A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

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 it's narrative along with other profiles, value sets, etc.

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).

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 condition 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 condition as it is known by various participating systems and in a way that remains consistent across servers.

Typically 'active' for the chief-complaint/working/differential/discharge stages — 'resolved'/'inactive' are rare in an acute encounter but keep the element populated for consistency with facility-side Condition records that will later track resolution. For category=past-medical-history, 'active' or 'inactive' both apply depending on the checklist item (e.g. an active chronic condition versus a past surgical history).

The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

Expected progression: chief-complaint typically 'unconfirmed' (it is not yet a diagnosis); past-medical-history is commonly patient-reported and therefore often 'unconfirmed'; working-diagnosis typically 'provisional' or 'differential'; discharge-diagnosis typically 'confirmed'. Never submit a claim against a 'provisional' or 'differential' instance as if it were 'confirmed' — see invariant em-condition-1.

verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

The single most important element on this profile — claims-mapping logic must read this before deciding which diagnosis code to submit for adjudication. Also carry the base condition-category code (problem-list-item | encounter-diagnosis) as a second Coding within the same CodeableConcept if base-spec conformance is required alongside the local staging value.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

Not every stage carries a severity marker (rarely meaningful on a chief-complaint or a past-medical-history item), but when present this feeds billing tier / benefit classification, so the profile must be able to carry it.

Coding of the severity with a terminology is preferred, where possible.

For category=chief-complaint, code a symptom/complaint (see ManifestationVS) rather than forcing an ICD diagnosis code — a chief complaint is not yet a diagnosis. For category=past-medical-history, code the comorbidity itself (e.g. hypertension, diabetes, asthma, HIV, TB — matching the ED intake checklist). For working-diagnosis/discharge-diagnosis, use an ICD diagnosis code system consistent with the existing standards stack. Source systems have been observed sending ICD-11-pattern values here; confirm the authoritative code system with the vendor and terminology team before finalizing this binding.

0..1 to account for primarily narrative only resources.

Deliberately 0..* rather than 0..1 so trauma cases with multiple co-occurring diagnoses across different body sites are supported without forcing an artificial single 'primary site'.

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Indicates the patient or group who the condition record is associated with.

Group is typically used for veterinary or public health use cases.

The primary linkage a claims pipeline reads to associate a diagnosis with the correct billable encounter and its stage.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Age is generally used when the patient reports an age at which the Condition began to occur.

Granular timing matters for time-sensitive protocols (stroke/MI 'minutes matter'). Capture relative to the parent encounter's period.start where the exact onset time is unknown but time-since-arrival is clinically meaningful. For category=past-medical-history, this instead captures when the pre-existing condition itself began, if known.

Age is generally used when the patient reports an age at which the Condition began to occur.

The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

Distinct from onset. Lets the staging timeline be reconstructed (e.g. chief-complaint recorded at T0, working-diagnosis at T+12min, discharge diagnosis at T+90min) even when clinical onset itself is unclear or unknown.

Will differ by stage — e.g. a triage nurse for past-medical-history, an EMT for working-diagnosis, an ED physician for discharge-diagnosis.

For category=chief-complaint or past-medical-history this is often the patient or caller themselves, not a clinician — distinguishes 'patient said chest pain' (asserter=Patient) from 'EMT suspects ACS' (asserter=Practitioner).

Not typically populated at the EMS/point-of-care stage; expect this to populate later once the patient reaches facility-based workup.

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

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).

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.

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

Typically 'active' for the chief-complaint/working/differential/discharge stages — 'resolved'/'inactive' are rare in an acute encounter but keep the element populated for consistency with facility-side Condition records that will later track resolution. For category=past-medical-history, 'active' or 'inactive' both apply depending on the checklist item (e.g. an active chronic condition versus a past surgical history).

Expected progression: chief-complaint typically 'unconfirmed' (it is not yet a diagnosis); past-medical-history is commonly patient-reported and therefore often 'unconfirmed'; working-diagnosis typically 'provisional' or 'differential'; discharge-diagnosis typically 'confirmed'. Never submit a claim against a 'provisional' or 'differential' instance as if it were 'confirmed' — see invariant em-condition-1.

The single most important element on this profile — claims-mapping logic must read this before deciding which diagnosis code to submit for adjudication. Also carry the base condition-category code (problem-list-item | encounter-diagnosis) as a second Coding within the same CodeableConcept if base-spec conformance is required alongside the local staging value.

Not every stage carries a severity marker (rarely meaningful on a chief-complaint or a past-medical-history item), but when present this feeds billing tier / benefit classification, so the profile must be able to carry it.

For category=chief-complaint, code a symptom/complaint (see ManifestationVS) rather than forcing an ICD diagnosis code — a chief complaint is not yet a diagnosis. For category=past-medical-history, code the comorbidity itself (e.g. hypertension, diabetes, asthma, HIV, TB — matching the ED intake checklist). For working-diagnosis/discharge-diagnosis, use an ICD diagnosis code system consistent with the existing standards stack. Source systems have been observed sending ICD-11-pattern values here; confirm the authoritative code system with the vendor and terminology team before finalizing this binding.

