Generated Narrative: StructureDefinition CarePlan-twcore Name Flags Card. Type Description & Constraints CarePlan 0..* CarePlan 特定照護目標下為一位患者或一群患者識別的活動、干預和結果計畫 #xD; id 0..1 id 不重複的 ID 用以識別儲存在特定 FHIR Server 中的 CarePlan 紀錄，通常又稱為邏輯性 ID。 #xD; meta 0..1 Meta 此 CarePlan Resource 的 metadata #xD; implicitRules 0..1 uri 創建此內容所依據的一組規則 #xD; language 0..1 code 用以表述 CarePlan Resource 內容的語言 Binding: CommonLanguages (preferred): 人類語言；鼓勵使用 CommonLanguages 代碼表中的代碼，但不強制一定要使用此代碼表，你也可使用其他代碼表的代碼或單純以文字表示。 Additional Bindings Purpose AllLanguages Max Binding Example Value: zh-TW #xD; text S 0..1 Narrative CarePlan Resource 之內容摘要以供人閱讀 #xD; status S 1..1 code generated | additional Binding: 臺灣衛福部資訊處Narrative狀態值集 (required): 敘述狀態的受限值集。 #xD; div S 1..1 xhtml 有限的 xhtml 內容 #xD; basedOn 0..* Reference(TW Core CarePlan) 履行或延伸的照護計畫 #xD; replaces 0..* Reference(TW Core CarePlan) 被此計畫取代的照護計畫 #xD; partOf 0..* Reference(TW Core CarePlan) 作為父照護計畫的一部分 #xD; status S 1..1 code 照護計畫目前的狀態 Binding: RequestStatus (required): 指出計畫是否正在實施、代表未來意圖或是現在的歷史記錄。 #xD; intent S 1..1 code 照護計畫的意圖 Binding: CarePlanIntent (required): 表示與照護計畫相關的權威性/意向性程度的代碼 #xD; Slices for category S 1..* CodeableConcept 照護計畫的類型 Slice: Unordered, Open by pattern:$this #xD; category:AssessPlan S 1..1 CodeableConcept 評估計畫 Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: assess-plan #xD; subject S 1..1 Reference(TW Core Patient S | Group) 照護計畫的對象 #xD; encounter 0..1 Reference(TW Core Encounter) 與此照護計畫相關的就醫事件 #xD; author 0..1 Reference(TW Core Patient | TW Core Practitioner | TW Core PractitionerRole | TW Core Implantable Device | TW Core RelatedPerson | TW Core Organization | TW Core CareTeam) 照護計畫的作者 #xD; contributor 0..* Reference(TW Core Patient | TW Core Practitioner | TW Core PractitionerRole | TW Core Implantable Device | TW Core RelatedPerson | TW Core Organization | TW Core CareTeam) 對計畫提供資訊的人員 #xD; careTeam 0..* Reference(TW Core CareTeam) 執行照護工作的團隊 #xD; addresses 0..* Reference(TW Core Condition) 本計畫處理的健康問題 #xD; activity #xD; reference 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | TW Core MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) 照護行動的明細 #xD; detail #xD; reasonReference 0..* Reference(TW Core Condition | TW Core Observation Clinical Result | TW Core DiagnosticReport | TW Core DocumentReference) 為何需要此行動 #xD; location 0..1 Reference(TW Core Location) 行動發生的地點 #xD; performer 0..* Reference(TW Core Practitioner | TW Core PractitionerRole | TW Core Organization | TW Core RelatedPerson | TW Core Patient | TW Core CareTeam | HealthcareService | TW Core Implantable Device) 執行或提供此行動的人員 #xD; Slices for product[x] 0..1 CodeableConcept, Reference(Medication | Substance) What is to be administered/supplied Slice: Unordered, Open by type:$this #xD; product[x]:productReference 0..1 Reference(TW Core Medication | Substance) 物料/主題/產品資訊要參照的資源 #xD; Documentation for this format
此臺灣核心-照護計畫(TW Core CarePlan) Profile 說明本 IG 如何進一步定義 FHIR 的 CarePlan Resource 以呈現照護計畫資料。
特定照護目標下為一位患者或一群患者識別的活動、干預和結果計畫
描述為實現一個或多個目標而將為一位患者(或一群患者)進行的活動的計畫，包括診斷、監測、評估、治療、藥物治療、追蹤等。
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
不重複的 ID 用以識別儲存在特定 FHIR Server 中的 CarePlan 紀錄，通常又稱為邏輯性 ID。
