HDRRecommendations
type: StructureDefinition
node role: treeRoot
id:
  v: HDRRecommendations
text:
  status:
    v: extensions
  div: Generated Narrative: StructureDefinition HDRRecommendations Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> HDRRecommendations 0..* Base A.2.9 - Care plan and other recommendations after discharge (eHN) #xD; carePlan 0..* BackboneElement A.2.9.1 - Care plan #xD; title 0..1 string A.2.9.1.1 - Title #xD; addresses 0..* CodeableConcept A.2.9.1.2 - Addresses #xD; description 0..1 string A.2.9.1.3 - Description #xD; planPeriod 0..1 Period A.2.9.1.4 - Plan Period #xD; details 0..* BackboneElement A.2.9.1.5 - Other details #xD; activity 0..* BackboneElement A.2.9.1.6 - Activity #xD; kind 0..1 CodeableConcept A.2.9.1.6.1 - Kind #xD; description 0..1 string A.2.9.1.6.2 - Activity description #xD; attribute 0..* BackboneElement A.2.9.1.6.3 - Specific attributes #xD; medicationSummary 1..* BackboneElement A.2.9.2 - Medication summary #xD; reason 0..* CodeableConcept A.2.9.2.1 - Medication reason #xD; changeReason 0..1 CodeableConcept A.2.9.2.2 - Reason for change #xD; productCode 1..1 CodeableConcept A.2.9.2.3 - Code #xD; productName 1..1 string A.2.9.2.4 - Brand name #xD; activeIngredient 0..* CodeableConcept A.2.9.2.5 - Active ingredient list #xD; strength 0..* Ratio A.2.9.2.6 - Strength #xD; doseForm 0..1 CodeableConcept A.2.9.2.7 - Pharmaceutical dose form #xD; dosageRegimen 0..* BackboneElement A.2.9.2.8 - Dosage Regimen #xD; route 0..1 CodeableConcept A.2.9.2.9 - Route of administration #xD; period 0..1 Period A.2.9.2.10 - Period of treatment #xD; daysSupplied 1..1 BackboneElement A.2.9.2.11 - Days supplied #xD; Recommendations 0..* string A.2.9.3 - Other recommendations #xD; <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
url:
  v: http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/HDRRecommendations
version:
  v: 0.1.0
name:
  v: HdrEHNRecommendations
title:
  v: A.2.9 - Care plan and other recommendations after discharge (eHN)
status:
  v: draft
date:
  v: 2025-10-10T16:32:47+00:00
publisher:
  v: XpanDH Project
contact:
  name:
    v: XpanDH Project
  telecom:
    system:
      v: url
    value:
      v: https://xpandh-project.iscte-iul.pt
description:
  v: Hospital Discharge Report - Care plan and other recommendations after discharge - A.2.9 eHN Maturity Level: 0 Draft
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
    code:
      v: 150
    display:
      v: Europe
copyright:
  v: Used by permission of the XpanDH project, all rights reserved Creative Commons License
fhir version:
  v: 4.0.1
kind:
  v: logical
abstract:
  v: false
type:
  v: http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/HDRRecommendations
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      v: A.2.9 - Care plan and other recommendations after discharge (eHN)
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      v: A.2.9.1 - Care plan
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comment:
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id:
  v: HDRRecommendations.carePlan.title
path:
  v: HDRRecommendations.carePlan.title
short:
  v: A.2.9.1.1 - Title
definition:
  v: Human-friendly name for the care plan (e.g. Hip replacement care plan)
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id:
  v: HDRRecommendations.carePlan.addresses
path:
  v: HDRRecommendations.carePlan.addresses
short:
  v: A.2.9.1.2 - Addresses
definition:
  v: Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. This element provides a linkage to the conditions recorded in the diagnostic summary section.
comment:
  v: ICD-10* SNOMED CT Orphacode if rare disease is diagnosed
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id:
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short:
  v: A.2.9.1.3 - Description
definition:
  v: A description of the scope and nature of the plan.
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id:
  v: HDRRecommendations.carePlan.planPeriod
path:
  v: HDRRecommendations.carePlan.planPeriod
short:
  v: A.2.9.1.4 - Plan Period
definition:
  v: Indicates when the plan did (or is intended to) come into effect and end.
