Patient Care Coordination (PCC) Implementation Guide
                
                0.1.1-current - ci-build
                    
                    
                    
  
                    
                    
            
            
Patient Care Coordination (PCC) Implementation Guide, published by Virtually Healthcare. This guide is not an authorized publication; it is the continuous build for version 0.1.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Virtually-Healthcare/R4/ and changes regularly. See the Directory of published versions
| Official URL: https://fhir.virtually.healthcare/StructureDefinition/Goal | Version: 0.1.1-current | |||
| Draft as of 2025-08-14 | Computable Name: Goal | |||
TODO in discovery
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | 
|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |
![]() ![]()  | 
?!Σ | 0..1 | uri | A set of rules under which this content was created | 
![]() ![]()  | 
?! | 0..* | Extension | Extensions that cannot be ignored | 
![]() ![]()  | 
?!Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted.  | 
![]() ![]()  | 
Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.  | 
![]() ![]()  | 
Σ | 1..1 | Reference(Patient | Group | Organization) | Who this goal is intended for | 
  Documentation for this format | ||||
| Path | Conformance | ValueSet | URI | 
| Goal.lifecycleStatus | required | GoalLifecycleStatushttp://hl7.org/fhir/ValueSet/goal-status|4.0.1From the FHIR Standard  | |
| Goal.description | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | 
| Id | Grade | Path(s) | Details | Requirements | 
| dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()  | |
| dom-3 | error | Goal | 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 | Goal | 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 | Goal | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()  | |
| dom-6 | best practice | Goal | 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 Goal
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | 
|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |
  Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | ||||
|---|---|---|---|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |||||
![]() ![]()  | 
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]()  | 
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]()  | 
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]()  | 
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language. 
  | |||||
![]() ![]()  | 
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  | |||||
![]() ![]()  | 
0..* | Resource | Contained, inline Resources | |||||
![]() ![]()  | 
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]()  | 
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]()  | 
0..* | Identifier | External Ids for this goal | |||||
![]() ![]()  | 
?!Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted.  | ||||
![]() ![]()  | 
Σ | 0..1 | CodeableConcept | in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.  | ||||
![]() ![]()  | 
Σ | 0..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.  | ||||
![]() ![]()  | 
Σ | 0..1 | CodeableConcept | high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.  | ||||
![]() ![]()  | 
Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.  | ||||
![]() ![]()  | 
Σ | 1..1 | Reference(Patient | Group | Organization) | Who this goal is intended for | ||||
![]() ![]()  | 
Σ | 0..1 | When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.  | |||||
![]() ![]() ![]()  | 
date | |||||||
![]() ![]() ![]()  | 
CodeableConcept | |||||||
![]() ![]()  | 
C | 0..* | BackboneElement | Target outcome for the goal Constraints: gol-1  | ||||
![]() ![]() ![]()  | 
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]()  | 
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]()  | 
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]()  | 
ΣC | 0..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.  | ||||
![]() ![]() ![]()  | 
ΣC | 0..1 | The target value to be achieved Binding Description: (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.  | |||||
![]() ![]() ![]() ![]()  | 
Quantity | |||||||
![]() ![]() ![]() ![]()  | 
Range | |||||||
![]() ![]() ![]() ![]()  | 
CodeableConcept | |||||||
![]() ![]() ![]() ![]()  | 
string | |||||||
![]() ![]() ![]() ![]()  | 
boolean | |||||||
![]() ![]() ![]() ![]()  | 
integer | |||||||
![]() ![]() ![]() ![]()  | 
Ratio | |||||||
![]() ![]() ![]()  | 
Σ | 0..1 | Reach goal on or before | |||||
![]() ![]() ![]() ![]()  | 
