New Zealand Rheumatic Fever FHIR Implementation Guide
1.0.0 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide, published by Te Whatu Ora. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/tewhatuora/fhir-rheumatic-fever/ and changes regularly. See the Directory of published versions

Resource Profile: RheumaticFeverCondition - Detailed Descriptions

Draft as of 2024-09-26

Definitions for the nz-rheumaticfever-condition resource profile.

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

0. Condition
InvariantsRFConditionNZCategoryConstraint: All RF Condition instances shall have a category #rf-nz (NZ rheumatic fever code defined in this IG) (Condition.category.where(coding.code='rf-nz').exists())
RFConditionSNOMEDCategoryConstraint: All RF Condition instances shall have a category SNOMED #58718002 'Rheumatic fever (disorder)' (Condition.category.where(coding.code='58718002').exists())
2. Condition.meta
InvariantsRFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
4. Condition.implicitRules
Control0..0
6. Condition.language
Control0..0
8. Condition.extension:rhdSeverity
Slice NamerhdSeverity
Control0..1
TypeExtension(Severity of rheumatic heart disease) (Extension Type: Coding)
10. Condition.extension:diagnosticCertainty
Slice NamediagnosticCertainty
Short**This certainty code MUST be interpreted in conjunction with the patient's diagnosis in the .code element**
Control0..1
TypeExtension(Certainty of rheumatic fever diagnosis) (Extension Type: Coding)
12. Condition.extension:assessmentDate
Slice NameassessmentDate
Shortdate (dateTime value in UTC timezone) of RHD severity assessment
Control0..1
TypeExtension(Date of assessment of rheumatic heart disease severity) (Extension Type: dateTime)
14. Condition.extension:symptomStatusAtDiagnosis
Slice NamesymptomStatusAtDiagnosis
Control0..1
TypeExtension(Symptom status at diagnosis) (Extension Type: Coding)
16. Condition.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
SlicingThis element introduces a set of slices on Condition.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ use
  • 18. Condition.identifier:NationalSystem
    Slice NameNationalSystem
    ShortThis stores the identifier of the corresponding record in the national system (RFCCS) to let it be kept in sync with FHIR.
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    20. Condition.identifier:NationalSystem.id
    Control0..0
    22. Condition.identifier:NationalSystem.extension
    Control0..0
    24. Condition.identifier:NationalSystem.use
    Control1..?
    Pattern Valueusual
    26. Condition.identifier:NationalSystem.type
    Control1..?
    BindingThe codes SHALL be taken from External identifier type codes
    (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/external-system-identifier-type-code)
    28. Condition.identifier:NationalSystem.system
    Example<br/><b>uri</b>:https://standards.digital.health.nz/ns/rfccs
    30. Condition.identifier:NationalSystem.value
    Control1..?
    Example<br/><b>RFCCS object id</b>:CON-0206
    32. Condition.category
    Control1..?
    34. Condition.code
    ShortMust be one of the diagnosis codes
    Control1..?
    BindingThe codes SHALL be taken from Codes for summary diagnosis of the rheumatic fever condition
    (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-condition-diagnosis-code)
    36. Condition.subject
    ShortMust be a reference to Patient instance using the rheumatic fever profile
    TypeReference(Rheumatic Fever Patient)
    38. Condition.onset[x]
    ShortThe date (UTC dateTime) when rheumatic fever was thought to have begun
    TypedateTime, string, Period, Range, Age
    [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
    40. Condition.recordedDate
    ShortThe date (UTC dateTime) of diagnosis
    42. Condition.recorder
    TypeReference(Practitioner)
    44. Condition.stage
    Control0..0
    46. Condition.evidence
    Control0..3
    48. Condition.evidence.extension
    Control0..0
    50. Condition.evidence.modifierExtension
    Control0..0
    52. Condition.evidence.code
    ShortIdentifies the GROUPing of diagnosis data in the linked Observation instance
    BindingThe codes SHOULD be taken from Codes for rheumatic fever diagnosis observation grouping
    (preferred to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-observation-diagnosisgroup-code)
    54. Condition.evidence.detail
    ShortLinks up to 3 Observation instances (all using the RF diagnosis group profile) to represent diagnosis detail
    TypeReference(Rheumatic Fever Diagnosis Group)