resource 的邏輯 ID，在 resource 的 URL 中使用。一旦指定，這個值永遠不會改變。
一個 resource 使用新增操作(create operation)提交給伺服器時，此 resource 沒有 id，它的 id 在 resource 被創建後由伺器分配/指定。
關於 resource 的 metadata。這是由基礎建設維護的內容。內容的更改可能並不總是與 resource 的版本更改相關聯。
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
構建 resource 時遵循的一系列規則的參照，在處理內容時必須理解這些規則。通常這是對 IG 所定義之特殊規則及其他 profiles 的參照。
宣告這套規則限制了內容只能被有限的交易夥伴所理解。這從本質上限制了資料的長期有用性。然而，現有的健康生態體系高度分裂，還沒有準備好以普遍可計算的方式定義、收集和交換資料。只要有可能，實作者和/或規範編寫者應該避免使用這個資料項目。通常在使用時，此 URL 是對 IG 的參照，此 IG 將這些特殊規則與其他 profiles、value sets 等一起定義為其敘述的一部分。
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
提供語言是為了支援索引和可存取性(通常，文字表述轉語音等服務使用此語言標籤)。html lanuage tag 適用於此敘述。resource 上的語言標籤可用於指定從 resource 中的資料所產成的其他表述之語言。不是所有的內容都必須使用此語言。不應該假定 Resource.language 自動適用於敘述。如果指定語言，它也應該被指定在 html 中的 div 資料項目(關於 xml:lang 和 html lang 屬性之間的關係，見 HTML5 中的規則)。
人類語言；鼓勵使用 CommonLanguages 代碼表中的代碼，但不強制一定要使用此代碼表，你也可使用其他代碼表的代碼或單純以文字表示。
人可讀的敘述，包含 resource 的摘要，可用於向人表述 resource 的內容。敘述不需要對所有的結構化資料進行編碼，但需要包含足夠的細節使人在閱讀敘述時理解「臨床安全性」。resource 定義有哪些內容應該在敘述中表示，以確保臨床安全。
內嵌(contained)的 resource 沒有敘述，非內嵌(contained)的 resource 則 **建議應該(SHOULD)** 有敘述。有時 resource 可能只有文字表述，很少或沒有額外的結構化資料(只要滿足所有 minOccurs=1 的資料項目)。這可能出現在舊系統的資料，當資訊以 「文字表述區塊(text blob)」的形式被取得，或者文字表述是原始輸入或說明，而編碼資訊稍後再添加。
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.
The actual narrative content, a stripped down version of XHTML.
The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
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, elements (either name or href), images and internally contained style attributes
not(descendant-or-self::*[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'sub', 'sup', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))]) and not(descendant-or-self::*/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))])
The narrative SHALL have some non-whitespace content
descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src]
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.
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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifiers assigned to this care plan 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](http://hl7.org/fhir/R4/resource.html#identifiers)). 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 care plan as it is known by various participating systems and in a way that remains consistent across servers.
Instantiates FHIR protocol or definition
The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.
Instantiates external protocol or definition
The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
參照可以是相對的、絕對的或內部的。
Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.
識別被此照護計畫所取代的照護計畫。
Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.
此照護計畫是另一個照護計畫的一部分。例如，專門針對骨折修復或糖尿病控制的計畫可能是出院護理計畫的一部分。
指明照護計畫是否正在執行中、表示未來意向或現在已成為歷史記錄。
可以在 事件模式 文件中找到一個標準的狀態轉換圖。「未知」不代表「其他」狀態 - 必須使用其中一個已定義的狀態，「未知」用於表示不確定當前狀態。
指出計畫是否正在實施、代表未來意圖或是現在的歷史記錄。
This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Request.status {uses different ValueSet}
.statusCode planned = new active = active completed = completed
表示與照護計畫相關的權威性/意向性程度。
This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.
