Implementation Guide
23.0.0 - R4 APIs

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Resource Profile: AthenaCarePlan - Detailed Descriptions

Active as of 2022-03-01

Definitions for the athena-careplan-profile resource profile.

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

0. CarePlan
Definition

Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

ShortHealthcare plan for patient or group
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate NamesCare Team
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. CarePlan.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
Typeidstring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
4. CarePlan.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
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. CarePlan.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

ShortVersion specific identifier
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Control0..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. CarePlan.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

ShortWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control10..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. CarePlan.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles this resource claims to conform to
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control20..*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
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 CarePlan.meta.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ uri
  • 12. CarePlan.meta.profile:USCoreCarePlan
    Slice NameUSCoreCarePlan
    Definition

    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

    ShortProfiles this resource claims to conform to
    Comments

    It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

    Control10..1*
    Typecanonical(StructureDefinition)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Fixed Valuehttp://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. CarePlan.meta.profile:AthenaCarePlan
    Slice NameAthenaCarePlan
    Definition

    A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

    ShortProfiles this resource claims to conform to
    Comments

    It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

    Control10..1*
    Typecanonical(StructureDefinition)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Fixed Valuehttps://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-careplan-profile
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. CarePlan.meta.security
    Definition

    Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

    ShortSecurity Labels applied to this resource
    Comments

    The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

    Control0..1*
    BindingUnless not suitable, these codes SHALL be taken from All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels
    (extensible to http://hl7.org/fhir/ValueSet/security-labels)

    Security Labels from the Healthcare Privacy and Security Classification System.

    TypeCoding
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. CarePlan.meta.security.code
    Definition

    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

    ShortSymbol in syntax defined by the system
    Control10..1
    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Need to refer to a particular code in the system.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. CarePlan.meta.tag
    Definition

    Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

    ShortTags applied to this resource
    Comments

    The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

    Control10..2*
    BindingFor example codes, see CommonTagshttp://hl7.org/fhir/ValueSet/common-tags
    (example to http://hl7.org/fhir/ValueSet/common-tags)

    Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

    TypeCoding
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. CarePlan.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()))
    24. CarePlan.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())
    26. CarePlan.identifier
    Definition

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

    ShortExternal Ids for this plan
    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
    Must Supportfalse
    Summarytrue
    Requirements

    Allows identification of the care plan 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()))
    28. CarePlan.status
    Definition

    Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

    Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
    Comments

    The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan.

    This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

    Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

    Typecode
    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Allows clinicians to determine whether the plan is actionable or not.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. CarePlan.intent
    Definition

    Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.

    Shortproposal | plan | order | option
    Comments

    This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

    Control1..1
    BindingThe codes SHALL be taken from CarePlanIntenthttp://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1
    (required to http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1)

    Codes indicating the degree of authority/intentionality associated with a care plan.

    Typecode
    Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request"
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Requirements

    Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. CarePlan.category
    Definition

    Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

    ShortType of plan
    Comments

    There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

    Control0..*
    BindingFor example codes, see CarePlanCategoryhttp://hl7.org/fhir/ValueSet/care-plan-category
    (example to http://hl7.org/fhir/ValueSet/care-plan-category)

    Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Used for filtering what plan(s) are retrieved and displayed to different types of users.

    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 CarePlan.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ category
    • 34. CarePlan.category:us-core
      Slice Nameus-core
      Definition

      Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

      ShortSDOH | NON-SDOHType of plan
      Comments

      There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

      Control0..*
      BindingFor example codes, see CarePlanCategoryhttp://hl7.org/fhir/ValueSet/care-plan-category
      (example to http://hl7.org/fhir/ValueSet/care-plan-category)

      Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Used for filtering what plan(s) are retrieved and displayed to different types of users.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. CarePlan.description
      Definition

      A description of the scope and nature of the plan.

      ShortSummary of nature of plan
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Provides more detail than conveyed by category.

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

      Identifies the patient or group whose intended care is described by the plan.

      ShortWho the care plan is for
      Control1..1
      TypeReference(Patient, Group)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Alternate Namespatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. CarePlan.encounter
      Definition

      The Encounter during which this CarePlan 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. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.

      Control0..1
      TypeReference(Encounter)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. CarePlan.period
      Definition

      Indicates when the plan did (or is intended to) come into effect and end.