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

    0. Condition
    Definition

    A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

    ShortDetailed information about conditions, problems or diagnoses
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    dom-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())
    RFConditionNZCategoryConstraint: All RF Condition instances shall have a category #rf-nz (NZ rheumatic fever code defined in this IG) (Condition.category.where(coding.code='rf-nz').exists())
    RFConditionSNOMEDCategoryConstraint: All RF Condition instances shall have a category SNOMED #58718002 'Rheumatic fever (disorder)' (Condition.category.where(coding.code='58718002').exists())
    con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    2. Condition.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()))
    RFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
    4. Condition.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..01
    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()))
    6. Condition.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..01
    BindingThe codes SHOULD be taken from CommonLanguageshttp://hl7.org/fhir/ValueSet/languages
    (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()))
    8. Condition.extension:long-term-condition
    Slice Namelong-term-condition
    Definition

    Long Term Condition Indicator. A long term condition can be defined as any ongoing, long term or recurring conditions that can have a significant impact on people’s lives.

    ShortLong Term Condition Indicator
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Long Term Condition Indicator) (Extension Type: boolean)
    Is Modifierfalse
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Condition.extension:rhdSeverity
    Slice NamerhdSeverity
    Definition

    Severity of rheumatic heart disease determines the severity of a patient's rheumatic fever condition.

    ShortSeverity of rheumatic heart disease
    Control0..1
    TypeExtension(Severity of rheumatic heart disease) (Extension Type: Coding)
    Is Modifierfalse
    Summaryfalse
    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())
    12. Condition.extension:diagnosticCertainty
    Slice NamediagnosticCertainty
    Definition

    Certainty of rheumatic fever diagnosis

    Short**This certainty code MUST be interpreted in conjunction with the patient's diagnosis in the .code element**
    Control0..1
    TypeExtension(Certainty of rheumatic fever diagnosis) (Extension Type: Coding)
    Is Modifierfalse
    Summaryfalse
    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())
    14. Condition.extension:assessmentDate
    Slice NameassessmentDate
    Definition

    Tracks the RF-specific date when rheumatic heart disease severity was assessed.

    Shortdate (dateTime value in UTC timezone) of RHD severity assessment
    Control0..1
    TypeExtension(Date of assessment of rheumatic heart disease severity) (Extension Type: dateTime)
    Is Modifierfalse
    Summaryfalse
    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. Condition.extension:symptomStatusAtDiagnosis
    Slice NamesymptomStatusAtDiagnosis
    Definition

    Symptom status at time of rheumatic fever diagnosis

    ShortSymptom status at diagnosis
    Control0..1
    TypeExtension(Symptom status at diagnosis) (Extension Type: Coding)
    Is Modifierfalse
    Summaryfalse
    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. Condition.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())
    20. Condition.identifier
    Definition

    Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

    ShortExternal Ids for this condition
    Comments

    This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    Summarytrue
    Requirements

    Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

    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 Condition.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ use
    • 22. Condition.identifier:NationalSystem
      Slice NameNationalSystem
      Definition

      Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

      ShortThis stores the identifier of the corresponding record in the national system (RFCCS) to let it be kept in sync with FHIR.External Ids for this condition
      Comments

      This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Condition.identifier:NationalSystem.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..01
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      26. Condition.identifier:NationalSystem.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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..0*
      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())
      SlicingThis element introduces a set of slices on Condition.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 28. Condition.identifier:NationalSystem.use
        Definition

        The purpose of this identifier.

