

        Concepts have both a display and an array of designation. The display is equivalent to a special designation with an implied designation.use of "primary code" and a language equal to the Resource Language.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Requirements

        Many concept definition systems support multiple representations, in multiple languages, and for multiple purposes.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        134. CodeSystem.concept.designation.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
        136. CodeSystem.concept.designation.extension
        Definition

        An Extension

        ShortExtension
        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on CodeSystem.concept.designation.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 138. CodeSystem.concept.designation.extension:caseSensitivity
          Slice NamecaseSensitivity
          Definition

          Coded value to identify what case sensitivity is reflected in the designation

          ShortDesignation Case Sensitivity
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Designation Case Sensitivity) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          140. CodeSystem.concept.designation.extension:acceptability
          Slice Nameacceptability
          Definition

          Coded value to convey the acceptability of a designation in the language or dialect specified by that Reference Set . Values include 'preferred' and 'acceptable'.

          ShortDesignation Acceptability
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Designation Acceptability) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          142. CodeSystem.concept.designation.extension:dialect
          Slice Namedialect
          Definition

          Subcategorization of language

          ShortDesignation Dialect
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Designation Dialect) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          144. CodeSystem.concept.designation.extension:changeType
          Slice NamechangeType
          Definition

          Coded value indicating the nature of a change made to the parent element

          ShortChange Type
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Change Type) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          146. CodeSystem.concept.designation.modifierExtension
          Definition

          An Extension

          ShortExtension
          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          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 CodeSystem.concept.designation.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 148. CodeSystem.concept.designation.modifierExtension:designationStatus
            Slice NamedesignationStatus
            Definition

            Complex extension to convey the status of a designation (active vs. inactive) and a timestamp for that status.

            ShortDesignation Status
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Designation Status) (Complex Extension)
            Is Modifiertrue because A designation that is not active should not be used by implementers in most cases
            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())
            150. CodeSystem.concept.designation.language
            Definition

            The language this designation is defined for.

            ShortHuman language of the designation
            Comments

            In the absence of a language, the resource language applies.

            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
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            152. CodeSystem.concept.designation.use
            Definition

            A code that details how this designation would be used.

            ShortDetails how this designation would be used
            Comments

            If no use is provided, the designation can be assumed to be suitable for general display to a human user.

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from DesignationUse
            (extensible to http://hl7.org/fhir/ValueSet/designation-use)

            Details of how a designation would be used.

            TypeCoding
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            154. CodeSystem.concept.designation.value
            Definition

            The text value for this designation.

            ShortThe text value for this designation
            Control1..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            156. CodeSystem.concept.property
            Definition

            A property value for this concept.

            ShortProperty value for the concept
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            158. CodeSystem.concept.property.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
            160. CodeSystem.concept.property.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on CodeSystem.concept.property.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 162. CodeSystem.concept.property.extension:DefiningRelationshipType
              Slice NameDefiningRelationshipType
              Definition

              Indicator to distinguish between axioms explicitly stated vs. inferred by a reasoner or other logical processes

              ShortDefining Relationship Type
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Defining Relationship Type) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              164. CodeSystem.concept.property.extension:elProfileSetOperator
              Slice NameelProfileSetOperator
              Definition

              EL++ profile to describe the axiom as being part of the Necessary vs. Sufficient set for defining the concept

              ShortEL Profile Set Operator
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(EL Profile Set Operator) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              166. CodeSystem.concept.property.extension:roleGroup
              Slice NameroleGroup
              Definition

              Where multiple property groupings are assigned for a particular concept, this identifies the group to which this property belongs. See also SNOMED concept 609096000 Role group (attribute)

              ShortSNOMED Role Group
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(SNOMED Role Group) (Extension Type: integer)
              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())
              168. CodeSystem.concept.property.extension:changeType
              Slice NamechangeType
              Definition

              Coded value indicating the nature of a change made to the parent element

              ShortChange Type
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Change Type) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              170. CodeSystem.concept.property.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())
              172. CodeSystem.concept.property.code
              Definition

              A code that is a reference to CodeSystem.property.code.

              ShortReference to CodeSystem.property.code
              Control1..1
              BindingUnless not suitable, these codes SHALL be taken from SNOMED Property ValueSet
              (extensible to http://hl7.org/fhir/uv/termchangeset/ValueSet/snomed-property-vs)
              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()))
              174. CodeSystem.concept.property.value[x]
              Definition

              The value of this property.

              ShortValue of the property for this concept
              Control1..1
              TypeChoice of: code, Coding, string, integer, boolean, dateTime, decimal
              [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
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              176. CodeSystem.concept.concept
              Definition

              Defines children of a concept to produce a hierarchy of concepts. The nature of the relationships is variable (is-a/contains/categorizes) - see hierarchyMeaning.

              ShortChild Concepts (is-a/contains/categorizes)
              Comments

              For CodeSystem Change Sets, relationships to child concepts should be done through concept.property values, not concept.concept elements

              Control0..0
              TypeSeettp://hl7.org/fhir/StructureDefinition/CodeSystem#CodeSystem.concept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))