臺灣長期照顧實作指引(TW LTC IG)
1.0.0 - STU 1.0.0

臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

Resource Profile: 長期照顧－照顧計畫

Official URL: http://ltc-ig.fhir.tw/StructureDefinition/LTCCarePlan Version: 1.0.0
Active as of 2026-03-01 Computable Name: LTCCarePlan

此 Profile 說明本 IG 如何進一步定義 FHIR 的 CarePlan Resource，以呈現長期照顧情境中涉及之照顧計畫內容。

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan 0..* TWCoreCarePlan Healthcare plan for patient or group
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 0..1 Narrative CarePlan Resource之內容摘要以供人閱讀
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... status S 1..1 code generated | additional
Binding: 臺灣衛福部資訊處Narrative狀態值集 (required): Constrained value set of narrative statuses.
.... div SC 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... reference ΣC 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
... replaces Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... reference ΣC 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
... partOf SΣ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... reference SΣC 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
... status ?!SΣ 1..1 code 照顧計畫的狀態。[應填入以下字串之一：active | on-hold | completed | cancelled | entered-in-error | unknown]
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
... intent ?!SΣ 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
... Slices for category SΣ 1..* CodeableConcept 照顧計畫的分類。
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... reference SΣC 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
... encounter SΣ 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... reference SΣC 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
... period SΣ 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... start SΣC 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end SΣC 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... author SΣ 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... reference SΣC 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... reference SΣC 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... addresses SΣ 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... reference SΣC 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... reference SΣC 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
... activity SC 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
Constraints: cpl-3
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... reference SC 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail SC 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... Slices for product[x] 0..1 What is to be administered/supplied
Slice: Unordered, Open by type:$this
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
...... product[x]:productReference 0..1 Reference(TW Core Medication | Substance) What is to be administered/supplied
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CarePlan.text.status Base required 臺灣衛福部資訊處Narrative狀態值集 📦0.3.0 臺灣核心實作指引 v0.3
CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
CarePlan.category Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.category:AssessPlan Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CarePlan 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 error CarePlan 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 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

This structure is derived from TWCoreCarePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan TWCoreCarePlan
... basedOn 0..* Reference(長期照顧－照顧計畫) 照顧計畫的來源，即這項照顧計畫是基於哪個照顧計畫？
.... reference 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
... replaces 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... reference 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
... partOf S 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... reference S 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
... intent 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
... category 1..* CodeableConcept 照顧計畫的分類。
... subject 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... reference S 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
... encounter S 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... reference S 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
... period S 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... start S 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end S 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... author S 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... reference S 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... reference S 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... addresses S 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... reference S 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... reference S 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
... activity S 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
.... reference S 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail S 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan 0..* TWCoreCarePlan Healthcare plan for patient or group
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative CarePlan Resource之內容摘要以供人閱讀
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... status S 1..1 code generated | additional
Binding: 臺灣衛福部資訊處Narrative狀態值集 (required): Constrained value set of narrative statuses.
.... div SC 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier External Ids for this plan
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的來源，即這項照顧計畫是基於哪個照顧計畫？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... replaces Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... partOf SΣ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... status ?!SΣ 1..1 code 照顧計畫的狀態。[應填入以下字串之一：active | on-hold | completed | cancelled | entered-in-error | unknown]
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
... intent ?!SΣ 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
... Slices for category SΣ 1..* CodeableConcept 照顧計畫的分類。
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... title Σ 0..1 string Human-friendly name for the care plan
... description Σ 0..1 string Summary of nature of plan
... subject SΣ 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... encounter SΣ 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... period SΣ 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end SΣC 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... created Σ 0..1 dateTime Date record was first recorded
... author SΣ 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... careTeam 0..* Reference(TW Core CareTeam) Who's involved in plan?