        Shortusual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control10..1
        BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Pattern Valueusual
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Condition.identifier:NationalSystem.type
        Definition

        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

        ShortDescription of identifier
        Comments

        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

        Control10..1
        BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from External identifier type codeshttp://hl7.org/fhir/ValueSet/identifier-type
        (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/external-system-identifier-type-code)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows users to make use of identifiers when the identifier system is not known.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Condition.identifier:NationalSystem.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        ShortThe namespace for the identifier value
        Comments

        Identifier.system is always case sensitive.

        Control0..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Example<br/><b>General</b>:http://www.acme.com/identifiers/patient <br/><b>uri</b>:https://standards.digital.health.nz/ns/rfccs
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Condition.identifier:NationalSystem.value
        Definition

        The portion of the identifier typically relevant to the user and which is unique within the context of the system.

        ShortThe value that is unique
        Comments

        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control10..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Example<br/><b>General</b>:123456 <br/><b>RFCCS object id</b>:CON-0206
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Condition.clinicalStatus
        Definition

        The clinical status of the condition.

        Shortactive | recurrence | relapse | inactive | remission | resolved
        Comments

        The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

        Control0..1
        This element is affected by the following invariants: con-3, con-4, con-5
        BindingThe codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
        (required to http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1)

        The clinical status of the condition or diagnosis.

        TypeCodeableConcept
        Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Condition.verificationStatus
        Definition

        The verification status to support the clinical status of the condition.

        Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
        Comments

        verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

        Control0..1
        This element is affected by the following invariants: con-3, con-5
        BindingThe codes SHALL be taken from ConditionVerificationStatushttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1)

        The verification status to support or decline the clinical status of the condition or diagnosis.

        TypeCodeableConcept
        Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Condition.category
        Definition

        A category assigned to the condition.

        Shortproblem-list-item | encounter-diagnosis
        Comments

        The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

        Control10..*
        BindingUnless not suitable, these codes SHALL be taken from ConditionCategoryCodeshttp://hl7.org/fhir/ValueSet/condition-category
        (extensible to http://hl7.org/fhir/ValueSet/condition-category)

        A category assigned to the condition.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Condition.code
        Definition

        Identification of the condition, problem or diagnosis.

        ShortMust be one of the diagnosis codesIdentification of the condition, problem or diagnosis
        Control10..1
        BindingThe codes SHALL be taken from For example codes, see Codes for summary diagnosis of the rheumatic fever conditionhttp://hl7.org/fhir/ValueSet/condition-code
        (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-condition-diagnosis-code)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Requirements

        0..1 to account for primarily narrative only resources.

        Alternate Namestype
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Condition.subject
        Definition

        Indicates the patient or group who the condition record is associated with.

        ShortMust be a reference to Patient instance using the rheumatic fever profileWho has the condition?
        Control1..1
        TypeReference(Rheumatic Fever Patient, Patient, Group)
        Is Modifierfalse
        Summarytrue
        Requirements

        Group is typically used for veterinary or public health use cases.

        Alternate Namespatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Condition.onset[x]
        Definition

        Estimated or actual date or date-time the condition began, in the opinion of the clinician.

        ShortThe date (UTC dateTime) when rheumatic fever was thought to have begunEstimated or actual date, date-time, or age
        Comments

        Age is generally used when the patient reports an age at which the Condition began to occur.

        Control0..1
        TypedateTime, string, Period, Range, Age
        [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
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Condition.recordedDate
        Definition

        The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

        ShortThe date (UTC dateTime) of diagnosisDate record was first recorded
        Control0..1
        TypedateTime
        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()))
        50. Condition.recorder
        Definition

        Individual who recorded the record and takes responsibility for its content.

        ShortWho recorded the condition
        Control0..1
        TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. Condition.stage
        Definition

        Clinical stage or grade of a condition. May include formal severity assessments.

        ShortStage/grade, usually assessed formally
        Control0..0*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        con-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
        55. Condition.evidence
        Definition

        Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

        ShortSupporting evidence
        Comments

        The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

        Control0..3*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        con-2: evidence SHALL have code or details (code.exists() or detail.exists())
        57. Condition.evidence.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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..0*
        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())
        59. Condition.evidence.modifierExtension
        Definition

        An Extension


        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).