      ShortTime period plan covers
      Comments

      Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).

      Control0..1
      TypePeriod
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Allows tracking what plan(s) are in effect at a particular time.

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

      Represents when this particular CarePlan record was created in the system, which is often a system-generated date.

      ShortDate record was first recorded
      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Alternate NamesauthoredOn
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. CarePlan.author
      Definition

      When populated, the author is responsible for the care plan. The care plan is attributed to the author.

      ShortWho is the designated responsible party
      Comments

      The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.

      Control0..1
      TypeReference(Practitioner, Patient, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. CarePlan.contributor
      Definition

      Identifies the individual(s) or organization who provided the contents of the care plan.

      ShortWho provided the content of the care plan
      Comments

      Collaborative care plans may have multiple contributors.

      Control0..*
      TypeReference(Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
      Is Modifierfalse
      Must Supportfalse
      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 CarePlan.contributor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ value
      • 50. CarePlan.contributor:RESPDOCTORID
        Slice NameRESPDOCTORID
        Definition

        Identifies the individual(s) or organization who provided the contents of the care plan.

        ShortWho provided the content of the care plan
        Comments

        Collaborative care plans may have multiple contributors.

        Control0..1*
        TypeReference(Practitioner, Patient, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. CarePlan.contributor:REFDOCTORID
        Slice NameREFDOCTORID
        Definition

        Identifies the individual(s) or organization who provided the contents of the care plan.

        ShortWho provided the content of the care plan
        Comments

        Collaborative care plans may have multiple contributors.

        Control0..1*
        TypeReference(Practitioner, Patient, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. CarePlan.contributor:PRIMARYCAREDOCTORID
        Slice NamePRIMARYCAREDOCTORID
        Definition

        Identifies the individual(s) or organization who provided the contents of the care plan.

        ShortWho provided the content of the care plan
        Comments

        Collaborative care plans may have multiple contributors.

        Control0..1*
        TypeReference(Practitioner, Patient, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. CarePlan.contributor:RELATEDPERSON
        Slice NameRELATEDPERSON
        Definition

        Identifies the individual(s) or organization who provided the contents of the care plan.

        ShortWho provided the content of the care plan
        Comments

        Collaborative care plans may have multiple contributors.

        Control0..1*
        TypeReference(RelatedPerson, Patient, Practitioner, PractitionerRole, Device, Organization, CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. CarePlan.careTeam
        Definition

        Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.

        ShortWho's involved in plan?
        Control0..*
        TypeReference(CareTeam)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. CarePlan.addresses
        Definition

        Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

        ShortHealth issues this plan addresses
        Comments

        When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.

        Control0..*
        TypeReference(Condition)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. CarePlan.goal
        Definition

        Describes the intended objective(s) of carrying out the care plan.

        ShortDesired outcome of plan
        Comments

        Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

        Control0..*
        TypeReference(Goal)
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. CarePlan.activity
        Definition

        Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.

        ShortAction to occur as part of plan
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Allows systems to prompt for performance of planned activities, and validate plans against best practice.

        Invariantscpl-3: Provide a reference or detail, not both (detail.empty() or reference.empty())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        cpl-3: Provide a reference or detail, not both (detail.empty() or reference.empty())
        66. CarePlan.activity.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())
        68. CarePlan.note
        Definition

        General notes about the care plan not covered elsewhere.

        ShortComments about the plan
        Control0..*
        TypeAnnotation
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.