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id:
  v: HDRRecommendations.carePlan.details
path:
  v: HDRRecommendations.carePlan.details
short:
  v: A.2.9.1.5 - Other details
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  v: Other structured and coded details, care team, goals to be achieved.
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id:
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path:
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short:
  v: A.2.9.1.6 - Activity
definition:
  v: Actions to occur as part of the plan.
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comment:
  v: 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.
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id:
  v: HDRRecommendations.carePlan.activity.kind
path:
  v: HDRRecommendations.carePlan.activity.kind
short:
  v: A.2.9.1.6.1 - Kind
definition:
  v: A description of the type of care plan activity. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.
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short:
  v: A.2.9.1.6.3 - Specific attributes
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  v: Specific structured attributes per each activity type expressed by the Activity kind element, E.g., specific attributes for prescription request, appointment, etc.
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id:
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  v: A.2.9.2 - Medication summary
definition:
  v: Summary information on the medication recommended for the period after discharge, indicating whether the medication is changed or newly started. Compared to previous practices, the overview is supplemented with medication that has been discontinued.
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    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: HDRRecommendations.medicationSummary.modifierExtension
path:
  v: HDRRecommendations.medicationSummary.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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).
alias:
  v: extensions
alias:
  v: user content
alias:
  v: modifiers
min:
  v: 0
max:
  v: *
base:
  path:
    v: BackboneElement.modifierExtension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    link: http://hl7.org/fhir/StructureDefinition/Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
  source:
    v: http://hl7.org/fhir/StructureDefinition/Extension
    link: http://hl7.org/fhir/StructureDefinition/Extension
is modifier:
  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: HDRRecommendations.medicationSummary.reason
path:
  v: HDRRecommendations.medicationSummary.reason
short:
  v: A.2.9.2.1 - Medication reason
definition:
  v: The reason why the medication is or was prescribed or used. It provides a link to the Past or current health condition(s) or problem(s) that the patient has had or has and for which this medication was prescribed.
comment:
  v: ICD-10* SNOMED CT Orphacode if rare disease is diagnosed
min:
  v: 0
max:
  v: *
base:
  path:
    v: HDRRecommendations.medicationSummary.reason
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.changeReason
path:
  v: HDRRecommendations.medicationSummary.changeReason
short:
  v: A.2.9.2.2 - Reason for change
definition:
  v: Reason for change of medication
comment:
  v: hl7:reason-medication-status-codes
min:
  v: 0
max:
  v: 1
base:
  path:
    v: HDRRecommendations.medicationSummary.changeReason
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.productCode
path:
  v: HDRRecommendations.medicationSummary.productCode
short:
  v: A.2.9.2.3 - Code
definition:
  v: Product code.
comment:
  v: IDMP
min:
  v: 1
max:
  v: 1
base:
  path:
    v: HDRRecommendations.medicationSummary.productCode
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.productName
path:
  v: HDRRecommendations.medicationSummary.productName
short:
  v: A.2.9.2.4 - Brand name
definition:
  v: Brand name if biological medicinal product or when justified by the health professional (ref. Commission Directive 2012/52/EU)
min:
  v: 1
max:
  v: 1
base:
  path:
    v: HDRRecommendations.medicationSummary.productName
  min:
    v: 1
  max:
    v: 1
type:
  code:
    v: string