... addresses SΣ 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... activity SC 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
Constraints: cpl-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
.... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
.... progress 0..* Annotation Comments about the activity status/progress
.... reference SC 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail SC 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.
..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
..... instantiatesUri 0..* uri Instantiates external protocol or definition
..... code 0..1 CodeableConcept Detail type of activity
Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.
..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.
..... reasonReference 0..* Reference(TW Core Condition | TW Core Observation Clinical Result | TW Core DiagnosticReport | TW Core DocumentReference) Why activity is needed
..... goal 0..* Reference(Goal) Goals this activity relates to
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
..... statusReason 0..1 CodeableConcept Reason for current status
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... scheduled[x] 0..1 When activity is to occur
...... scheduledTiming Timing
...... scheduledPeriod Period
...... scheduledString string
..... location 0..1 Reference(TW Core Location) Where it should happen
..... performer 0..* Reference(TW Core Practitioner | TW Core PractitionerRole | TW Core Organization | TW Core RelatedPerson | TW Core Patient | TW Core CareTeam | HealthcareService | TW Core Implantable Device) Who will be responsible?
..... Slices for product[x] 0..1 What is to be administered/supplied
Slice: Unordered, Open by type:$this
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
...... product[x]:productReference 0..1 Reference(TW Core Medication | Substance) What is to be administered/supplied
..... dailyAmount 0..1 SimpleQuantity How to consume/day?
..... quantity 0..1 SimpleQuantity How much to administer/supply/consume
..... description 0..1 string Extra info describing activity to perform
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CarePlan.language Base preferred Common Languages 📦4.0.1 FHIR Std.
CarePlan.text.status Base required 臺灣衛福部資訊處Narrative狀態值集 📦0.3.0 臺灣核心實作指引 v0.3
CarePlan.basedOn.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.replaces.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.partOf.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
CarePlan.category Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.category:AssessPlan Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.subject.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.encounter.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.author.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.contributor.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.addresses.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.goal.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.activity.outcomeCodeableConcept Base example Care Plan Activity Outcome 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​kind Base required Care Plan Activity Kind 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​code Base example Procedure Codes (SNOMED CT) 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​reasonCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CarePlan 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 error CarePlan 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 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan 0..* TWCoreCarePlan Healthcare plan for patient or group
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 0..1 Narrative CarePlan Resource之內容摘要以供人閱讀
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... status S 1..1 code generated | additional
Binding: 臺灣衛福部資訊處Narrative狀態值集 (required): Constrained value set of narrative statuses.
.... div SC 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... reference ΣC 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
... replaces Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... reference ΣC 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
... partOf SΣ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... reference SΣC 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
... status ?!SΣ 1..1 code 照顧計畫的狀態。[應填入以下字串之一：active | on-hold | completed | cancelled | entered-in-error | unknown]
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
... intent ?!SΣ 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
... Slices for category SΣ 1..* CodeableConcept 照顧計畫的分類。
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... subject SΣ 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... reference SΣC 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
... encounter SΣ 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... reference SΣC 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
... period SΣ 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... start SΣC 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end SΣC 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... author SΣ 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... reference SΣC 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... reference SΣC 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... addresses SΣ 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... reference SΣC 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... reference SΣC 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
... activity SC 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
Constraints: cpl-3
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... reference SC 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail SC 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... Slices for product[x] 0..1 What is to be administered/supplied
Slice: Unordered, Open by type:$this
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
...... product[x]:productReference 0..1 Reference(TW Core Medication | Substance) What is to be administered/supplied
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CarePlan.text.status Base required 臺灣衛福部資訊處Narrative狀態值集 📦0.3.0 臺灣核心實作指引 v0.3
CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
CarePlan.category Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.category:AssessPlan Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CarePlan 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 error CarePlan 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 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