        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. CarePlan
        Must Supportfalse
        Alternate NamesCare Team
        2. CarePlan.id
        Control0..1
        Typeid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        4. CarePlan.meta
        Control0..1
        TypeMeta
        Must Supportfalse
        6. CarePlan.meta.versionId
        Control0..1
        Typeid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        8. CarePlan.meta.lastUpdated
        Control1..1
        Typeinstant
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        10. CarePlan.meta.profile
        Control2..*
        Typecanonical
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        SlicingThis element introduces a set of slices on CarePlan.meta.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ uri
        • 12. CarePlan.meta.profile:USCoreCarePlan
          Slice NameUSCoreCarePlan
          Control1..1
          Typecanonical
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Fixed Valuehttp://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan
          14. CarePlan.meta.profile:AthenaCarePlan
          Slice NameAthenaCarePlan
          Control1..1
          Typecanonical
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Fixed Valuehttps://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-careplan-profile
          16. CarePlan.meta.security
          Control0..1
          TypeCoding
          Must Supportfalse
          18. CarePlan.meta.security.code
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          20. CarePlan.meta.tag
          Control1..2
          TypeCoding
          Must Supportfalse
          22. CarePlan.identifier
          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control0..*
          TypeIdentifier
          Must Supportfalse
          24. CarePlan.status
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          26. CarePlan.intent
          Control1..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          28. CarePlan.category
          Control0..*
          TypeCodeableConcept
          Must Supportfalse
          SlicingThis element introduces a set of slices on CarePlan.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ category
          • 30. CarePlan.category:us-core
            Slice Nameus-core
            ShortSDOH | NON-SDOH
            Control0..*
            TypeCodeableConcept
            Must Supportfalse
            32. CarePlan.description
            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            34. CarePlan.subject
            Control1..1
            TypeReference(Patient)
            Must Supporttrue
            36. CarePlan.encounter
            Control0..1
            TypeReference(Encounter)
            Must Supportfalse
            38. CarePlan.period
            Control0..1
            TypePeriod
            Must Supportfalse
            40. CarePlan.created
            Control0..1
            TypedateTime
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            42. CarePlan.author
            Control0..1
            TypeReference(Practitioner)
            Must Supportfalse
            44. CarePlan.contributor
            Control0..*
            Must Supportfalse
            SlicingThis element introduces a set of slices on CarePlan.contributor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ value
            • 46. CarePlan.contributor:RESPDOCTORID
              Slice NameRESPDOCTORID
              Control0..1
              TypeReference(Practitioner)
              Must Supportfalse
              48. CarePlan.contributor:REFDOCTORID
              Slice NameREFDOCTORID
              Control0..1
              TypeReference(Practitioner)
              Must Supportfalse
              50. CarePlan.contributor:PRIMARYCAREDOCTORID
              Slice NamePRIMARYCAREDOCTORID
              Control0..1
              TypeReference(Practitioner)
              Must Supportfalse
              52. CarePlan.contributor:RELATEDPERSON
              Slice NameRELATEDPERSON
              Control0..1
              TypeReference(RelatedPerson)
              Must Supportfalse
              54. CarePlan.careTeam
              Control0..*
              TypeReference(CareTeam)
              Must Supportfalse
              56. CarePlan.addresses
              Control0..*
              TypeReference(Condition)
              Must Supportfalse
              58. CarePlan.goal
              Control0..*
              TypeReference(Goal)
              Must Supportfalse
              60. CarePlan.activity
              Control0..*
              TypeBackboneElement
              Must Supportfalse
              62. CarePlan.note
              Control0..*
              TypeAnnotation
              Must Supportfalse

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

              0. CarePlan
              Definition

              Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

              ShortHealthcare plan for patient or group
              Control0..*
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Alternate NamesCare Team
              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. CarePlan.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
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              4. CarePlan.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
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. CarePlan.meta.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
              8. CarePlan.meta.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())
              SlicingThis element introduces a set of slices on CarePlan.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 10. CarePlan.meta.versionId
                Definition

                The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

                ShortVersion specific identifier
                Comments

                The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

                Control0..1
                Typeid
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. CarePlan.meta.lastUpdated
                Definition

                When the resource last changed - e.g. when the version changed.

                ShortWhen the resource version last changed
                Comments

                This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

                Control1..1
                Typeinstant
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                14. CarePlan.meta.source
                Definition

                A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

                ShortIdentifies where the resource comes from
                Comments

                In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

                This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

                Control0..1
                Typeuri
                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()))
                16. CarePlan.meta.profile
                Definition

                A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                ShortProfiles this resource claims to conform to
                Comments

                It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                Control2..*
                Typecanonical
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                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 CarePlan.meta.profile. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ uri
                • 18. CarePlan.meta.profile:USCoreCarePlan
                  Slice NameUSCoreCarePlan
                  Definition

                  A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                  ShortProfiles this resource claims to conform to
                  Comments

                  It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                  Control1..1
                  Typecanonical
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summarytrue
                  Fixed Valuehttp://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  20. CarePlan.meta.profile:AthenaCarePlan
                  Slice NameAthenaCarePlan
                  Definition

                  A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

                  ShortProfiles this resource claims to conform to
                  Comments

                  It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

                  Control1..1
                  Typecanonical
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supportfalse
                  Summarytrue
                  Fixed Valuehttps://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-careplan-profile
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  22. CarePlan.meta.security
                  Definition

                  Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

                  ShortSecurity Labels applied to this resource
                  Comments

                  The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                  (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                  Security Labels from the Healthcare Privacy and Security Classification System.