id:
  v: HDRRecommendations.medicationSummary.activeIngredient
path:
  v: HDRRecommendations.medicationSummary.activeIngredient
short:
  v: A.2.9.2.5 - Active ingredient list
definition:
  v: Substance that alone or in combination with one or more other ingredients produces the intended activity of a medicinal product. Example: \"paracetamol\"
comment:
  v: ATC (IDMP / EMA SPOR SMS)
min:
  v: 0
max:
  v: *
base:
  path:
    v: HDRRecommendations.medicationSummary.activeIngredient
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    v: 0
  max:
    v: *
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.strength
path:
  v: HDRRecommendations.medicationSummary.strength
short:
  v: A.2.9.2.6 - Strength
definition:
  v: The content of the active ingredient expressed quantifiably per dosage unit, per unit of volume or per unit of weight, according to the pharmaceutical dose form. Example: 500 mg per tablet
comment:
  v: UCUM EDQM Standard terms
min:
  v: 0
max:
  v: *
base:
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    v: HDRRecommendations.medicationSummary.strength
  min:
    v: 0
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    v: *
type:
  code:
    v: Ratio

id:
  v: HDRRecommendations.medicationSummary.doseForm
path:
  v: HDRRecommendations.medicationSummary.doseForm
short:
  v: A.2.9.2.7 - Pharmaceutical dose form
definition:
  v: The form in which a pharmaceutical product is presented in the medicinal product package (e.g. tablet, syrup)
comment:
  v: EDQM Standard terms
min:
  v: 0
max:
  v: 1
base:
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    v: HDRRecommendations.medicationSummary.doseForm
  min:
    v: 0
  max:
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type:
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    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.dosageRegimen
path:
  v: HDRRecommendations.medicationSummary.dosageRegimen
short:
  v: A.2.9.2.8 - Dosage Regimen
definition:
  v: Number of units per intake and frequency of intake over a specified duration of time. Example: 1 tablet every 24h, for 10 days
min:
  v: 0
max:
  v: *
base:
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type:
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id:
  v: HDRRecommendations.medicationSummary.route
path:
  v: HDRRecommendations.medicationSummary.route
short:
  v: A.2.9.2.9 - Route of administration
definition:
  v: Path by which the pharmaceutical product is taken into or makes contact with the body.
comment:
  v: EDQM Standard terms
min:
  v: 0
max:
  v: 1
base:
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    v: HDRRecommendations.medicationSummary.route
  min:
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type:
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    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.period
path:
  v: HDRRecommendations.medicationSummary.period
short:
  v: A.2.9.2.10 - Period of treatment
definition:
  v: The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking).
min:
  v: 0
max:
  v: 1
base:
  path:
    v: HDRRecommendations.medicationSummary.period
  min:
    v: 0
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type:
  code:
    v: Period

id:
  v: HDRRecommendations.medicationSummary.daysSupplied
path:
  v: HDRRecommendations.medicationSummary.daysSupplied
short:
  v: A.2.9.2.11 - Days supplied
definition:
  v: Number of days for which the patient was provided with the drug. Supply is intended to either hand over the medicine or write out a prescription. A 0 value indicates that the patient has not been provided with the drug (e.g. if the patient has a sufficient supply of the drug)
comment:
  v: UCUM
min:
  v: 1
max:
  v: 1
base:
  path:
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  min:
    v: 1
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type:
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    v: BackboneElement

id:
  v: HDRRecommendations.Recommendations
path:
  v: HDRRecommendations.Recommendations
short:
  v: A.2.9.3 - Other recommendations
definition:
  v: Other recommendations (advice) after discharge. Multiple recommendations could be provided. E.g., recommendation to suggest hip replacement, reduce number of cigarettes, stop smoking, increase physical exercises, etc.
min:
  v: 0
max:
  v: *
base:
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    v: HDRRecommendations.Recommendations
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    v: *
type:
  code:
    v: string