Deliberately 0..* rather than 0..1 so trauma cases with multiple co-occurring diagnoses across different body sites are supported without forcing an artificial single 'primary site'.

The primary linkage a claims pipeline reads to associate a diagnosis with the correct billable encounter and its stage.

Granular timing matters for time-sensitive protocols (stroke/MI 'minutes matter'). Capture relative to the parent encounter's period.start where the exact onset time is unknown but time-since-arrival is clinically meaningful. For category=past-medical-history, this instead captures when the pre-existing condition itself began, if known.

Distinct from onset. Lets the staging timeline be reconstructed (e.g. chief-complaint recorded at T0, working-diagnosis at T+12min, discharge diagnosis at T+90min) even when clinical onset itself is unclear or unknown.

Will differ by stage — e.g. a triage nurse for past-medical-history, an EMT for working-diagnosis, an ED physician for discharge-diagnosis.

For category=chief-complaint or past-medical-history this is often the patient or caller themselves, not a clinician — distinguishes 'patient said chest pain' (asserter=Patient) from 'EMT suspects ACS' (asserter=Practitioner).

Not typically populated at the EMS/point-of-care stage; expect this to populate later once the patient reaches facility-based workup.

A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

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

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

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 it's 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).

A human language.

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.

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.

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.

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.

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.

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 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).

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 condition 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 condition as it is known by various participating systems and in a way that remains consistent across servers.

Typically 'active' for the chief-complaint/working/differential/discharge stages — 'resolved'/'inactive' are rare in an acute encounter but keep the element populated for consistency with facility-side Condition records that will later track resolution. For category=past-medical-history, 'active' or 'inactive' both apply depending on the checklist item (e.g. an active chronic condition versus a past surgical history).

The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

Expected progression: chief-complaint typically 'unconfirmed' (it is not yet a diagnosis); past-medical-history is commonly patient-reported and therefore often 'unconfirmed'; working-diagnosis typically 'provisional' or 'differential'; discharge-diagnosis typically 'confirmed'. Never submit a claim against a 'provisional' or 'differential' instance as if it were 'confirmed' — see invariant em-condition-1.

verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

The single most important element on this profile — claims-mapping logic must read this before deciding which diagnosis code to submit for adjudication. Also carry the base condition-category code (problem-list-item | encounter-diagnosis) as a second Coding within the same CodeableConcept if base-spec conformance is required alongside the local staging value.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

Not every stage carries a severity marker (rarely meaningful on a chief-complaint or a past-medical-history item), but when present this feeds billing tier / benefit classification, so the profile must be able to carry it.

Coding of the severity with a terminology is preferred, where possible.

For category=chief-complaint, code a symptom/complaint (see ManifestationVS) rather than forcing an ICD diagnosis code — a chief complaint is not yet a diagnosis. For category=past-medical-history, code the comorbidity itself (e.g. hypertension, diabetes, asthma, HIV, TB — matching the ED intake checklist). For working-diagnosis/discharge-diagnosis, use an ICD diagnosis code system consistent with the existing standards stack. Source systems have been observed sending ICD-11-pattern values here; confirm the authoritative code system with the vendor and terminology team before finalizing this binding.

0..1 to account for primarily narrative only resources.

Deliberately 0..* rather than 0..1 so trauma cases with multiple co-occurring diagnoses across different body sites are supported without forcing an artificial single 'primary site'.

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Indicates the patient or group who the condition record is associated with.

Group is typically used for veterinary or public health use cases.

The primary linkage a claims pipeline reads to associate a diagnosis with the correct billable encounter and its stage.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Age is generally used when the patient reports an age at which the Condition began to occur.

Granular timing matters for time-sensitive protocols (stroke/MI 'minutes matter'). Capture relative to the parent encounter's period.start where the exact onset time is unknown but time-since-arrival is clinically meaningful. For category=past-medical-history, this instead captures when the pre-existing condition itself began, if known.

Age is generally used when the patient reports an age at which the Condition began to occur.

The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

Distinct from onset. Lets the staging timeline be reconstructed (e.g. chief-complaint recorded at T0, working-diagnosis at T+12min, discharge diagnosis at T+90min) even when clinical onset itself is unclear or unknown.

Will differ by stage — e.g. a triage nurse for past-medical-history, an EMT for working-diagnosis, an ED physician for discharge-diagnosis.

For category=chief-complaint or past-medical-history this is often the patient or caller themselves, not a clinician — distinguishes 'patient said chest pain' (asserter=Patient) from 'EMT suspects ACS' (asserter=Practitioner).

Clinical stage or grade of a condition. May include formal severity assessments.

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 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.

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 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).

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 simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

Codes describing condition stages (e.g. Cancer stages).

Reference to a formal record of the evidence on which the staging assessment is based.

The kind of staging, such as pathological or clinical staging.

Codes describing the kind of condition staging (e.g. clinical or pathological).

Not typically populated at the EMS/point-of-care stage; expect this to populate later once the patient reaches facility-based workup.

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

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 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.

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 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).

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 manifestation or symptom that led to the recording of this condition.

Codes that describe the manifestation or symptoms of a condition.

Links to other relevant information, including pathology reports.

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.