date | |||||||
![]() ![]() ![]() ![]()  | 
Duration | |||||||
![]() ![]()  | 
Σ | 0..1 | date | When goal status took effect | ||||
![]() ![]()  | 
0..1 | string | Reason for current status | |||||
![]() ![]()  | 
Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | Who's responsible for creating Goal? | ||||
![]() ![]()  | 
0..* | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) | Issues addressed by this goal | |||||
![]() ![]()  | 
0..* | Annotation | Comments about the goal | |||||
![]() ![]()  | 
0..* | CodeableConcept | What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".  | |||||
![]() ![]()  | 
0..* | Reference(Observation) | Observation that resulted from goal | |||||
  Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| Goal.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard 
  | ||||
| Goal.lifecycleStatus | required | GoalLifecycleStatushttp://hl7.org/fhir/ValueSet/goal-status|4.0.1From the FHIR Standard  | ||||
| Goal.achievementStatus | preferred | GoalAchievementStatushttp://hl7.org/fhir/ValueSet/goal-achievementFrom the FHIR Standard  | ||||
| Goal.category | example | GoalCategoryhttp://hl7.org/fhir/ValueSet/goal-categoryFrom the FHIR Standard  | ||||
| Goal.priority | preferred | GoalPriorityhttp://hl7.org/fhir/ValueSet/goal-priorityFrom the FHIR Standard  | ||||
| Goal.description | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | ||||
| Goal.start[x] | example | GoalStartEventhttp://hl7.org/fhir/ValueSet/goal-start-eventFrom the FHIR Standard  | ||||
| Goal.target.measure | example | LOINCCodes(a valid code from LOINC)http://hl7.org/fhir/ValueSet/observation-codesFrom the FHIR Standard  | ||||
| Goal.target.detail[x] | example | |||||
| Goal.outcomeCode | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | 
| Id | Grade | Path(s) | Details | Requirements | 
| dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()  | |
| dom-3 | error | Goal | 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 | Goal | 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 | Goal | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()  | |
| dom-6 | best practice | Goal | 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()  | |
| gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated : (detail.exists() and measure.exists()) or detail.exists().not()  | 
This structure is derived from Goal
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | 
|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |
![]() ![]()  | 
?!Σ | 0..1 | uri | A set of rules under which this content was created | 
![]() ![]()  | 
?! | 0..* | Extension | Extensions that cannot be ignored | 
![]() ![]()  | 
?!Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted.  | 
![]() ![]()  | 
Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.  | 
![]() ![]()  | 
Σ | 1..1 | Reference(Patient | Group | Organization) | Who this goal is intended for | 
  Documentation for this format | ||||
| Path | Conformance | ValueSet | URI | 
| Goal.lifecycleStatus | required | GoalLifecycleStatushttp://hl7.org/fhir/ValueSet/goal-status|4.0.1From the FHIR Standard  | |
| Goal.description | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | 
| Id | Grade | Path(s) | Details | Requirements | 
| dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()  | |
| dom-3 | error | Goal | 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 | Goal | 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 | Goal | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()  | |
| dom-6 | best practice | Goal | 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 Goal
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | 
|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |
  Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints    Filter:  ![]() ![]()  | ||||
|---|---|---|---|---|---|---|---|---|
![]()  | 
0..* | Goal | Describes the intended objective(s) for a patient, group or organization | |||||
![]() ![]()  | 
Σ | 0..1 | id | Logical id of this artifact | ||||
![]() ![]()  | 
Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]()  | 
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]()  | 
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language. 
  | |||||
![]() ![]()  | 
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  | |||||
![]() ![]()  | 
0..* | Resource | Contained, inline Resources | |||||
![]() ![]()  | 
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]()  | 
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]()  | 