element:
  id:
    v: HDRRecommendations
  path:
    v: HDRRecommendations
  short:
    v: A.2.9 - Care plan and other recommendations after discharge (eHN)
  definition:
    v: Hospital Discharge Report - Care plan and other recommendations after discharge - A.2.9 eHN Maturity Level: 0 Draft
element:
  id:
    v: HDRRecommendations.carePlan
  path:
    v: HDRRecommendations.carePlan
  short:
    v: A.2.9.1 - Care plan
  definition:
    v: Care plan after discharge. Multiple care plans could be provided.
  min:
    v: 0
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  type:
    code:
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element:
  id:
    v: HDRRecommendations.carePlan.title
  path:
    v: HDRRecommendations.carePlan.title
  short:
    v: A.2.9.1.1 - Title
  definition:
    v: Human-friendly name for the care plan (e.g. Hip replacement care plan)
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
element:
  id:
    v: HDRRecommendations.carePlan.addresses
  path:
    v: HDRRecommendations.carePlan.addresses
  short:
    v: A.2.9.1.2 - Addresses
  definition:
    v: Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. This element provides a linkage to the conditions recorded in the diagnostic summary section.
  comment:
    v: ICD-10* SNOMED CT Orphacode if rare disease is diagnosed
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: CodeableConcept
element:
  id:
    v: HDRRecommendations.carePlan.description
  path:
    v: HDRRecommendations.carePlan.description
  short:
    v: A.2.9.1.3 - Description
  definition:
    v: A description of the scope and nature of the plan.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
element:
  id:
    v: HDRRecommendations.carePlan.planPeriod
  path:
    v: HDRRecommendations.carePlan.planPeriod
  short:
    v: A.2.9.1.4 - Plan Period
  definition:
    v: Indicates when the plan did (or is intended to) come into effect and end.
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Period
element:
  id:
    v: HDRRecommendations.carePlan.details
  path:
    v: HDRRecommendations.carePlan.details
  short:
    v: A.2.9.1.5 - Other details
  definition:
    v: Other structured and coded details, care team, goals to be achieved.
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: BackboneElement
element:
  id:
    v: HDRRecommendations.carePlan.activity
  path:
    v: HDRRecommendations.carePlan.activity
  short:
    v: A.2.9.1.6 - Activity
  definition:
    v: Actions to occur as part of the plan.
  min:
    v: 0
  max:
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element:
  id:
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  path:
    v: HDRRecommendations.carePlan.activity.kind
  short:
    v: A.2.9.1.6.1 - Kind
  definition:
    v: A description of the type of care plan activity. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.
  comment:
    v: hl7:resource-types
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: CodeableConcept
element:
  id:
    v: HDRRecommendations.carePlan.activity.description
  path:
    v: HDRRecommendations.carePlan.activity.description
  short:
    v: A.2.9.1.6.2 - Activity description
  definition:
    v: A detailed description of the activity.
  min:
    v: 0
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    v: 1
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    code:
      v: string
element:
  id:
    v: HDRRecommendations.carePlan.activity.attribute
  path:
    v: HDRRecommendations.carePlan.activity.attribute
  short:
    v: A.2.9.1.6.3 - Specific attributes
  definition:
    v: Specific structured attributes per each activity type expressed by the Activity kind element, E.g., specific attributes for prescription request, appointment, etc.
  min:
    v: 0
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    v: *
  type:
    code:
      v: BackboneElement
element:
  id:
    v: HDRRecommendations.medicationSummary
  path:
    v: HDRRecommendations.medicationSummary
  short:
    v: A.2.9.2 - Medication summary
  definition:
    v: Summary information on the medication recommended for the period after discharge, indicating whether the medication is changed or newly started. Compared to previous practices, the overview is supplemented with medication that has been discontinued.
  min:
    v: 1
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  type:
    code:
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element:
  id:
    v: HDRRecommendations.medicationSummary.reason
  path:
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  short:
    v: A.2.9.2.1 - Medication reason
  definition:
    v: The reason why the medication is or was prescribed or used. It provides a link to the Past or current health condition(s) or problem(s) that the patient has had or has and for which this medication was prescribed.
  comment:
    v: ICD-10* SNOMED CT Orphacode if rare disease is diagnosed
  min:
    v: 0