Differential View

This structure is derived from TWCoreCarePlan

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan TWCoreCarePlan
... basedOn 0..* Reference(長期照顧－照顧計畫) 照顧計畫的來源，即這項照顧計畫是基於哪個照顧計畫？
.... reference 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
... replaces 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... reference 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
... partOf S 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... reference S 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
... intent 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
... category 1..* CodeableConcept 照顧計畫的分類。
... subject 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... reference S 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
... encounter S 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... reference S 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
... period S 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... start S 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end S 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... author S 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... reference S 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... reference S 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
... addresses S 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... reference S 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... reference S 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
... activity S 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
.... reference S 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail S 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. CarePlan 0..* TWCoreCarePlan Healthcare plan for patient or group
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative CarePlan Resource之內容摘要以供人閱讀
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... status S 1..1 code generated | additional
Binding: 臺灣衛福部資訊處Narrative狀態值集 (required): Constrained value set of narrative statuses.
.... div SC 1..1 xhtml Limited xhtml content
Constraints: txt-1, txt-2
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier External Ids for this plan
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的來源，即這項照顧計畫是基於哪個照顧計畫？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string 照顧計畫的來源。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... replaces Σ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的替代，即這項照顧計畫已經被哪個照顧計畫替代？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 1..1 string 照顧計畫的替代。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... partOf SΣ 0..* Reference(長期照顧－照顧計畫) 照顧計畫的緊急備用方案，即這項照顧計畫使用哪個緊急備用方案？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的緊急備用方案。[應輸入 CarePlan Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... status ?!SΣ 1..1 code 照顧計畫的狀態。[應填入以下字串之一：active | on-hold | completed | cancelled | entered-in-error | unknown]
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
... intent ?!SΣ 1..1 code 照顧計畫的意圖。[應填入以下字串之一：proposal | plan | order | option]
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
... Slices for category SΣ 1..* CodeableConcept 照顧計畫的分類。
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... title Σ 0..1 string Human-friendly name for the care plan
... description Σ 0..1 string Summary of nature of plan
... subject SΣ 1..1 Reference(長期照顧－住民基本資料) 照顧計畫的適用主體，即這個照顧計畫的適用對象是誰？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的適用主體。[應輸入 Patient Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... encounter SΣ 0..1 Reference(TW Core Encounter) 照顧計畫對應的就診資訊，即這個照顧計畫是哪個就診資訊的一部分？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫對應的就診資訊。[應輸入 Encounter Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... period SΣ 0..1 Period 照顧計畫的有效期間，即這個照顧計畫的有效期間是多久？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC 1..1 dateTime 照顧計畫的開始日期。[應填入日期或日期時間]
.... end SΣC 0..1 dateTime 照顧計畫的結束日期。[應填入日期或日期時間]
... created Σ 0..1 dateTime Date record was first recorded
... author SΣ 0..1 Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的提出者，即這個照顧計畫是由誰提出或計畫的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的提出者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... contributor S 0..* Reference(長期照顧－照顧服務提供者 | 長期照顧－關係人 | 長期照顧－服務人員角色 | TW Core Organization | TW Core Organization Hospital Department | 長期照顧－機構 | 長期照顧－照顧團隊) 照顧計畫的參與者，即這個照顧計畫是由誰來參與的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的參與者。[應輸入 Practitioner / RelatedPerson / PractitionerRole / Organization / CareTeam Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... careTeam 0..* Reference(TW Core CareTeam) Who's involved in plan?
... addresses SΣ 0..* Reference(長期照顧－病情、問題或診斷) 照顧計畫對應的需求，即這個照顧計畫是針對哪些問題或需求而設計的？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫對應的需求。[應輸入 Condition Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... supportingInfo S 0..* Reference(Resource) 照顧計畫的輔助資訊，即這個照顧計畫應該考量到哪些資訊？
... goal S 0..* Reference(長期照顧－照顧目標) 照顧計畫的目標，即這個照顧計畫預期達成哪些目標？
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference SΣC 1..1 string 照顧計畫的目標。[應輸入 Goal Resource ID]
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... activity SC 1..* BackboneElement 照顧計畫的活動，即這個照顧計畫包含哪些活動？這裡可以使用 Reference 或是純文字來表述。
Constraints: cpl-3
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
.... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
.... progress 0..* Annotation Comments about the activity status/progress
.... reference SC 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照顧計畫的活動參考 Resource。
.... detail SC 0..1 BackboneElement 照顧計畫的活動詳細資訊，即這個照顧計畫的活動內容是什麼？這裡可以直接描述活動內容，或是針對 Reference 內容進行更進一步的描述。
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.
..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
..... instantiatesUri 0..* uri Instantiates external protocol or definition
..... code 0..1 CodeableConcept Detail type of activity
Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.
..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.
..... reasonReference 0..* Reference(TW Core Condition | TW Core Observation Clinical Result | TW Core DiagnosticReport | TW Core DocumentReference) Why activity is needed
..... goal 0..* Reference(Goal) Goals this activity relates to
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
..... statusReason 0..1 CodeableConcept Reason for current status
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... scheduled[x] 0..1 When activity is to occur
...... scheduledTiming Timing
...... scheduledPeriod Period
...... scheduledString string
..... location 0..1 Reference(TW Core Location) Where it should happen
..... performer 0..* Reference(TW Core Practitioner | TW Core PractitionerRole | TW Core Organization | TW Core RelatedPerson | TW Core Patient | TW Core CareTeam | HealthcareService | TW Core Implantable Device) Who will be responsible?
..... Slices for product[x] 0..1 What is to be administered/supplied
Slice: Unordered, Open by type:$this
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
...... product[x]:productReference 0..1 Reference(TW Core Medication | Substance) What is to be administered/supplied
..... dailyAmount 0..1 SimpleQuantity How to consume/day?
..... quantity 0..1 SimpleQuantity How much to administer/supply/consume
..... description 0..1 string Extra info describing activity to perform
... note S 0..* Annotation 照顧計畫的附註。

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
CarePlan.language Base preferred Common Languages 📦4.0.1 FHIR Std.
CarePlan.text.status Base required 臺灣衛福部資訊處Narrative狀態值集 📦0.3.0 臺灣核心實作指引 v0.3
CarePlan.basedOn.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.replaces.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.partOf.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
CarePlan.category Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.category:AssessPlan Base example Care Plan Category 📦4.0.1 FHIR Std.
CarePlan.subject.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.encounter.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.author.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.contributor.​type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.addresses.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.goal.type Base extensible ResourceType 📍4.0.1 FHIR Std.
CarePlan.activity.outcomeCodeableConcept Base example Care Plan Activity Outcome 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​kind Base required Care Plan Activity Kind 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​code Base example Procedure Codes (SNOMED CT) 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​reasonCode Base example SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📦4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error CarePlan 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 error CarePlan 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 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

 

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