This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request"
表示與照護計畫相關的權威性/意向性程度的代碼
There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.
識別這是什麼「種類」的計畫，以支援多個共存計畫之間的區分；例如：「居家健康」、「精神科」、「氣喘」、「疾病管理」、「保健計畫」等。
Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.
Used for filtering what plan(s) are retrieved and displayed to different types of users.
A description of the scope and nature of the plan.
Provides more detail than conveyed by category.
識別計畫描述其意圖照護的病人或群體。
此照護計畫是在哪個就醫情境產生的。
參照可以是相對的、絕對的或內部的。注意：如果 Encounter 參照是一個 Episode of Care 的一部分，則此資料點不足以隱含建立關聯。
Indicates when the plan did (or is intended to) come into effect and end.
Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).
Allows tracking what plan(s) are in effect at a particular time.
Represents when this particular CarePlan record was created in the system, which is often a system-generated date.
負責建立照護計畫內容的個人或組織。
對照護計畫的建立提供資訊的個人或組織，但不對照護計畫負責。
確定負責執行此照護計畫的照護團隊。
Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.
Request.performer {similar but does not entail CareTeam}
本照護計畫試圖解決的健康問題(例如：疾病、病情、問題)。
Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.
.actRelationship[typeCode=SUBJ].target[classCode=CONC, moodCode=EVN]
Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.
Use "concern" to identify specific conditions addressed by the care plan.
Identifies barriers and other considerations associated with the care plan.
Describes the intended objective(s) of carrying out the care plan.
Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.
Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.
Allows systems to prompt for performance of planned activities, and validate plans against best practice.
not(exists(f:detail)) or not(exists(f:reference))
{no mapping NOTE: This is a list of contained Request-Event tuples!}
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).
Note that this should not duplicate the activity status (e.g. completed or in progress).
Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).
The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.
{Event that is outcome of Request in activity.reference}
Comments about the activity status/progress
Notes about the adherence/status/progress of the activity.
This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.
Can be used to capture information about adherence, progress, concerns, etc.
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
包含照護計畫之照護行動(診斷、治療等)明細的 request/request-like 資源。
Details in a form consistent with other applications and contexts of use.
{Request that resulted in Event in activity.actionResulting}
A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.
Details in a simple form for generic care plan systems.
.outboundRelationship[typeCode=COMP, subsetCode=SUMM].target
Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.
May determine what types of extensions are permitted.
Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.
The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.
Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.
The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.
Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.
Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.
Allows matching performed to planned as well as validation against protocols.
Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.
Why activity should be done or why activity was prohibited
Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.
This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.
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.
指出為何此行動是此照護計畫的一部分。
Conditions can be identified at the activity level that are not identified as reasons for the overall plan.
Internal reference that identifies the goals that this activity is intended to contribute towards meeting.
So that participants know the link explicitly.
not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Identifies what progress is being made for the specific activity.
Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.
Indicates progress against the plan, whether the activity is still relevant for the plan.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid
Codes that reflect the current state of a care plan activity within its overall life cycle.
.statusCode not-started = new scheduled = not-started (and fulfillment relationship to appointent) in-progress = active on-hold = suspended completed = completed cancelled = aborted
Provides reason why the activity isn't yet started, is on hold, was cancelled, etc.
Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.
If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.
This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.
Captures intention to not do something that may have been previously typical.
If missing indicates that the described activity is one that should be engaged in when following the plan.
If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur.
The period, timing or frequency upon which the described activity is to occur.
Allows prompting for activities and detection of missed planned activities.
確定預期要執行此行動的特定人員或組織。
PRT-5 : ( PRV-4 = (provider participations)); PRT-5 : ( PRV-4 = (non-provider person participations )) ; PRT-5 : ( PRV-4 = (patient non-subject of care) ) ; PRT-8
Identifies the food, drug or other product to be consumed or supplied in the activity.
A product supplied or administered as part of a care plan activity.
Identifies the quantity expected to be consumed in a given day.
Identifies the quantity expected to be supplied, administered or consumed by the subject.
Extra info describing activity to perform
This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.
General notes about the care plan not covered elsewhere.
Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.