        ShortExtensionExtensions 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..0*
        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())
        61. Condition.evidence.code
        Definition

        A manifestation or symptom that led to the recording of this condition.

        ShortIdentifies the GROUPing of diagnosis data in the linked Observation instanceManifestation/symptom
        Control0..*
        This element is affected by the following invariants: con-2
        BindingThe codes SHOULD be taken from For example codes, see Codes for rheumatic fever diagnosis observation groupinghttp://hl7.org/fhir/ValueSet/manifestation-or-symptom
        (preferred to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-observation-diagnosisgroup-code)
        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        63. Condition.evidence.detail
        Definition

        Links to other relevant information, including pathology reports.

        ShortLinks up to 3 Observation instances (all using the RF diagnosis group profile) to represent diagnosis detailSupporting information found elsewhere
        Control0..*
        This element is affected by the following invariants: con-2
        TypeReference(Rheumatic Fever Diagnosis Group, Resource)
        Is Modifierfalse
        Summarytrue
        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. Condition
        Definition

        A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

        ShortDetailed information about conditions, problems or diagnoses
        Control0..*
        Is Modifierfalse
        Summaryfalse
        Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
        con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
        con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
        dom-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())
        RFConditionNZCategoryConstraint: All RF Condition instances shall have a category #rf-nz (NZ rheumatic fever code defined in this IG) (Condition.category.where(coding.code='rf-nz').exists())
        RFConditionSNOMEDCategoryConstraint: All RF Condition instances shall have a category SNOMED #58718002 'Rheumatic fever (disorder)' (Condition.category.where(coding.code='58718002').exists())
        2. Condition.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. Condition.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()))
        RFNZTagConstraint: All instances shall have an #rf-nz meta.tag (the NZ rheumatic fever generic code defined in this IG) (tag.code contains 'rf-nz')
        6. Condition.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..0
        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. Condition.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..0
        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. Condition.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. Condition.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. Condition.extension
        Definition

        An Extension

        ShortExtension
        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        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())
        SlicingThis element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. Condition.extension:long-term-condition
          Slice Namelong-term-condition
          Definition

          Long Term Condition Indicator. A long term condition can be defined as any ongoing, long term or recurring conditions that can have a significant impact on people’s lives.

          ShortLong Term Condition Indicator
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Long Term Condition Indicator) (Extension Type: boolean)
          Is Modifierfalse
          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. Condition.extension:rhdSeverity
          Slice NamerhdSeverity
          Definition

          Severity of rheumatic heart disease determines the severity of a patient's rheumatic fever condition.

          ShortSeverity of rheumatic heart disease
          Control0..1
          TypeExtension(Severity of rheumatic heart disease) (Extension Type: Coding)
          Is Modifierfalse
          Summaryfalse
          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())
          20. Condition.extension:diagnosticCertainty
          Slice NamediagnosticCertainty
          Definition

          Certainty of rheumatic fever diagnosis

          Short**This certainty code MUST be interpreted in conjunction with the patient's diagnosis in the .code element**
          Control0..1
          TypeExtension(Certainty of rheumatic fever diagnosis) (Extension Type: Coding)
          Is Modifierfalse
          Summaryfalse
          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())
          22. Condition.extension:assessmentDate
          Slice NameassessmentDate
          Definition

          Tracks the RF-specific date when rheumatic heart disease severity was assessed.