                  TypeCoding
                  Is Modifierfalse
                  Must Supportfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  24. CarePlan.meta.security.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
                  26. CarePlan.meta.security.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())
                  SlicingThis element introduces a set of slices on CarePlan.meta.security.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 28. CarePlan.meta.security.system
                    Definition

                    The identification of the code system that defines the meaning of the symbol in the code.

                    ShortIdentity of the terminology system
                    Comments

                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

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

                    Need to be unambiguous about the source of the definition of the symbol.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    30. CarePlan.meta.security.version
                    Definition

                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                    ShortVersion of the system - if relevant
                    Comments

                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                    NoteThis is a business version Id, not a resource version Id (see discussion)
                    Control0..1
                    Typestring
                    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()))
                    32. CarePlan.meta.security.code
                    Definition

                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                    ShortSymbol in syntax defined by the system
                    Control1..1
                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Need to refer to a particular code in the system.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    34. CarePlan.meta.security.display
                    Definition

                    A representation of the meaning of the code in the system, following the rules of the system.

                    ShortRepresentation defined by the system
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Requirements

                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    36. CarePlan.meta.security.userSelected
                    Definition

                    Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                    ShortIf this coding was chosen directly by the user
                    Comments

                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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

                    Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

                    ShortTags applied to this resource
                    Comments

                    The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

                    Control1..2
                    BindingFor example codes, see CommonTags
                    (example to http://hl7.org/fhir/ValueSet/common-tags)

                    Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

                    TypeCoding
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    40. CarePlan.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()))
                    42. CarePlan.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()))
                    44. CarePlan.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()))
                    46. CarePlan.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
                    48. CarePlan.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())
                    50. CarePlan.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())
                    52. CarePlan.identifier
                    Definition

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

                    ShortExternal Ids for this plan
                    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
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Allows identification of the care plan 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()))
                    54. CarePlan.instantiatesCanonical
                    Definition

                    The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.

                    ShortInstantiates FHIR protocol or definition
                    Control0..*
                    Typecanonical(PlanDefinition, Questionnaire, Measure, ActivityDefinition, OperationDefinition)
                    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()))
                    56. CarePlan.instantiatesUri
                    Definition

                    The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.

                    ShortInstantiates external protocol or definition
                    Comments

                    This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

                    Control0..*
                    Typeuri
                    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()))
                    58. CarePlan.basedOn
                    Definition

                    A care plan that is fulfilled in whole or in part by this care plan.

                    ShortFulfills CarePlan
                    Control0..*
                    TypeReference(CarePlan)
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.

                    Alternate Namesfulfills
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    60. CarePlan.replaces
                    Definition

                    Completed or terminated care plan whose function is taken by this new care plan.

                    ShortCarePlan replaced by this CarePlan
                    Comments

                    The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.

                    Control0..*
                    TypeReference(CarePlan)
                    Is Modifierfalse
                    Summarytrue
                    Requirements

                    Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.

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

                    A larger care plan of which this particular care plan is a component or step.

                    ShortPart of referenced CarePlan
                    Comments

                    Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.

                    Control0..*
                    TypeReference(CarePlan)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    64. CarePlan.status
                    Definition

                    Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

                    Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
                    Comments

                    The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan.

                    This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.

                    Control1..1
                    BindingThe codes SHALL be taken from RequestStatus
                    (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

                    Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

                    Typecode
                    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Allows clinicians to determine whether the plan is actionable or not.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    66. CarePlan.intent
                    Definition

                    Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.

                    Shortproposal | plan | order | option
                    Comments

                    This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

                    Control1..1
                    BindingThe codes SHALL be taken from CarePlanIntent
                    (required to http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1)

                    Codes indicating the degree of authority/intentionality associated with a care plan.

