PanCareSurPass Project HL7 FHIR Implementation Guide
1.0.0 - release 150

PanCareSurPass Project HL7 FHIR Implementation Guide, published by PanCareSurPass Project. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/pcsp/ and changes regularly. See the Directory of published versions

## Logical Model: Care Plan

Official URL: http://hl7.eu/fhir/ig/pcsp/StructureDefinition/PlanOfCare | Version: 1.0.0
Active as of 2026-01-16 | Computable Name: PlanOfCare

Care Plan

Usages:

- Use this Logical Model: SurPass V2.0

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
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
@id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Base

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
@id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Base

Summary

Mandatory: 0 element(2 nested mandatory elements)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
@id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Base

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
PlanOfCare |  | 0..* | Base | Care Plan
identifier |  | 1..* | Identifier | Care plan Identifier
addressedProblem |  | 0..* | Identifier | Problems addressed by this plan
author |  | 0..1 | BackboneElement | Author
creationTime |  | 0..1 | dateTime | Date the plan was created
note |  | 0..1 | string | Plan note
chronicConditions |  | 0..1 | string | Chronic condition
reccomandation |  | 1..* | BackboneElement | Reccomandation
@id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
riskFactor |  | 0..* | CodeableConcept | Risk factors
conditionAtRisk |  | 0..* | CodeableConcept | Conditions at risk
reccomandation |  | 0..1 | CodeableConcept | Suggested reccomandation
note |  | 0..1 | string | Note
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Description | Expression
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 Base

Summary

Mandatory: 0 element(2 nested mandatory elements)

Other representations of profile: CSV, Excel