LK NEHR Sri Lanka Patient Summary (IPS based) Implementation Guide
0.1.0 - STU1 Sri Lanka flag

LK NEHR Sri Lanka Patient Summary (IPS based) Implementation Guide, published by Ministry of Health, Sri Lanka. 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/lk-gov-health-hiu/lk-nehr-fhir-ips/ and changes regularly. See the Directory of published versions

Resource Profile: CVDRiskCategory - Detailed Descriptions

Active as of 2024-09-10

Definitions for the cvd-risk-category resource profile.

Guidance on how to interpret the contents of this table can be found here

0. RiskAssessment
2. RiskAssessment.code
Control1..?
Pattern Value{
  "coding" : [{
    "system" : "http://snomed.info/sct",
    "code" : "441829007"
  }]
}
4. RiskAssessment.subject
TypeReference(Patient)
6. RiskAssessment.encounter
Control1..?
TypeReference(Target Facility Encounter)
8. RiskAssessment.occurrence[x]
Control1..?
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
SlicingThis element introduces a set of slices on RiskAssessment.occurrence[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 10. RiskAssessment.occurrence[x]:occurrenceDateTime
    Slice NameoccurrenceDateTime
    Control1..1
    TypedateTime
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    12. RiskAssessment.performer
    Control1..?
    TypeReference(Practitioner, Device Information)
    14. RiskAssessment.prediction
    Control1..?
    16. RiskAssessment.prediction.outcome
    Control1..?
    18. RiskAssessment.prediction.probability[x]
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on RiskAssessment.prediction.probability[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 20. RiskAssessment.prediction.probability[x]:probabilityDecimal
      Slice NameprobabilityDecimal
      Definition

      reason(s) why this should be supported.

      Control0..1
      Typedecimal
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      22. RiskAssessment.prediction.qualitativeRisk
      Control1..?
      BindingUnless not suitable, these codes SHALL be taken from Cardiovascular Risk Categories
      (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-cvd-risk-category)
      24. RiskAssessment.prediction.when[x]
      Control1..?
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on RiskAssessment.prediction.when[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 26. RiskAssessment.prediction.when[x]:whenRange
        Slice NamewhenRange
        Control1..1
        TypeRange
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]

        Guidance on how to interpret the contents of this table can be found here

        0. RiskAssessment
        Definition

        An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.

        ShortPotential outcomes for a subject with likelihood
        Control0..*
        Is Modifierfalse
        Summaryfalse
        Alternate NamesPrognosis
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        2. RiskAssessment.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. RiskAssessment.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).

        ShortExtensions that cannot be ignored
        Comments

        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.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        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.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        6. RiskAssessment.status
        Definition

        The status of the RiskAssessment, using the same statuses as an Observation.

        Shortregistered | preliminary | final | amended +
        Control1..1
        BindingThe codes SHALL be taken from ObservationStatushttp://hl7.org/fhir/ValueSet/observation-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

        The status of the risk assessment; e.g. preliminary, final, amended, etc.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. RiskAssessment.code
        Definition

        The type of the risk assessment performed.

        ShortType of assessment
        Control10..1
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Pattern Value{
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "441829007"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. RiskAssessment.subject
        Definition

        The patient or group the risk assessment applies to.

        ShortWho/what does assessment apply to?
        Control1..1
        TypeReference(Patient, Patient, Group)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. RiskAssessment.encounter
        Definition

        The encounter where the assessment was performed.

        ShortWhere was assessment performed?
        Control10..1
        TypeReference(Target Facility Encounter, Encounter)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. RiskAssessment.occurrence[x]
        Definition

        The date (and possibly time) the risk assessment was performed.

        ShortWhen was assessment made?
        Control10..1
        TypedateTime, Period
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        The assessment results lose validity the more time elapses from when they are first made.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on RiskAssessment.occurrence[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 16. RiskAssessment.occurrence[x]:occurrenceDateTime
          Slice NameoccurrenceDateTime
          Definition

          The date (and possibly time) the risk assessment was performed.

