Mobile access to Health Documents (MHD)
4.2.3-current - ci-build International flag

Mobile access to Health Documents (MHD), published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 4.2.3-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.MHD/ and changes regularly. See the Directory of published versions

Resource Profile: MhdList - Detailed Descriptions

Active as of 2024-07-15

Definitions for the IHE.MHD.List resource profile.

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

0. List
2. List.extension
SlicingThis element introduces a set of slices on List.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. List.extension:designationType
    Slice NamedesignationType
    Control0..*
    TypeExtension(Clinical code of the List) (Extension Type: CodeableConcept)
    6. List.modifierExtension
    Control0..0
    8. List.code
    Control1..?
    BindingThe codes SHALL be taken from MHD List Types ValueSet
    (required to https://profiles.ihe.net/ITI/MHD/ValueSet/MHDlistTypesVS)

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

    0. List
    Definition

    A list is a curated collection of resources.

    ShortA list is a curated collection of resources
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesCollection, WorkingList, Organizer
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    lst-1: A list can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
    lst-2: The deleted flag can only be used if the mode of the list is "changes" (mode = 'changes' or entry.deleted.empty())
    lst-3: An entry date can only be used if the mode of the list is "working" (mode = 'working' or entry.date.empty())
    lst-1: A list can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
    lst-2: The deleted flag can only be used if the mode of the list is "changes" (mode = 'changes' or entry.deleted.empty())
    lst-3: An entry date can only be used if the mode of the list is "working" (mode = 'working' or entry.date.empty())
    2. List.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. List.extension
    Definition

    An Extension


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

    ShortExtensionAdditional content defined by implementations
    Comments

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

    Control0..*
    TypeExtension
    Is Modifierfalse
    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 List.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. List.extension:designationType
      Slice NamedesignationType
      Definition

      Expresses contentType of submissionSet or the codeList of a Folder. Usually expressed in LOINC or SNOMED.

      ShortClinical code of the List
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Clinical code of the List) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      8. List.modifierExtension
      Definition

      An Extension


      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).

      ShortExtensionExtensions 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..0*
      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())
      10. List.status
      Definition

      Indicates the current state of this list.

      Shortcurrent | retired | entered-in-error
      Comments

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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

      The current state of the list.

      Typecode
      Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      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()))
      12. List.mode
      Definition

      How this list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.

      Shortworking | snapshot | changes
      Comments

      This element is labeled as a modifier because a change list must not be misunderstood as a complete list.

      Control1..1
      BindingThe codes SHALL be taken from ListModehttp://hl7.org/fhir/ValueSet/list-mode|4.0.1
      (required to http://hl7.org/fhir/ValueSet/list-mode|4.0.1)

      The processing mode that applies to this list.

      Typecode
      Is Modifiertrue because If set to "changes", the list is considered incomplete, while the other two codes indicate the list is complete, which changes the understanding of the elements listed
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Lists are used in various ways, and it must be known in what way it is safe to use them.

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

      This code defines the purpose of the list - why it was created.

      ShortWhat the purpose of this list is
      Comments

      If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code.

      Control10..1
      BindingThe codes SHALL be taken from For example codes, see MHD List Types ValueSethttp://hl7.org/fhir/ValueSet/list-example-codes
      (required to https://profiles.ihe.net/ITI/MHD/ValueSet/MHDlistTypesVS)
      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Requirements

      Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included.

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

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

      0. List
      Definition

      A list is a curated collection of resources.

      ShortA list is a curated collection of resources
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesCollection, WorkingList, Organizer
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      lst-1: A list can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
      lst-2: The deleted flag can only be used if the mode of the list is "changes" (mode = 'changes' or entry.deleted.empty())
      lst-3: An entry date can only be used if the mode of the list is "working" (mode = 'working' or entry.date.empty())
      2. List.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. List.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. List.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. List.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. List.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. List.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. List.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 List.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. List.extension:designationType
        Slice NamedesignationType
        Definition

        Expresses contentType of submissionSet or the codeList of a Folder. Usually expressed in LOINC or SNOMED.

        ShortClinical code of the List
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Clinical code of the List) (Extension Type: CodeableConcept)
        Is Modifierfalse
        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. List.modifierExtension
        Definition

        An Extension

        ShortExtension
        Control0..0
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. List.identifier
        Definition

        Identifier for the List assigned for business purposes outside the context of FHIR.

        ShortBusiness identifier
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. List.status
        Definition

        Indicates the current state of this list.

        Shortcurrent | retired | entered-in-error
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

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

        The current state of the list.

        Typecode
        Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        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()))
        24. List.mode
        Definition

        How this list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.

        Shortworking | snapshot | changes
        Comments

        This element is labeled as a modifier because a change list must not be misunderstood as a complete list.

        Control1..1
        BindingThe codes SHALL be taken from ListMode
        (required to http://hl7.org/fhir/ValueSet/list-mode|4.0.1)

        The processing mode that applies to this list.