                    Typecode
                    Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request"
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    68. CarePlan.category
                    Definition

                    Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

                    ShortType of plan
                    Comments

                    There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

                    Control0..*
                    BindingFor example codes, see CarePlanCategory
                    (example to http://hl7.org/fhir/ValueSet/care-plan-category)

                    Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supportfalse
                    Summarytrue
                    Requirements

                    Used for filtering what plan(s) are retrieved and displayed to different types of users.

                    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 CarePlan.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ category
                    • 70. CarePlan.category:us-core
                      Slice Nameus-core
                      Definition

                      Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

                      ShortSDOH | NON-SDOH
                      Comments

                      There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

                      Control0..*
                      BindingFor example codes, see CarePlanCategory
                      (example to http://hl7.org/fhir/ValueSet/care-plan-category)

                      Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      Used for filtering what plan(s) are retrieved and displayed to different types of users.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      72. CarePlan.title
                      Definition

                      Human-friendly name for the care plan.

                      ShortHuman-friendly name for the care plan
                      Control0..1
                      Typestring
                      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()))
                      74. CarePlan.description
                      Definition

                      A description of the scope and nature of the plan.

                      ShortSummary of nature of plan
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      Provides more detail than conveyed by category.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. CarePlan.subject
                      Definition

                      Identifies the patient or group whose intended care is described by the plan.

                      ShortWho the care plan is for
                      Control1..1
                      TypeReference(Patient)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Alternate Namespatient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      78. CarePlan.encounter
                      Definition

                      The Encounter during which this CarePlan 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. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.

                      Control0..1
                      TypeReference(Encounter)
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      80. CarePlan.period
                      Definition

                      Indicates when the plan did (or is intended to) come into effect and end.

                      ShortTime period plan covers
                      Comments

                      Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).

                      Control0..1
                      TypePeriod
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Requirements

                      Allows tracking what plan(s) are in effect at a particular time.

                      Alternate Namestiming
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      82. CarePlan.created
                      Definition

                      Represents when this particular CarePlan record was created in the system, which is often a system-generated date.

                      ShortDate record was first recorded
                      Control0..1
                      TypedateTime
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supportfalse
                      Summarytrue
                      Alternate NamesauthoredOn
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      84. CarePlan.author
                      Definition

                      When populated, the author is responsible for the care plan. The care plan is attributed to the author.

                      ShortWho is the designated responsible party
                      Comments

                      The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.

                      Control0..1
                      TypeReference(Practitioner)
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      86. CarePlan.contributor
                      Definition

                      Identifies the individual(s) or organization who provided the contents of the care plan.

                      ShortWho provided the content of the care plan
                      Comments

                      Collaborative care plans may have multiple contributors.

                      Control0..*
                      TypeReference(Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
                      Is Modifierfalse
                      Must Supportfalse
                      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 CarePlan.contributor. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ value
                      • 88. CarePlan.contributor:RESPDOCTORID
                        Slice NameRESPDOCTORID
                        Definition

                        Identifies the individual(s) or organization who provided the contents of the care plan.

                        ShortWho provided the content of the care plan
                        Comments

                        Collaborative care plans may have multiple contributors.

                        Control0..1
                        TypeReference(Practitioner)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        90. CarePlan.contributor:REFDOCTORID
                        Slice NameREFDOCTORID
                        Definition

                        Identifies the individual(s) or organization who provided the contents of the care plan.

                        ShortWho provided the content of the care plan
                        Comments

                        Collaborative care plans may have multiple contributors.

                        Control0..1
                        TypeReference(Practitioner)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        92. CarePlan.contributor:PRIMARYCAREDOCTORID
                        Slice NamePRIMARYCAREDOCTORID
                        Definition

                        Identifies the individual(s) or organization who provided the contents of the care plan.

                        ShortWho provided the content of the care plan
                        Comments

                        Collaborative care plans may have multiple contributors.

                        Control0..1
                        TypeReference(Practitioner)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        94. CarePlan.contributor:RELATEDPERSON
                        Slice NameRELATEDPERSON
                        Definition

                        Identifies the individual(s) or organization who provided the contents of the care plan.

                        ShortWho provided the content of the care plan
                        Comments

                        Collaborative care plans may have multiple contributors.

                        Control0..1
                        TypeReference(RelatedPerson)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        96. CarePlan.careTeam
                        Definition

                        Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.