          ShortWhen was assessment made?
          Control10..1
          TypedateTime, Period
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The assessment results lose validity the more time elapses from when they are first made.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. RiskAssessment.performer
          Definition

          The provider or software application that performed the assessment.

          ShortWho did assessment?
          Control10..1
          TypeReference(Practitioner, Device Information, Practitioner, PractitionerRole, Device)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. RiskAssessment.prediction
          Definition

          Describes the expected outcome for the subject.

          ShortOutcome predicted
          Comments

          Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.

          Control10..*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ras-2: Must be <= 100 (probability is decimal implies (probability as decimal) <= 100)
          ras-2: Must be <= 100 (probability is decimal implies (probability as decimal) <= 100)
          22. RiskAssessment.prediction.modifierExtension
          Definition

          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).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          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.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          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.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          24. RiskAssessment.prediction.outcome
          Definition

          One of the potential outcomes for the patient (e.g. remission, death, a particular condition).

          ShortPossible outcome for the subject
          Control10..1
          Binding

          The condition or other outcome; e.g. death, remission, amputation, infection, etc.

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. RiskAssessment.prediction.probability[x]
          Definition

          Indicates how likely the outcome is (in the specified timeframe).

          ShortLikelihood of specified outcome
          Comments

          If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

          Control0..1
          TypeChoice of: decimal, Range
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
          ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
          SlicingThis element introduces a set of slices on RiskAssessment.prediction.probability[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • type @ $this
          • 28. RiskAssessment.prediction.probability[x]:probabilityDecimal
            Slice NameprobabilityDecimal
            Definition

            reason(s) why this should be supported.


            Indicates how likely the outcome is (in the specified timeframe).

            ShortLikelihood of specified outcome
            Comments

            If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

            Control0..1
            Typedecimal, Range
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
            ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
            30. RiskAssessment.prediction.qualitativeRisk
            Definition

            Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).

            ShortLikelihood of specified outcome as a qualitative value
            Control10..1
            BindingUnless not suitable, these codes SHALL be taken from For example codes, see Cardiovascular Risk Categorieshttp://hl7.org/fhir/ValueSet/risk-probability
            (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-cvd-risk-category)
            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. RiskAssessment.prediction.when[x]
            Definition

            Indicates the period of time or age range of the subject to which the specified probability applies.

            ShortTimeframe or age range
            Comments

            If not specified, the risk applies "over the subject's lifespan".

            Control10..1
            TypeRange, Period
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on RiskAssessment.prediction.when[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
            • type @ $this
            • 34. RiskAssessment.prediction.when[x]:whenRange
              Slice NamewhenRange
              Definition

              Indicates the period of time or age range of the subject to which the specified probability applies.

              ShortTimeframe or age range
              Comments

              If not specified, the risk applies "over the subject's lifespan".

              Control10..1
              TypeRange, Period
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

              Guidance on how to interpret the contents of this table can be found here

              0. RiskAssessment
              Definition

              An assessment of the likely outcome(s) for a patient or other subject as well as the likelihood of each outcome.

              ShortPotential outcomes for a subject with likelihood
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Alternate NamesPrognosis
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              2. RiskAssessment.id
              Definition

              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

              ShortLogical id of this artifact
              Comments

              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

              Control0..1
              Typeid
              Is Modifierfalse
              Summarytrue
              4. RiskAssessment.meta
              Definition

              The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. RiskAssessment.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              ShortA set of rules under which this content was created
              Comments

              Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. RiskAssessment.language
              Definition

              The base language in which the resource is written.

