A summary sentence describing the communication, as currently appears in report narratives.

This is often absent unless there was a specific request for the communication that can be referenced. See communication.reason for communications triggered by specific impression findings.

The current diagnostic report, which provides the context of the communication

Should be COMPLETED in many cases. When documenting attempted communications, the status might have another value.

Communication resources where the .status is not COMPLETED may trigger subsequent follow-up workflows, but the management of such follow-up is not reflected in the diagnostic report.

In some reporting workflows, such communications may be included in an Addendum to the report (e.g. when the report is distributed prior to the communication being successfully completed).

For imaging, the value will typically be PHONE, or in the case of leaving a voicemail message, DICTATE.

May contain the code for "summary-report". Sites may wish to use a code for critical findings.

May reference any or all of the specific impression Conditions or recommendation ServiceRequests discussed during the communication if such information is made available to the encoding system.

Should either reference the encounter for the imaging procedure, or be absent.

For phone communications, this value will typically be the same time as Communication.sent. In the case of leaving a message, this will likely be be absent since it won't be known and the resource is not expected to be updated.

For imaging, the value should be the patient or the referring clinician in most cases, but may be their staff.

For imaging, the value should be the imaging clinician in most cases but may be their staff.

May reference one or more of the specific impression Conditions or recommendation ServiceRequests that prompted the communication.

A clinical or business level record of information being transmitted or shared; e.g. an alert that was sent to a responsible provider, a public health agency communication to a provider/reporter in response to a case report for a reportable condition.

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.

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 its narrative along with other profiles, value sets, etc.

A summary sentence describing the communication, as currently appears in report narratives.

Contained resources do not have a 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.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

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 managable, 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).

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.

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.

An order, proposal or plan fulfilled in whole or in part by this Communication.

This is often absent unless there was a specific request for the communication that can be referenced. See communication.reason for communications triggered by specific impression findings.

A larger event (e.g. Communication, Procedure) of which this particular communication is a component or step.

The current diagnostic report, which provides the context of the communication

The status of the transmission.

Should be COMPLETED in many cases. When documenting attempted communications, the status might have another value.

Communication resources where the .status is not COMPLETED may trigger subsequent follow-up workflows, but the management of such follow-up is not reflected in the diagnostic report.

In some reporting workflows, such communications may be included in an Addendum to the report (e.g. when the report is distributed prior to the communication being successfully completed).

The status of the communication.

A channel that was used for this communication (e.g. email, fax).

For imaging, the value will typically be PHONE, or in the case of leaving a voicemail message, DICTATE.

Codes for communication mediums such as phone, fax, email, in person, etc.

The patient or group that was the focus of this communication.

Description of the purpose/content, similar to a subject line in an email.

May contain the code for "summary-report". Sites may wish to use a code for critical findings.

Codes describing the purpose or content of the communication.

Other resources that pertain to this communication and to which this communication should be associated.

May reference any or all of the specific impression Conditions or recommendation ServiceRequests discussed during the communication if such information is made available to the encoding system.

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

Should either reference the encounter for the imaging procedure, or be absent.

The time when this communication was sent.

The time when this communication arrived at the destination.

For phone communications, this value will typically be the same time as Communication.sent. In the case of leaving a message, this will likely be be absent since it won't be known and the resource is not expected to be updated.

The entity (e.g. person, organization, clinical information system, care team or device) which is the target of the communication.

For imaging, the value should be the patient or the referring clinician in most cases, but may be their staff.

The entity (e.g. person, organization, clinical information system, or device) which is the source of the communication.

For imaging, the value should be the imaging clinician in most cases but may be their staff.

The reason or justification for the communication.

May reference one or more of the specific impression Conditions or recommendation ServiceRequests that prompted the communication.

Codes for describing reasons for the occurrence of a communication.

A clinical or business level record of information being transmitted or shared; e.g. an alert that was sent to a responsible provider, a public health agency communication to a provider/reporter in response to a case report for a reportable condition.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

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.

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.

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 its narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

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).

IETF language tag for a human language

A summary sentence describing the communication, as currently appears in report narratives.

Contained resources do not have a 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.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

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 managable, 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.

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.

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 managable, 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).

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.

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.

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

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

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

An order, proposal or plan fulfilled in whole or in part by this Communication.

This is often absent unless there was a specific request for the communication that can be referenced. See communication.reason for communications triggered by specific impression findings.

A larger event (e.g. Communication, Procedure) of which this particular communication is a component or step.

The current diagnostic report, which provides the context of the communication

Prior communication that this communication is in response to.

The status of the transmission.

Should be COMPLETED in many cases. When documenting attempted communications, the status might have another value.

Communication resources where the .status is not COMPLETED may trigger subsequent follow-up workflows, but the management of such follow-up is not reflected in the diagnostic report.

In some reporting workflows, such communications may be included in an Addendum to the report (e.g. when the report is distributed prior to the communication being successfully completed).

The status of the communication.

Captures the reason for the current state of the Communication.

This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

Codes for the reason why a communication did not happen.

The type of message conveyed such as alert, notification, reminder, instruction, etc.

There may be multiple axes of categorization and one communication may serve multiple purposes.

Codes for general categories of communications such as alerts, instructions, etc.

Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine.

Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress.

Codes indicating the relative importance of a communication.

A channel that was used for this communication (e.g. email, fax).

For imaging, the value will typically be PHONE, or in the case of leaving a voicemail message, DICTATE.

Codes for communication mediums such as phone, fax, email, in person, etc.

The patient or group that was the focus of this communication.

Description of the purpose/content, similar to a subject line in an email.

May contain the code for "summary-report". Sites may wish to use a code for critical findings.

Codes describing the purpose or content of the communication.

Other resources that pertain to this communication and to which this communication should be associated.

May reference any or all of the specific impression Conditions or recommendation ServiceRequests discussed during the communication if such information is made available to the encoding system.

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

Should either reference the encounter for the imaging procedure, or be absent.

The time when this communication was sent.

The time when this communication arrived at the destination.

For phone communications, this value will typically be the same time as Communication.sent. In the case of leaving a message, this will likely be be absent since it won't be known and the resource is not expected to be updated.

The entity (e.g. person, organization, clinical information system, care team or device) which is the target of the communication.

For imaging, the value should be the patient or the referring clinician in most cases, but may be their staff.

The entity (e.g. person, organization, clinical information system, or device) which is the source of the communication.

For imaging, the value should be the imaging clinician in most cases but may be their staff.

The reason or justification for the communication.

May reference one or more of the specific impression Conditions or recommendation ServiceRequests that prompted the communication.

Codes for describing reasons for the occurrence of a communication.

Text, attachment(s), or resource(s) that was communicated to the recipient.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

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 managable, 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.

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.

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 managable, 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).

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.

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.

A communicated content (or for multi-part communications, one portion of the communication).

The content can be codified or textual. As an example of codified content, when working with machine generated communications, the payload may be drawn from a finite, terminology defined set of communications, especially for short, status update kinds of communications where more of a natural language approach isn't appropriate.

If the content isn't codified, contentCodeableConcept.text can be used.

When using contentCodeableConcept, the CodeableConcept is what is being communicated and is not a categorization of the content.

Additional notes or commentary about the communication by the sender, receiver or other interested parties.