                        ShortWho's involved in plan?
                        Control0..*
                        TypeReference(CareTeam)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        98. CarePlan.addresses
                        Definition

                        Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

                        ShortHealth issues this plan addresses
                        Comments

                        When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.

                        Control0..*
                        TypeReference(Condition)
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Requirements

                        Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        100. CarePlan.supportingInfo
                        Definition

                        Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.

                        ShortInformation considered as part of plan
                        Comments

                        Use "concern" to identify specific conditions addressed by the care plan.

                        Control0..*
                        TypeReference(Resource)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Identifies barriers and other considerations associated with the care plan.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        102. CarePlan.goal
                        Definition

                        Describes the intended objective(s) of carrying out the care plan.

                        ShortDesired outcome of plan
                        Comments

                        Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

                        Control0..*
                        TypeReference(Goal)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        104. CarePlan.activity
                        Definition

                        Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.

                        ShortAction to occur as part of plan
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Allows systems to prompt for performance of planned activities, and validate plans against best practice.

                        Invariantscpl-3: Provide a reference or detail, not both (detail.empty() or reference.empty())
                        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        106. CarePlan.activity.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
                        108. CarePlan.activity.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())
                        110. CarePlan.activity.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())
                        112. CarePlan.activity.outcomeCodeableConcept
                        Definition

                        Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).

                        ShortResults of the activity
                        Comments

                        Note that this should not duplicate the activity status (e.g. completed or in progress).

                        Control0..*
                        BindingFor example codes, see CarePlanActivityOutcome
                        (example to http://hl7.org/fhir/ValueSet/care-plan-activity-outcome)

                        Identifies the results of the activity.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        114. CarePlan.activity.outcomeReference
                        Definition

                        Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).

                        ShortAppointment, Encounter, Procedure, etc.
                        Comments

                        The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.

                        Control0..*
                        TypeReference(Resource)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Links plan to resulting actions.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        116. CarePlan.activity.progress
                        Definition

                        Notes about the adherence/status/progress of the activity.

                        ShortComments about the activity status/progress
                        Comments

                        This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.

                        Control0..*
                        TypeAnnotation
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Can be used to capture information about adherence, progress, concerns, etc.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        118. CarePlan.activity.reference
                        Definition

                        The details of the proposed activity represented in a specific resource.

                        ShortActivity details defined in specific resource
                        Comments

                        Standard extension exists (resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference.
                        The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan.

                        Control0..1
                        This element is affected by the following invariants: cpl-3
                        TypeReference(Appointment, CommunicationRequest, DeviceRequest, MedicationRequest, NutritionOrder, Task, ServiceRequest, VisionPrescription, RequestGroup)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Details in a form consistent with other applications and contexts of use.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        120. CarePlan.activity.detail
                        Definition

                        A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.

                        ShortIn-line definition of activity
                        Control0..1
                        This element is affected by the following invariants: cpl-3
                        TypeBackboneElement
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Details in a simple form for generic care plan systems.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        122. CarePlan.activity.detail.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
                        124. CarePlan.activity.detail.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())
                        126. CarePlan.activity.detail.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())
                        128. CarePlan.activity.detail.kind
                        Definition

                        A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.

                        ShortAppointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
                        Control0..1
                        BindingThe codes SHALL be taken from CarePlanActivityKind
                        (required to http://hl7.org/fhir/ValueSet/care-plan-activity-kind|4.0.1)

                        Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.

                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        May determine what types of extensions are permitted.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        130. CarePlan.activity.detail.instantiatesCanonical
                        Definition

                        The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.

                        ShortInstantiates FHIR protocol or definition
                        Control0..*
                        Typecanonical(PlanDefinition, ActivityDefinition, Questionnaire, Measure, OperationDefinition)
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        132. CarePlan.activity.detail.instantiatesUri
                        Definition

                        The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.

                        ShortInstantiates external protocol or definition
                        Comments

                        This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

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

                        Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        134. CarePlan.activity.detail.code
                        Definition

                        Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.

                        ShortDetail type of activity
                        Comments

                        Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.

                        Control0..1
                        BindingFor example codes, see ProcedureCodes(SNOMEDCT)
                        (example to http://hl7.org/fhir/ValueSet/procedure-code)

                        Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Allows matching performed to planned as well as validation against protocols.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        136. CarePlan.activity.detail.reasonCode
                        Definition

                        Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.