          Shortdate (dateTime value in UTC timezone) of RHD severity assessment
          Control0..1
          TypeExtension(Date of assessment of rheumatic heart disease severity) (Extension Type: dateTime)
          Is Modifierfalse
          Summaryfalse
          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. Condition.extension:symptomStatusAtDiagnosis
          Slice NamesymptomStatusAtDiagnosis
          Definition

          Symptom status at time of rheumatic fever diagnosis

          ShortSymptom status at diagnosis
          Control0..1
          TypeExtension(Symptom status at diagnosis) (Extension Type: Coding)
          Is Modifierfalse
          Summaryfalse
          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())
          26. Condition.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())
          28. Condition.identifier
          Definition

          Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

          ShortExternal Ids for this condition
          Comments

          This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

          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 Condition.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ use
          • 30. Condition.identifier:NationalSystem
            Slice NameNationalSystem
            Definition

            Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

            ShortThis stores the identifier of the corresponding record in the national system (RFCCS) to let it be kept in sync with FHIR.
            Comments

            This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..*
            TypeIdentifier
            Is Modifierfalse
            Summarytrue
            Requirements

            Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Condition.identifier:NationalSystem.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..0
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            34. Condition.identifier:NationalSystem.extension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            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())
            SlicingThis element introduces a set of slices on Condition.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 36. Condition.identifier:NationalSystem.use
              Definition

              The purpose of this identifier.

              Shortusual | official | temp | secondary | old (If known)
              Comments

              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

              Control1..1
              BindingThe codes SHALL be taken from IdentifierUse
              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

              Identifies the purpose for this identifier, if known .

              Typecode
              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

              Pattern Valueusual
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. Condition.identifier:NationalSystem.type
              Definition

              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

              ShortDescription of identifier
              Comments

              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

              Control1..1
              BindingThe codes SHALL be taken from External identifier type codes
              (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/external-system-identifier-type-code)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows users to make use of identifiers when the identifier system is not known.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. Condition.identifier:NationalSystem.system
              Definition

              Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

              ShortThe namespace for the identifier value
              Comments

              Identifier.system is always case sensitive.

              Control0..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

              Example<br/><b>General</b>:http://www.acme.com/identifiers/patient <br/><b>uri</b>:https://standards.digital.health.nz/ns/rfccs
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. Condition.identifier:NationalSystem.value
              Definition

              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

              ShortThe value that is unique
              Comments

              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

              Control1..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Example<br/><b>General</b>:123456 <br/><b>RFCCS object id</b>:CON-0206
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. Condition.identifier:NationalSystem.period
              Definition

              Time period during which identifier is/was valid for use.

              ShortTime period when id is/was valid for use
              Control0..1
              TypePeriod
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. Condition.identifier:NationalSystem.assigner
              Definition

              Organization that issued/manages the identifier.

              ShortOrganization that issued id (may be just text)
              Comments

              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

              Control0..1
              TypeReference(Organization)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. Condition.clinicalStatus
              Definition

              The clinical status of the condition.

              Shortactive | recurrence | relapse | inactive | remission | resolved
              Comments

              The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

              Control0..1
              This element is affected by the following invariants: con-3, con-4, con-5
              BindingThe codes SHALL be taken from ConditionClinicalStatusCodes
              (required to http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1)

              The clinical status of the condition or diagnosis.

              TypeCodeableConcept
              Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. Condition.verificationStatus
              Definition

              The verification status to support the clinical status of the condition.

              Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
              Comments

              verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

              Control0..1
              This element is affected by the following invariants: con-3, con-5
              BindingThe codes SHALL be taken from ConditionVerificationStatus
              (required to http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1)

              The verification status to support or decline the clinical status of the condition or diagnosis.

              TypeCodeableConcept
              Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              52. Condition.category
              Definition

              A category assigned to the condition.

              Shortproblem-list-item | encounter-diagnosis
              Comments

              The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

              Control1..*
              BindingUnless not suitable, these codes SHALL be taken from ConditionCategoryCodes
              (extensible to http://hl7.org/fhir/ValueSet/condition-category)

              A category assigned to the condition.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              54. Condition.severity
              Definition

              A subjective assessment of the severity of the condition as evaluated by the clinician.

              ShortSubjective severity of condition
              Comments

              Coding of the severity with a terminology is preferred, where possible.