              ShortLanguage of the resource content
              Comments

              Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

              Control0..1
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. RiskAssessment.text
              Definition

              A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

              ShortText summary of the resource, for human interpretation
              Comments

              Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

              Control0..1
              TypeNarrative
              Is Modifierfalse
              Summaryfalse
              Alternate Namesnarrative, html, xhtml, display
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              12. RiskAssessment.contained
              Definition

              These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

              ShortContained, inline Resources
              Comments

              This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

              Control0..*
              TypeResource
              Is Modifierfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. RiskAssessment.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource. 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.

              ShortAdditional content defined by implementations
              Comments

              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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              16. RiskAssessment.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 is allowed to 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).

              ShortExtensions that cannot be ignored
              Comments

              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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              Requirements

              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.

              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              18. RiskAssessment.identifier
              Definition

              Business identifier assigned to the risk assessment.

              ShortUnique identifier for the assessment
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              20. RiskAssessment.basedOn
              Definition

              A reference to the request that is fulfilled by this risk assessment.

              ShortRequest fulfilled by this assessment
              Control0..1
              TypeReference(Resource)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. RiskAssessment.parent
              Definition

              A reference to a resource that this risk assessment is part of, such as a Procedure.

              ShortPart of this occurrence
              Control0..1
              TypeReference(Resource)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. RiskAssessment.status
              Definition

              The status of the RiskAssessment, using the same statuses as an Observation.

              Shortregistered | preliminary | final | amended +
              Control1..1
              BindingThe codes SHALL be taken from ObservationStatus
              (required to http://hl7.org/fhir/ValueSet/observation-status|4.0.1)

              The status of the risk assessment; e.g. preliminary, final, amended, etc.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. RiskAssessment.method
              Definition

              The algorithm, process or mechanism used to evaluate the risk.

              ShortEvaluation mechanism
              Control0..1
              Binding

              The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              The method can influence the results of the assessment.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. RiskAssessment.code
              Definition

              The type of the risk assessment performed.

              ShortType of assessment
              Control1..1
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Pattern Value{
                "coding" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "441829007"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. RiskAssessment.subject
              Definition

              The patient or group the risk assessment applies to.

              ShortWho/what does assessment apply to?
              Control1..1
              TypeReference(Patient)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. RiskAssessment.encounter
              Definition

              The encounter where the assessment was performed.

              ShortWhere was assessment performed?
              Control1..1
              TypeReference(Target Facility Encounter)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. RiskAssessment.occurrence[x]
              Definition

              The date (and possibly time) the risk assessment was performed.

              ShortWhen was assessment made?
              Control1..1
              TypedateTime
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              The assessment results lose validity the more time elapses from when they are first made.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on RiskAssessment.occurrence[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 36. RiskAssessment.occurrence[x]:occurrenceDateTime
                Slice NameoccurrenceDateTime
                Definition

                The date (and possibly time) the risk assessment was performed.

                ShortWhen was assessment made?
                Control1..1
                TypedateTime
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Requirements

                The assessment results lose validity the more time elapses from when they are first made.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. RiskAssessment.condition
                Definition

                For assessments or prognosis specific to a particular condition, indicates the condition being assessed.

                ShortCondition assessed
                Control0..1
                TypeReference(Condition)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                40. RiskAssessment.performer
                Definition

                The provider or software application that performed the assessment.

                ShortWho did assessment?
                Control1..1
                TypeReference(Practitioner, Device Information)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. RiskAssessment.reasonCode
                Definition

                The reason the risk assessment was performed.

                ShortWhy the assessment was necessary?
                Control0..*
                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                44. RiskAssessment.reasonReference
                Definition

                Resources supporting the reason the risk assessment was performed.

                ShortWhy the assessment was necessary?
                Control0..*
                TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                46. RiskAssessment.basis
                Definition

                Indicates the source data considered as part of the assessment (for example, FamilyHistory, Observations, Procedures, Conditions, etc.).

                ShortInformation used in assessment
                Control0..*
                TypeReference(Resource)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                48. RiskAssessment.prediction
                Definition

                Describes the expected outcome for the subject.

