XpanDH Hospital Discharge Report
0.1.0 - ci-build 150

XpanDH Hospital Discharge Report, published by XpanDH Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/xpandh-hdr/ and changes regularly. See the Directory of published versions

## Resource Profile: Xpandh Clinical Impression Profile

Official URL: http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/clinical-impression-hdr-xpandh | Version: 0.1.0
Draft as of 2025-10-10 | Computable Name: ClinicalImpressionHdrXpandh
Copyright/Legal: Used by permission of the XpanDH project, all rights reserved Creative Commons License

This profile represents the constraints applied to the ClinicalImpression resource by the Xpandh FHIR Implementation Guide.

Usages:

- Refer to this Profile: Composition: Hospital Discharge Report

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 | Xpandh Clinical Impression Profile
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(Patient: HDR) | Patient or group assessed
assessor | Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
problem | Σ | 0..* | Reference(Condition Xpandh Profile | Xpandh Alergy Intolerance Profile) | Relevant impressions of patient state
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 |  | 0..* | ClinicalImpression | Xpandh Clinical Impression Profile
code |  | 0..0 |  |
subject |  | 1..1 | Reference(Patient: HDR) | Patient or group assessed
assessor |  | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
problem |  | 0..* | Reference(Condition Xpandh Profile | Xpandh Alergy Intolerance Profile) | Relevant impressions of patient state
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | Xpandh Clinical Impression Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(Patient: HDR) | Patient or group assessed
encounter | Σ | 0..1 | Reference(Encounter) | 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 Xpandh Profile | Xpandh Alergy Intolerance Profile) | 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 |  | 0..1 | string | Summary of the assessment
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.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 Stated | 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

Prohibited: 1 element

Structures

This structure refers to these other structures:

- Patient: HDR (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/Patient-eu-xpandh)
- Practitioner (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/Practitioner-eu-xpandh)
- PractitionerRole (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/PractitionerRole-eu-xpandh)
- Condition Xpandh Profile (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/condition-hdr-xpandh)
- Xpandh Alergy Intolerance Profile (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/allergy-intolerance-xpandh)

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | Xpandh Clinical Impression Profile
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(Patient: HDR) | Patient or group assessed
assessor | Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
problem | Σ | 0..* | Reference(Condition Xpandh Profile | Xpandh Alergy Intolerance Profile) | Relevant impressions of patient state
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 |  | 0..* | ClinicalImpression | Xpandh Clinical Impression Profile
code |  | 0..0 |  |
subject |  | 1..1 | Reference(Patient: HDR) | Patient or group assessed
assessor |  | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment
problem |  | 0..* | Reference(Condition Xpandh Profile | Xpandh Alergy Intolerance Profile) | Relevant impressions of patient state
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
ClinicalImpression |  | 0..* | ClinicalImpression | Xpandh Clinical Impression Profile
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
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.
description | Σ | 0..1 | string | Why/how the assessment was performed
subject | Σ | 1..1 | Reference(Patient: HDR) | Patient or group assessed
encounter | Σ | 0..1 | Reference(Encounter) | 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 Xpandh Profile | Xpandh Alergy Intolerance Profile) | 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 |  | 0..1 | string | Summary of the assessment
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.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 Stated | 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

Prohibited: 1 element

Structures

This structure refers to these other structures:

- Patient: HDR (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/Patient-eu-xpandh)
- Practitioner (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/Practitioner-eu-xpandh)
- PractitionerRole (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/PractitionerRole-eu-xpandh)
- Condition Xpandh Profile (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/condition-hdr-xpandh)
- Xpandh Alergy Intolerance Profile (http://hl7.eu/fhir/ig/xpandh/hdr/StructureDefinition/allergy-intolerance-xpandh)

Other representations of profile: CSV, Excel, Schematron