                        ShortWhy activity should be done or why activity was prohibited
                        Comments

                        This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.

                        Control0..*
                        BindingFor example codes, see SNOMEDCTClinicalFindings
                        (example to http://hl7.org/fhir/ValueSet/clinical-findings)

                        Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        138. CarePlan.activity.detail.reasonReference
                        Definition

                        Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.

                        ShortWhy activity is needed
                        Comments

                        Conditions can be identified at the activity level that are not identified as reasons for the overall plan.

                        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()))
                        140. CarePlan.activity.detail.goal
                        Definition

                        Internal reference that identifies the goals that this activity is intended to contribute towards meeting.

                        ShortGoals this activity relates to
                        Control0..*
                        TypeReference(Goal)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        So that participants know the link explicitly.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        142. CarePlan.activity.detail.status
                        Definition

                        Identifies what progress is being made for the specific activity.

                        Shortnot-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
                        Comments

                        Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated.
                        The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.

                        Control1..1
                        BindingThe codes SHALL be taken from CarePlanActivityStatus
                        (required to http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1)

                        Codes that reflect the current state of a care plan activity within its overall life cycle.

                        Typecode
                        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Indicates progress against the plan, whether the activity is still relevant for the plan.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        144. CarePlan.activity.detail.statusReason
                        Definition

                        Provides reason why the activity isn't yet started, is on hold, was cancelled, etc.

                        ShortReason for current status
                        Comments

                        Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.

                        Control0..1
                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        146. CarePlan.activity.detail.doNotPerform
                        Definition

                        If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.

                        ShortIf true, activity is prohibiting action
                        Comments

                        This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.

                        Control0..1
                        Typeboolean
                        Is Modifiertrue because If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur.
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Requirements

                        Captures intention to not do something that may have been previously typical.

                        Meaning if MissingIf missing indicates that the described activity is one that should be engaged in when following the plan.
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        148. CarePlan.activity.detail.scheduled[x]
                        Definition

                        The period, timing or frequency upon which the described activity is to occur.

                        ShortWhen activity is to occur
                        Control0..1
                        TypeChoice of: Timing, Period, 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
                        Requirements

                        Allows prompting for activities and detection of missed planned activities.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        150. CarePlan.activity.detail.location
                        Definition

                        Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.

                        ShortWhere it should happen
                        Comments

                        May reference a specific clinical location or may identify a type of location.

                        Control0..1
                        TypeReference(Location)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Helps in planning of activity.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        152. CarePlan.activity.detail.performer
                        Definition

                        Identifies who's expected to be involved in the activity.

                        ShortWho will be responsible?
                        Comments

                        A performer MAY also be a participant in the care plan.

                        Control0..*
                        TypeReference(Practitioner, PractitionerRole, Organization, RelatedPerson, Patient, CareTeam, HealthcareService, Device)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Helps in planning of activity.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        154. CarePlan.activity.detail.product[x]
                        Definition

                        Identifies the food, drug or other product to be consumed or supplied in the activity.

                        ShortWhat is to be administered/supplied
                        Control0..1
                        BindingFor example codes, see SNOMEDCTMedicationCodes
                        (example to http://hl7.org/fhir/ValueSet/medication-codes)

                        A product supplied or administered as part of a care plan activity.

                        TypeChoice of: CodeableConcept, Reference(Medication, Substance)
                        [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()))
                        156. CarePlan.activity.detail.dailyAmount
                        Definition

                        Identifies the quantity expected to be consumed in a given day.

                        ShortHow to consume/day?
                        Control0..1
                        TypeQuantity(SimpleQuantity)
                        Is Modifierfalse
                        Summaryfalse
                        Requirements

                        Allows rough dose checking.

                        Alternate Namesdaily dose
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        158. CarePlan.activity.detail.quantity
                        Definition

                        Identifies the quantity expected to be supplied, administered or consumed by the subject.

                        ShortHow much to administer/supply/consume
                        Control0..1
                        TypeQuantity(SimpleQuantity)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        160. CarePlan.activity.detail.description
                        Definition

                        This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.

                        ShortExtra info describing activity to perform
                        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()))
                        162. CarePlan.note
                        Definition

                        General notes about the care plan not covered elsewhere.

                        ShortComments about the plan
                        Control0..*
                        TypeAnnotation
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.

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