              Control0..1
              BindingThe codes SHOULD be taken from Condition/DiagnosisSeverity
              (preferred to http://hl7.org/fhir/ValueSet/condition-severity)

              A subjective assessment of the severity of the condition as evaluated by the clinician.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              56. Condition.code
              Definition

              Identification of the condition, problem or diagnosis.

              ShortMust be one of the diagnosis codes
              Control1..1
              BindingThe codes SHALL be taken from Codes for summary diagnosis of the rheumatic fever condition
              (required to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-condition-diagnosis-code)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Requirements

              0..1 to account for primarily narrative only resources.

              Alternate Namestype
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              58. Condition.bodySite
              Definition

              The anatomical location where this condition manifests itself.

              ShortAnatomical location, if relevant
              Comments

              Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

              Control0..*
              BindingFor example codes, see SNOMEDCTBodyStructures
              (example to http://hl7.org/fhir/ValueSet/body-site)

              Codes describing anatomical locations. May include laterality.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. Condition.subject
              Definition

              Indicates the patient or group who the condition record is associated with.

              ShortMust be a reference to Patient instance using the rheumatic fever profile
              Control1..1
              TypeReference(Rheumatic Fever Patient)
              Is Modifierfalse
              Summarytrue
              Requirements

              Group is typically used for veterinary or public health use cases.

              Alternate Namespatient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. Condition.encounter
              Definition

              The Encounter during which this Condition was created or to which the creation of this record is tightly associated.

              ShortEncounter created as part of
              Comments

              This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

              Control0..1
              TypeReference(Encounter)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Condition.onset[x]
              Definition

              Estimated or actual date or date-time the condition began, in the opinion of the clinician.

              ShortThe date (UTC dateTime) when rheumatic fever was thought to have begun
              Comments

              Age is generally used when the patient reports an age at which the Condition began to occur.

              Control0..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
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. Condition.abatement[x]
              Definition

              The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

              ShortWhen in resolution/remission
              Comments

              There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

              Control0..1
              This element is affected by the following invariants: con-4
              TypeChoice of: dateTime, Age, Period, Range, string
              [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()))
              68. Condition.recordedDate
              Definition

              The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

              ShortThe date (UTC dateTime) of diagnosis
              Control0..1
              TypedateTime
              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()))
              70. Condition.recorder
              Definition

              Individual who recorded the record and takes responsibility for its content.

              ShortWho recorded the condition
              Control0..1
              TypeReference(Practitioner)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. Condition.asserter
              Definition

              Individual who is making the condition statement.

              ShortPerson who asserts this condition
              Control0..1
              TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Condition.stage
              Definition

              Clinical stage or grade of a condition. May include formal severity assessments.

              ShortStage/grade, usually assessed formally
              Control0..0
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              82. Condition.evidence
              Definition

              Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

              ShortSupporting evidence
              Comments

              The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

              Control0..3
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              84. Condition.evidence.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
              86. Condition.evidence.extension
              Definition

              An Extension

              ShortExtension
              Control0..0
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              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())
              88. Condition.evidence.modifierExtension
              Definition

              An Extension

              ShortExtension
              Control0..0
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              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())
              90. Condition.evidence.code
              Definition

              A manifestation or symptom that led to the recording of this condition.

              ShortIdentifies the GROUPing of diagnosis data in the linked Observation instance
              Control0..*
              This element is affected by the following invariants: con-2
              BindingThe codes SHOULD be taken from Codes for rheumatic fever diagnosis observation grouping
              (preferred to https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/rf-observation-diagnosisgroup-code)
              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. Condition.evidence.detail
              Definition

              Links to other relevant information, including pathology reports.

              ShortLinks up to 3 Observation instances (all using the RF diagnosis group profile) to represent diagnosis detail
              Control0..*
              This element is affected by the following invariants: con-2
              TypeReference(Rheumatic Fever Diagnosis Group)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              94. Condition.note
              Definition

              Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

              ShortAdditional information about the Condition
              Control0..*
              TypeAnnotation
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))