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: SNOMEDCTChangeSetFHIR46709 - Detailed Descriptions

Page standards status: Draft Maturity Level: 0

Definitions for the snomed-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.

ShortProperty values should follow the SNOMED CT-specific guidance available here: https://terminology.hl7.org/SNOMEDCT.html#snomed-ct-propertiesAdditional information supplied about each concept
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 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
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 representing the concept
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
Definition

An Extension


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.

ShortExtensionAdditional content defined by implementations
Comments

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

Control20..*
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.concept.property.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 68. 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
    Control1..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())
    70. 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
    Control1..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())
    72. 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())
    74. 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())
    76. 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())
    78. 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()))
    80. 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()))
    82. 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
    ShortProperty values should follow the SNOMED CT-specific guidance available here: https://terminology.hl7.org/SNOMEDCT.html#snomed-ct-properties
    4. CodeSystem.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)
    6. CodeSystem.concept
    8. CodeSystem.concept.code
    10. CodeSystem.concept.designation
    12. CodeSystem.concept.designation.extension
    Control2..?
    14. CodeSystem.concept.designation.extension:caseSensitivity
    Slice NamecaseSensitivity
    Control1..?
    16. CodeSystem.concept.designation.extension:acceptability
    Slice Nameacceptability
    Control1..?
    18. CodeSystem.concept.property
    20. CodeSystem.concept.property.extension
    Control2..?
    22. CodeSystem.concept.property.extension:DefiningRelationshipType
    Slice NameDefiningRelationshipType
    Control1..?
    24. CodeSystem.concept.property.extension:elProfileSetOperator
    Slice NameelProfileSetOperator
    Control1..?
    26. 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

        ShortProperty values should follow the SNOMED CT-specific guidance available here: https://terminology.hl7.org/SNOMEDCT.html#snomed-ct-properties
        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 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
        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 representing the concept
          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
          Control2..*
          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
            Control1..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
            Control1..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
              Control2..*
              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
                Control1..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
                Control1..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()))