臺灣健保事前審查實作指引
1.1.0 - ci-build

臺灣健保事前審查實作指引, published by 衛生福利部中央健康保險署. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TWNHIFHIR/pas/ and changes regularly. See the Directory of published versions

## Resource Profile: 評估-ClinicalImpression TWPAS

Official URL: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas | Version: 1.1.0
Active as of 2025-12-29 | Computable Name: ClinicalImpressionTWPAS

此評估-ClinicalImpression TWPAS Profile說明本IG如何進一步定義FHIR的ClinicalImpression Resource以呈現免疫製劑事前審查之評估（A）

Usages:

- Use this Profile: 免疫製劑事前審查-Bundle Immunologic Aagent TWPAS and 癌藥事前審查-Bundle TWPAS
- Refer to this Profile: 門診病歷-Composition OPD TWPAS
- Examples for this Profile: ClinicalImpression/cliImp-min
- CapabilityStatements using this Profile: 臺灣事前審查-用戶端(TWPAS Client) and 臺灣事前審查-伺服端(TWPAS Server)

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
meta | Σ | 1..1 | Meta | Metadata about the resource
profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
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(病人資訊-Patient TWPAS) | Patient or group assessed
encounter | Σ | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
summary |  | 1..1 | string | 評估，由醫院自行填寫。
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍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 |  |  | ClinicalImpression |
meta |  | 1..1 | Meta | Metadata about the resource
profile |  | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
subject |  | 1..1 | Reference(病人資訊-Patient TWPAS) | Patient or group assessed
encounter |  | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
summary |  | 1..1 | string | 評估，由醫院自行填寫。
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 | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
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".
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | Business identifier
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression.
code | Σ | 0..1 | CodeableConcept | Kind of assessment performed Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(病人資訊-Patient TWPAS) | Patient or group assessed
encounter | Σ | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
effective[x] | Σ | 0..1 |  | Time of assessment
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
date | Σ | 0..1 | dateTime | When the assessment was documented
assessor | Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
previous |  | 0..1 | Reference(ClinicalImpression) | Reference to last assessment
problem | Σ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state
investigation |  | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.)
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
code |  | 1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations.
item |  | 0..* | Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media) | Record of a specific investigation
protocol |  | 0..* | uri | Clinical Protocol followed
summary |  | 1..1 | string | 評估，由醫院自行填寫。
finding |  | 0..* | BackboneElement | Possible or likely findings and diagnoses
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
itemCodeableConcept |  | 0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
itemReference |  | 0..1 | Reference(Condition | Observation | Media) | What was found
basis |  | 0..1 | string | Which investigations support finding
prognosisCodeableConcept |  | 0..* | CodeableConcept | Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.
prognosisReference |  | 0..* | Reference(RiskAssessment) | RiskAssessment expressing likely outcome
supportingInfo |  | 0..* | Reference(Resource) | Information supporting the clinical impression
note |  | 0..* | Annotation | Comments made about the ClinicalImpression
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.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.statusReason | Base | example |  | Not State | Unknown
ClinicalImpression.code | Base | example |  | Not State | Unknown
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.
ClinicalImpression.prognosisCodeableConcept | Base | example | Clinical Impression Prognosis | 📍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

Mandatory: 4 elements

Structures

This structure refers to these other structures:

- 病人資訊-Patient TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Patient-twpas)
- 門診病歷-Encounter OPD TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Encounter-opd-twpas)

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
meta | Σ | 1..1 | Meta | Metadata about the resource
profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
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(病人資訊-Patient TWPAS) | Patient or group assessed
encounter | Σ | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
summary |  | 1..1 | string | 評估，由醫院自行填寫。
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍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 |  |  | ClinicalImpression |
meta |  | 1..1 | Meta | Metadata about the resource
profile |  | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
subject |  | 1..1 | Reference(病人資訊-Patient TWPAS) | Patient or group assessed
encounter |  | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
summary |  | 1..1 | string | 評估，由醫院自行填寫。
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 | 1..1 | Meta | Metadata about the resource
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
versionId | Σ | 0..1 | id | Version specific identifier
lastUpdated | Σ | 0..1 | instant | When the resource version last changed
source | Σ | 0..1 | uri | Identifies where the resource comes from
profile | Σ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ClinicalImpression-twpas
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".
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 Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | Business identifier
status | ?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression.
statusReason |  | 0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression.
code | Σ | 0..1 | CodeableConcept | Kind of assessment performed Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(病人資訊-Patient TWPAS) | Patient or group assessed
encounter | Σ | 1..1 | Reference(門診病歷-Encounter OPD TWPAS) | Encounter created as part of
effective[x] | Σ | 0..1 |  | Time of assessment
effectiveDateTime |  |  | dateTime |
effectivePeriod |  |  | Period |
date | Σ | 0..1 | dateTime | When the assessment was documented
assessor | Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
previous |  | 0..1 | Reference(ClinicalImpression) | Reference to last assessment
problem | Σ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state
investigation |  | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.)
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
code |  | 1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations.
item |  | 0..* | Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media) | Record of a specific investigation
protocol |  | 0..* | uri | Clinical Protocol followed
summary |  | 1..1 | string | 評估，由醫院自行填寫。
finding |  | 0..* | BackboneElement | Possible or likely findings and diagnoses
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
itemCodeableConcept |  | 0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
itemReference |  | 0..1 | Reference(Condition | Observation | Media) | What was found
basis |  | 0..1 | string | Which investigations support finding
prognosisCodeableConcept |  | 0..* | CodeableConcept | Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.
prognosisReference |  | 0..* | Reference(RiskAssessment) | RiskAssessment expressing likely outcome
supportingInfo |  | 0..* | Reference(Resource) | Information supporting the clinical impression
note |  | 0..* | Annotation | Comments made about the ClinicalImpression
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.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std.
ClinicalImpression.statusReason | Base | example |  | Not State | Unknown
ClinicalImpression.code | Base | example |  | Not State | Unknown
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.
ClinicalImpression.prognosisCodeableConcept | Base | example | Clinical Impression Prognosis | 📍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

Mandatory: 4 elements

Structures

This structure refers to these other structures:

- 病人資訊-Patient TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Patient-twpas)
- 門診病歷-Encounter OPD TWPAS (https://nhicore.nhi.gov.tw/pas/StructureDefinition/Encounter-opd-twpas)

Other representations of profile: CSV, Excel, Schematron