        Typecode
        Is Modifiertrue because If set to "changes", the list is considered incomplete, while the other two codes indicate the list is complete, which changes the understanding of the elements listed
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Lists are used in various ways, and it must be known in what way it is safe to use them.

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

        A label for the list assigned by the author.

        ShortDescriptive name for the list
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows customization beyond just the code identifying the kind of list.

        Example<br/><b>General</b>:Dr. Jane's Patients
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. List.code
        Definition

        This code defines the purpose of the list - why it was created.

        ShortWhat the purpose of this list is
        Comments

        If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code.

        Control1..1
        BindingThe codes SHALL be taken from MHD List Types ValueSet
        (required to https://profiles.ihe.net/ITI/MHD/ValueSet/MHDlistTypesVS)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included.

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

        The common subject (or patient) of the resources that are in the list if there is one.

        ShortIf all resources have the same subject
        Comments

        Some purely arbitrary lists do not have a common subject, so this is optional.

        Control0..1
        TypeReference(Patient, Group, Device, Location)
        Is Modifierfalse
        Summarytrue
        Requirements

        The primary purpose of listing the subject explicitly is to help with finding the right list.

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

        The encounter that is the context in which this list was created.

        ShortContext in which list created
        Control0..1
        TypeReference(Encounter)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. List.date
        Definition

        The date that the list was prepared.

        ShortWhen the list was prepared
        Comments

        The actual important date is the date of currency of the resources that were summarized, but it is usually assumed that these are current when the preparation occurs.

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

        Identifies how current the list is which affects relevance.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. List.source
        Definition

        The entity responsible for deciding what the contents of the list were. Where the list was created by a human, this is the same as the author of the list.

        ShortWho and/or what defined the list contents (aka Author)
        Comments

        The primary source is the entity that made the decisions what items are in the list. This may be software or user.

        Control0..1
        TypeReference(Practitioner, PractitionerRole, Patient, Device)
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows follow-up as well as context.

        Alternate NamesAuthor
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. List.orderedBy
        Definition

        What order applies to the items in the list.

        ShortWhat order the list has
        Comments

        Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

        Control0..1
        BindingThe codes SHOULD be taken from ListOrderCodes
        (preferred to http://hl7.org/fhir/ValueSet/list-order)

        What order applies to the items in a list.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. List.note
        Definition

        Comments that apply to the overall list.

        ShortComments about the list
        Control0..*
        TypeAnnotation
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. List.entry
        Definition

        Entries in this list.

        ShortEntries in the list
        Comments

        If there are no entries in the list, an emptyReason SHOULD be provided.

        Control0..*
        This element is affected by the following invariants: lst-1
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. List.entry.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
        46. List.entry.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())
        48. List.entry.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

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

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

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

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

        The flag allows the system constructing the list to indicate the role and significance of the item in the list.

        ShortStatus/Workflow information about this item
        Comments

        The flag can only be understood in the context of the List.code. If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Deleted can only be used if the List.mode is "changes".

        Control0..1
        BindingFor example codes, see PatientMedicineChangeTypes
        (example to http://hl7.org/fhir/ValueSet/list-item-flag)

        Codes that provide further information about the reason and meaning of the item in the list.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        This field is present to support various clinical uses of lists, such as a discharge summary medication list, where flags specify whether the medication was added, modified, or deleted from the list.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. List.entry.deleted
        Definition

        True if this item is marked as deleted in the list.

        ShortIf this item is actually marked as deleted
        Comments

        If the flag means that the entry has actually been deleted from the list, the deleted element SHALL be true. Both flag and deleted can only be used if the List.mode is "changes". A deleted entry should be displayed in narrative as deleted. This element is labeled as a modifier because it indicates that an item is (to be) no longer in the list.

        Control0..1
        This element is affected by the following invariants: lst-2
        Typeboolean
        Is Modifiertrue because If deleted is true, then the item included in the list isn't actually part of the list anymore
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        The flag element may contain codes that an application processing the list does not understand. However there can be no ambiguity if a list item is actually marked as "deleted".

        Meaning if MissingList items are generally only treated as deleted when this element explicitly carries a value of true. Systems SHOULD always populate this value when mode is 'changes'
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. List.entry.date
        Definition

        When this item was added to the list.

        ShortWhen item added to list
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        The date may be significant for understanding the meaning of items in a working list.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. List.entry.item
        Definition

        A reference to the actual resource from which data was derived.

        ShortActual entry
        Control1..1
        TypeReference(Resource)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. List.emptyReason
        Definition

        If the list is empty, why the list is empty.

        ShortWhy list is empty
        Comments

        The various reasons for an empty list make a significant interpretation to its interpretation. Note that this code is for use when the entire list has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

        Control0..1
        This element is affected by the following invariants: lst-1
        BindingThe codes SHOULD be taken from ListEmptyReasons
        (preferred to http://hl7.org/fhir/ValueSet/list-empty-reason)

        If a list is empty, why it is empty.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Allows capturing things like "none exist" or "not asked" which can be important for most lists.

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