v: *

code:
  v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.changeReason
path:
  v: HDRRecommendations.medicationSummary.changeReason
short:
  v: A.2.9.2.2 - Reason for change
definition:
  v: Reason for change of medication
comment:
  v: hl7:reason-medication-status-codes
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.productCode
path:
  v: HDRRecommendations.medicationSummary.productCode
short:
  v: A.2.9.2.3 - Code
definition:
  v: Product code.
comment:
  v: IDMP
min:
  v: 1
max:
  v: 1
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.productName
path:
  v: HDRRecommendations.medicationSummary.productName
short:
  v: A.2.9.2.4 - Brand name
definition:
  v: Brand name if biological medicinal product or when justified by the health professional (ref. Commission Directive 2012/52/EU)
min:
  v: 1
max:
  v: 1
type:
  code:
    v: string

id:
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path:
  v: HDRRecommendations.medicationSummary.activeIngredient
short:
  v: A.2.9.2.5 - Active ingredient list
definition:
  v: Substance that alone or in combination with one or more other ingredients produces the intended activity of a medicinal product. Example: \"paracetamol\"
comment:
  v: ATC (IDMP / EMA SPOR SMS)
min:
  v: 0
max:
  v: *
type:
  code:
    v: CodeableConcept

id:
  v: HDRRecommendations.medicationSummary.strength
path:
  v: HDRRecommendations.medicationSummary.strength
short:
  v: A.2.9.2.6 - Strength
definition:
  v: The content of the active ingredient expressed quantifiably per dosage unit, per unit of volume or per unit of weight, according to the pharmaceutical dose form. Example: 500 mg per tablet
comment:
  v: UCUM EDQM Standard terms
min:
  v: 0
max:
  v: *
type:
  code:
    v: Ratio

id:
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path:
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short:
  v: A.2.9.2.7 - Pharmaceutical dose form
definition:
  v: The form in which a pharmaceutical product is presented in the medicinal product package (e.g. tablet, syrup)
comment:
  v: EDQM Standard terms
min:
  v: 0
max:
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type:
  code:
    v: CodeableConcept

id:
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path:
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short:
  v: A.2.9.2.8 - Dosage Regimen
definition:
  v: Number of units per intake and frequency of intake over a specified duration of time. Example: 1 tablet every 24h, for 10 days
min:
  v: 0
max:
  v: *
type:
  code:
    v: BackboneElement

id:
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path:
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short:
  v: A.2.9.2.9 - Route of administration
definition:
  v: Path by which the pharmaceutical product is taken into or makes contact with the body.
comment:
  v: EDQM Standard terms
min:
  v: 0
max:
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type:
  code:
    v: CodeableConcept

id:
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path:
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short:
  v: A.2.9.2.10 - Period of treatment
definition:
  v: The interval of time during which it is being asserted that the patient is/was/will be taking the medication (or was not taking).
min:
  v: 0
max:
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type:
  code:
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id:
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path:
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short:
  v: A.2.9.2.11 - Days supplied
definition:
  v: Number of days for which the patient was provided with the drug. Supply is intended to either hand over the medicine or write out a prescription. A 0 value indicates that the patient has not been provided with the drug (e.g. if the patient has a sufficient supply of the drug)
comment:
  v: UCUM
min:
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max:
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type:
  code:
    v: BackboneElement

id:
  v: HDRRecommendations.Recommendations
path:
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short:
  v: A.2.9.3 - Other recommendations
definition:
  v: Other recommendations (advice) after discharge. Multiple recommendations could be provided. E.g., recommendation to suggest hip replacement, reduce number of cigarettes, stop smoking, increase physical exercises, etc.
min:
  v: 0
max:
  v: *
type:
  code:
    v: string