0..* | Identifier | External Ids for this goal | |||||
![]() ![]()  | 
?!Σ | 1..1 | code | proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required): Codes that reflect the current state of a goal and whether the goal is still being targeted.  | ||||
![]() ![]()  | 
Σ | 0..1 | CodeableConcept | in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.  | ||||
![]() ![]()  | 
Σ | 0..* | CodeableConcept | E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.  | ||||
![]() ![]()  | 
Σ | 0..1 | CodeableConcept | high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.  | ||||
![]() ![]()  | 
Σ | 1..1 | CodeableConcept | Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.  | ||||
![]() ![]()  | 
Σ | 1..1 | Reference(Patient | Group | Organization) | Who this goal is intended for | ||||
![]() ![]()  | 
Σ | 0..1 | When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.  | |||||
![]() ![]() ![]()  | 
date | |||||||
![]() ![]() ![]()  | 
CodeableConcept | |||||||
![]() ![]()  | 
C | 0..* | BackboneElement | Target outcome for the goal Constraints: gol-1  | ||||
![]() ![]() ![]()  | 
0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]()  | 
0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]()  | 
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]()  | 
ΣC | 0..1 | CodeableConcept | The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.  | ||||
![]() ![]() ![]()  | 
ΣC | 0..1 | The target value to be achieved Binding Description: (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.  | |||||
![]() ![]() ![]() ![]()  | 
Quantity | |||||||
![]() ![]() ![]() ![]()  | 
Range | |||||||
![]() ![]() ![]() ![]()  | 
CodeableConcept | |||||||
![]() ![]() ![]() ![]()  | 
string | |||||||
![]() ![]() ![]() ![]()  | 
boolean | |||||||
![]() ![]() ![]() ![]()  | 
integer | |||||||
![]() ![]() ![]() ![]()  | 
Ratio | |||||||
![]() ![]() ![]()  | 
Σ | 0..1 | Reach goal on or before | |||||
![]() ![]() ![]() ![]()  | 
date | |||||||
![]() ![]() ![]() ![]()  | 
Duration | |||||||
![]() ![]()  | 
Σ | 0..1 | date | When goal status took effect | ||||
![]() ![]()  | 
0..1 | string | Reason for current status | |||||
![]() ![]()  | 
Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | Who's responsible for creating Goal? | ||||
![]() ![]()  | 
0..* | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment) | Issues addressed by this goal | |||||
![]() ![]()  | 
0..* | Annotation | Comments about the goal | |||||
![]() ![]()  | 
0..* | CodeableConcept | What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".  | |||||
![]() ![]()  | 
0..* | Reference(Observation) | Observation that resulted from goal | |||||
  Documentation for this format | ||||||||
| Path | Conformance | ValueSet | URI | |||
| Goal.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesFrom the FHIR Standard 
  | ||||
| Goal.lifecycleStatus | required | GoalLifecycleStatushttp://hl7.org/fhir/ValueSet/goal-status|4.0.1From the FHIR Standard  | ||||
| Goal.achievementStatus | preferred | GoalAchievementStatushttp://hl7.org/fhir/ValueSet/goal-achievementFrom the FHIR Standard  | ||||
| Goal.category | example | GoalCategoryhttp://hl7.org/fhir/ValueSet/goal-categoryFrom the FHIR Standard  | ||||
| Goal.priority | preferred | GoalPriorityhttp://hl7.org/fhir/ValueSet/goal-priorityFrom the FHIR Standard  | ||||
| Goal.description | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | ||||
| Goal.start[x] | example | GoalStartEventhttp://hl7.org/fhir/ValueSet/goal-start-eventFrom the FHIR Standard  | ||||
| Goal.target.measure | example | LOINCCodes(a valid code from LOINC)http://hl7.org/fhir/ValueSet/observation-codesFrom the FHIR Standard  | ||||
| Goal.target.detail[x] | example | |||||
| Goal.outcomeCode | example | SNOMEDCTClinicalFindingshttp://hl7.org/fhir/ValueSet/clinical-findingsFrom the FHIR Standard  | 
| Id | Grade | Path(s) | Details | Requirements | 
| dom-2 | error | Goal | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()  | |
| dom-3 | error | Goal | 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 | Goal | 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 | Goal | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()  | |
| dom-6 | best practice | Goal | 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()  | |
| gol-1 | error | Goal.target | Goal.target.measure is required if Goal.target.detail is populated : (detail.exists() and measure.exists()) or detail.exists().not()  | 
This structure is derived from Goal
Other representations of profile: CSV, Excel, Schematron