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: Folder - Detailed Descriptions

Active as of 2024-06-11

Definitions for the IHE.MHD.Minimal.Folder resource profile.

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

0. List
2. List.meta
4. List.meta.profile
6. List.extension:designationType
Slice NamedesignationType
Must Supporttrue
8. List.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
SlicingThis element introduces a set of slices on List.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ use
  • 10. List.identifier:uniqueId
    Slice NameuniqueId
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..1
    TypeIdentifier(uniqueId Identifier)
    12. List.identifier:entryUUID
    Slice NameentryUUID
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier(entryUUID Identifier)
    14. List.status
    16. List.mode
    Pattern Valueworking
    18. List.title
    20. List.code
    Pattern Value{
      "coding" : [{
        "system" : "https://profiles.ihe.net/ITI/MHD/CodeSystem/MHDlistTypes",
        "code" : "folder"
      }]
    }
    22. List.subject
    TypeReference(Patient)
    Must Supporttrue
    24. List.encounter
    Control0..0
    26. List.date
    28. List.source
    Control0..0
    30. List.orderedBy
    Control0..0
    32. List.note
    Control0..1
    34. List.entry
    36. List.entry.flag
    Control0..0
    38. List.entry.deleted
    Control0..0
    40. List.entry.date
    Control0..0
    42. List.entry.item
    TypeReference(DocumentReference)
    44. List.emptyReason
    Control0..0

    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: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
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. 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())
    8. 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()))
    SlicingThis element introduces a set of slices on List.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ use
    • 10. List.identifier:uniqueId
      Slice NameuniqueId
      Definition

      An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.


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

      ShortAn identifier intended for computationBusiness identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1*
      This element is affected by the following invariants: ele-1
      TypeIdentifier(uniqueId Identifier)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. List.identifier:entryUUID
      Slice NameentryUUID
      Definition

      An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.


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

      ShortAn identifier intended for computationBusiness identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeIdentifier(entryUUID Identifier)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. 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()))
      16. 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.

      Pattern Valueworking
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. 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()))
      20. 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.

      Pattern Value{
        "coding" : [{
          "system" : "https://profiles.ihe.net/ITI/MHD/CodeSystem/MHDlistTypes",
          "code" : "folder"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. 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
      Must Supporttrue
      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()))
      24. List.encounter
      Definition

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

      ShortContext in which list created
      Control0..01
      TypeReference(Encounter)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. 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()))
      28. 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..01
      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()))
      30. 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..01
      BindingThe codes SHOULD be taken from ListOrderCodeshttp://hl7.org/fhir/ValueSet/list-order
      (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()))
      32. List.note
      Definition

      Comments that apply to the overall list.

      ShortComments about the list
      Control0..1*
      TypeAnnotation
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. 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..01
      This element is affected by the following invariants: lst-1
      BindingThe codes SHOULD be taken from ListEmptyReasonshttp://hl7.org/fhir/ValueSet/list-empty-reason
      (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()))

      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.meta.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
      8. List.meta.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 List.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 10. List.meta.versionId
        Definition

        The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

        ShortVersion specific identifier
        Comments

        The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

        Control0..1
        Typeid
        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()))
        12. List.meta.lastUpdated
        Definition

        When the resource last changed - e.g. when the version changed.

        ShortWhen the resource version last changed
        Comments

        This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

        Control0..1
        Typeinstant
        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()))
        14. List.meta.source
        Definition

        A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

        ShortIdentifies where the resource comes from
        Comments

        In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

        This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

        Control0..1
        Typeuri
        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. List.meta.profile
        Definition

        A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

        ShortProfiles this resource claims to conform to
        Comments

        It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

        Control0..*
        Typecanonical(StructureDefinition)
        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()))
        18. List.meta.security
        Definition

        Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

        ShortSecurity Labels applied to this resource
        Comments

        The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
        (extensible to http://hl7.org/fhir/ValueSet/security-labels)

        Security Labels from the Healthcare Privacy and Security Classification System.

        TypeCoding
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. List.meta.tag
        Definition

        Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

        ShortTags applied to this resource
        Comments

        The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

        Control0..*
        BindingFor example codes, see CommonTags
        (example to http://hl7.org/fhir/ValueSet/common-tags)

        Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

        TypeCoding
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. 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()))
        24. 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()))
        26. 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()))
        28. 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
        30. 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
        • 32. 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
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          34. 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())
          36. 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()))
          SlicingThis element introduces a set of slices on List.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ use
          • 38. List.identifier:uniqueId
            Slice NameuniqueId
            Definition

            An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

            ShortAn identifier intended for computation
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeIdentifier(uniqueId Identifier)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            40. List.identifier:entryUUID
            Slice NameentryUUID
            Definition

            An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.

            ShortAn identifier intended for computation
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeIdentifier(entryUUID Identifier)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            42. 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()))
            44. 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.

            Pattern Valueworking
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. 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()))
            48. 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.

            Pattern Value{
              "coding" : [{
                "system" : "https://profiles.ihe.net/ITI/MHD/CodeSystem/MHDlistTypes",
                "code" : "folder"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. 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)
            Is Modifierfalse
            Must Supporttrue
            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()))
            52. List.encounter
            Definition

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

            ShortContext in which list created
            Control0..0
            TypeReference(Encounter)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. 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()))
            56. 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..0
            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()))
            58. 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..0
            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()))
            60. List.note
            Definition

            Comments that apply to the overall list.

            ShortComments about the list
            Control0..1
            TypeAnnotation
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. 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()))
            64. 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
            66. 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())
            68. 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())
            70. 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..0
            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()))
            72. 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..0
            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()))
            74. List.entry.date
            Definition

            When this item was added to the list.

            ShortWhen item added to list
            Control0..0
            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()))
            76. List.entry.item
            Definition

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

            ShortActual entry
            Control1..1
            TypeReference(DocumentReference)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            78. 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..0
            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()))