                ShortOutcome predicted
                Comments

                Multiple repetitions can be used to identify the same type of outcome in different timeframes as well as different types of outcomes.

                Control1..*
                TypeBackboneElement
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ras-2: Must be <= 100 (probability is decimal implies (probability as decimal) <= 100)
                50. RiskAssessment.prediction.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                52. RiskAssessment.prediction.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. 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.

                ShortAdditional content defined by implementations
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                54. RiskAssessment.prediction.modifierExtension
                Definition

                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).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                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.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                56. RiskAssessment.prediction.outcome
                Definition

                One of the potential outcomes for the patient (e.g. remission, death, a particular condition).

                ShortPossible outcome for the subject
                Control1..1
                Binding

                The condition or other outcome; e.g. death, remission, amputation, infection, etc.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. RiskAssessment.prediction.probability[x]
                Definition

                Indicates how likely the outcome is (in the specified timeframe).

                ShortLikelihood of specified outcome
                Comments

                If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

                Control0..1
                TypeChoice of: decimal, Range
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
                SlicingThis element introduces a set of slices on RiskAssessment.prediction.probability[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • type @ $this
                • 60. RiskAssessment.prediction.probability[x]:probabilityDecimal
                  Slice NameprobabilityDecimal
                  Definition

                  reason(s) why this should be supported.

                  ShortLikelihood of specified outcome
                  Comments

                  If range is used, it represents the lower and upper bounds of certainty; e.g. 40-60% Decimal values are expressed as percentages as well (max = 100).

                  Control0..1
                  Typedecimal
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ras-1: low and high must be percentages, if present ((low.empty() or ((low.code = '%') and (low.system = %ucum))) and (high.empty() or ((high.code = '%') and (high.system = %ucum))))
                  62. RiskAssessment.prediction.qualitativeRisk
                  Definition

                  Indicates how likely the outcome is (in the specified timeframe), expressed as a qualitative value (e.g. low, medium, or high).

                  ShortLikelihood of specified outcome as a qualitative value
                  Control1..1
                  BindingUnless not suitable, these codes SHALL be taken from Cardiovascular Risk Categories
                  (extensible to http://fhir.health.gov.lk/ips/ValueSet/vs-cvd-risk-category)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  64. RiskAssessment.prediction.relativeRisk
                  Definition

                  Indicates the risk for this particular subject (with their specific characteristics) divided by the risk of the population in general. (Numbers greater than 1 = higher risk than the population, numbers less than 1 = lower risk.).

                  ShortRelative likelihood
                  Control0..1
                  Typedecimal
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  Absolute risk is less meaningful than relative risk.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. RiskAssessment.prediction.when[x]
                  Definition

                  Indicates the period of time or age range of the subject to which the specified probability applies.

                  ShortTimeframe or age range
                  Comments

                  If not specified, the risk applies "over the subject's lifespan".

                  Control1..1
                  TypeRange
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on RiskAssessment.prediction.when[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 68. RiskAssessment.prediction.when[x]:whenRange
                    Slice NamewhenRange
                    Definition

                    Indicates the period of time or age range of the subject to which the specified probability applies.

                    ShortTimeframe or age range
                    Comments

                    If not specified, the risk applies "over the subject's lifespan".

                    Control1..1
                    TypeRange
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    70. RiskAssessment.prediction.rationale
                    Definition

                    Additional information explaining the basis for the prediction.

                    ShortExplanation of prediction
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    72. RiskAssessment.mitigation
                    Definition

                    A description of the steps that might be taken to reduce the identified risk(s).

                    ShortHow to reduce risk
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Requirements

                    One of the main reasons for assessing risks is to identify whether interventional steps are needed to reduce risk.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    74. RiskAssessment.note
                    Definition

                    Additional comments about the risk assessment.

                    ShortComments on the risk assessment
                    Control0..*
                    TypeAnnotation
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))