NHDR Implementation Guide Release 1.0
0.1.0 - ci-build

NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/nhdr-fhir-ig-review-project-2/ and changes regularly. See the Directory of published versions

## Resource Profile: PH ClinicalImpression

Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-ClinicalImpression | Version: 0.1.0
Standards status: Draft | Computable Name: PH_ClinicalImpression
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score.

Usages:

- This Profile is not used by any profiles in this Implementation Guide

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.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
subject | Σ | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
effective[x] | Σ | 0..1 | dateTime | Time of assessment
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.investigation.​code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClinicalImpression | 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 | ClinicalImpression | 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 | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClinicalImpression | 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()`

This structure is derived from ClinicalImpression

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
meta |  |  |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
lastUpdated |  | 0..1 | instant | When the resource was uploaded to the NHDR.
implicitRules |  | 0..0 |  | A set of rules under which this content was created
language |  | 0..0 |  | Language of the resource content
text |  | 0..0 |  | Text summary of the resource, for human interpretation
contained |  | 0..0 |  | Contained, inline Resources
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
identifier |  | 0..0 |  | Business identifier
statusReason |  | 0..0 |  | Reason for current status
code |  | 0..0 |  | Kind of assessment performed
subject |  | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
encounter |  | 0..0 |  | Encounter created as part of
effective[x] |  | 0..1 | dateTime | Time of assessment
date |  | 0..0 |  | When the assessment was documented
assessor |  | 0..0 |  | The clinician performing the assessment
previous |  | 0..0 |  | Reference to last assessment
problem |  | 0..0 |  | Relevant impressions of patient state
investigation |  | 0..0 |  | One or more sets of investigations (signs, symptoms, etc.)
protocol |  | 0..0 |  | Clinical Protocol followed
summary |  | 0..0 |  | Summary of the assessment
finding |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
itemReference |  | 0..0 |  | What was found
basis |  | 0..0 |  | Which investigations support finding
prognosisCodeableConcept |  | 0..0 |  | Estimate of likely outcome
prognosisReference |  | 0..0 |  | RiskAssessment expressing likely outcome
supportingInfo |  | 0..0 |  | Information supporting the clinical impression
note |  | 0..0 |  | Comments made about the ClinicalImpression
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource was uploaded to the NHDR.
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
effective[x] | Σ | 0..1 | dateTime | Time of assessment
finding |  | 0..* | BackboneElement | Possible or likely findings and diagnoses
itemCodeableConcept |  | 0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.meta.​security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
ClinicalImpression.meta.​tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.investigation.​code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std.
ClinicalImpression.finding.​itemCodeableConcept | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClinicalImpression | 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 | ClinicalImpression | 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 | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClinicalImpression | 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()`

This structure is derived from ClinicalImpression

Summary

Prohibited: 26 elements

Structures

This structure refers to these other structures:

- PH Patient (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient)

Extensions

This structure refers to these extensions:

- https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
- https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
subject | Σ | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
effective[x] | Σ | 0..1 | dateTime | Time of assessment
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.investigation.​code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClinicalImpression | 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 | ClinicalImpression | 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 | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClinicalImpression | 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()`

Differential View

This structure is derived from ClinicalImpression

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
meta |  |  |  |
Slices for extension |  |  |  | Content/Rules for all slices
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
lastUpdated |  | 0..1 | instant | When the resource was uploaded to the NHDR.
implicitRules |  | 0..0 |  | A set of rules under which this content was created
language |  | 0..0 |  | Language of the resource content
text |  | 0..0 |  | Text summary of the resource, for human interpretation
contained |  | 0..0 |  | Contained, inline Resources
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
identifier |  | 0..0 |  | Business identifier
statusReason |  | 0..0 |  | Reason for current status
code |  | 0..0 |  | Kind of assessment performed
subject |  | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
encounter |  | 0..0 |  | Encounter created as part of
effective[x] |  | 0..1 | dateTime | Time of assessment
date |  | 0..0 |  | When the assessment was documented
assessor |  | 0..0 |  | The clinician performing the assessment
previous |  | 0..0 |  | Reference to last assessment
problem |  | 0..0 |  | Relevant impressions of patient state
investigation |  | 0..0 |  | One or more sets of investigations (signs, symptoms, etc.)
protocol |  | 0..0 |  | Clinical Protocol followed
summary |  | 0..0 |  | Summary of the assessment
finding |  |  |  |
id |  | 0..0 |  | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension
modifierExtension |  | 0..0 |  | Extension
itemReference |  | 0..0 |  | What was found
basis |  | 0..0 |  | Which investigations support finding
prognosisCodeableConcept |  | 0..0 |  | Estimate of likely outcome
prognosisReference |  | 0..0 |  | RiskAssessment expressing likely outcome
supportingInfo |  | 0..0 |  | Information supporting the clinical impression
note |  | 0..0 |  | Comments made about the ClinicalImpression
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:hfRecordedDate |  | 0..1 | dateTime | The recorded date indicating when the record was uploaded by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
extension:hfLastUpdated |  | 0..* | dateTime | The date indicating when the record was last updated by the health facility. URL: https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource was uploaded to the NHDR.
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to
security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(PH Patient | Group) | Patient or group assessed
effective[x] | Σ | 0..1 | dateTime | Time of assessment
finding |  | 0..* | BackboneElement | Possible or likely findings and diagnoses
itemCodeableConcept |  | 0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.meta.​security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std.
ClinicalImpression.meta.​tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std.
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.investigation.​code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std.
ClinicalImpression.finding.​itemCodeableConcept | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | ClinicalImpression | 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 | ClinicalImpression | 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 | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | ClinicalImpression | 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()`

This structure is derived from ClinicalImpression

Summary

Prohibited: 26 elements

Structures

This structure refers to these other structures:

- PH Patient (https://nhdr.gov.ph/fhir/StructureDefinition/PH-Patient)

Extensions

This structure refers to these extensions:

- https://nhdr.gov.ph/fhir/StructureDefinition/HFRecordedDate
- https://nhdr.gov.ph/fhir/StructureDefinition/HFLastUpdated

Other representations of profile: CSV, Excel, Schematron