臺灣核心實作指引(TW Core IG)
0.3.1 - Trial Use

This page is part of the 臺灣核心實作指引(TW Core IG) (v0.3.1: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: TWCoreCarePlan - Detailed Descriptions

Active as of 2024-10-22

Definitions for the CarePlan-twcore resource profile.

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

0. CarePlan
2. CarePlan.text
ShortCarePlan Resource之內容摘要以供人閱讀
Must Supporttrue
4. CarePlan.text.status
Shortgenerated | additional
BindingThe codes SHALL be taken from 臺灣衛福部資訊處Narrative狀態值集
(required to https://twcore.mohw.gov.tw/ig/twcore/ValueSet/narrative-status)

Constrained value set of narrative statuses.

Must Supporttrue
6. CarePlan.text.div
Must Supporttrue
8. CarePlan.basedOn
TypeReference(TW Core CarePlan)
10. CarePlan.replaces
TypeReference(TW Core CarePlan)
12. CarePlan.partOf
TypeReference(TW Core CarePlan)
14. CarePlan.status
BindingThe codes SHALL be taken from RequestStatus
(required to http://hl7.org/fhir/ValueSet/request-status)

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

Must Supporttrue
Requirements

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

16. CarePlan.intent
BindingThe codes SHALL be taken from CarePlanIntent
(required to http://hl7.org/fhir/ValueSet/care-plan-intent)

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

Must Supporttrue
18. CarePlan.category
Definition

Type of plan.

Control1..?
Must Supporttrue
Requirements

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.

SlicingThis element introduces a set of slices on CarePlan.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
  • 20. CarePlan.category:AssessPlan
    Slice NameAssessPlan
    Control1..1
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw",
        "code" : "assess-plan"
      }]
    }
    22. CarePlan.subject
    Definition

    Who care plan is for.

    TypeReference(TW Core Patient, Group)
    Must Supporttrue
    Must Support TypesReference(TW Core Patient)
    Requirements

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

    24. CarePlan.encounter
    TypeReference(TW Core Encounter)
    26. CarePlan.author
    TypeReference(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam)
    28. CarePlan.contributor
    TypeReference(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam)
    30. CarePlan.careTeam
    TypeReference(TW Core CareTeam)
    32. CarePlan.addresses
    TypeReference(TW Core Condition)
    34. CarePlan.activity
    36. CarePlan.activity.reference
    TypeReference(Appointment, CommunicationRequest, DeviceRequest, TW Core MedicationRequest, NutritionOrder, Task, ServiceRequest, VisionPrescription, RequestGroup)
    38. CarePlan.activity.detail
    40. CarePlan.activity.detail.reasonReference
    TypeReference(TW Core Condition, TW Core Observation Clinical Result, TW Core DiagnosticReport, TW Core DocumentReference)
    42. CarePlan.activity.detail.location
    TypeReference(TW Core Location)
    44. CarePlan.activity.detail.performer
    TypeReference(TW Core Practitioner, TW Core PractitionerRole, TW Core Organization, TW Core RelatedPerson, TW Core Patient, TW Core CareTeam, HealthcareService, TW Core Implantable Device)
    46. CarePlan.activity.detail.product[x]
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on CarePlan.activity.detail.product[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 48. CarePlan.activity.detail.product[x]:productReference
      Slice NameproductReference
      Control0..1
      TypeReference(TW Core Medication, Substance)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]

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

      0. 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
      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.implicitRules
      Definition

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

      ShortA set of rules under which this content was created
      Comments

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

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

      ShortCarePlan Resource之內容摘要以供人閱讀Text 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
      Must Supporttrue
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. CarePlan.text.status
      Definition

      The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

      Shortgenerated | additionalgenerated | extensions | additional | empty
      Control1..1
      BindingThe codes SHALL be taken from 臺灣衛福部資訊處Narrative狀態值集http://hl7.org/fhir/ValueSet/narrative-status|4.0.1
      (required to https://twcore.mohw.gov.tw/ig/twcore/ValueSet/narrative-status)

      Constrained value set of narrative statuses.


      The status of a resource narrative.

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

      The actual narrative content, a stripped down version of XHTML.

      ShortLimited xhtml content
      Comments

      The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

      Control1..1
      Typexhtml
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
      txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
      txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
      txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
      10. 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())
      12. CarePlan.basedOn
      Definition

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

      ShortFulfills CarePlan
      Control0..*
      TypeReference(TW Core CarePlan, 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()))
      14. 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(TW Core CarePlan, 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()))
      16. 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(TW Core CarePlan, CarePlan)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. 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)

      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

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


      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()))
      20. 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)

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


      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()))
      22. CarePlan.category
      Definition

      Type of plan.


      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.

      Control10..*
      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 Supporttrue
      Summarytrue
      Requirements

      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.


      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:
      • pattern @ $this
      • 24. CarePlan.category:AssessPlan
        Slice NameAssessPlan
        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.

        Control10..1*
        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 Supporttrue
        Summarytrue
        Requirements

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

        Pattern Value{
          "coding" : [{
            "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw",
            "code" : "assess-plan"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. CarePlan.subject
        Definition

        Who care plan is for.


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

        ShortWho the care plan is for
        Control1..1
        TypeReference(TW Core Patient, Group, Patient)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesReference(TW Core Patient)
        Summarytrue
        Requirements

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

        Alternate Namespatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. 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(TW Core Encounter, Encounter)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. 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(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam, Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. 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(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam, Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. 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(TW Core CareTeam, CareTeam)
        Is Modifierfalse
        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()))
        36. 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(TW Core Condition, Condition)
        Is Modifierfalse
        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()))

        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
        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
        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
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. 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()))
        8. 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()))
        10. 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.

        ShortCarePlan Resource之內容摘要以供人閱讀
        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
        Must Supporttrue
        Summaryfalse
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. CarePlan.text.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
        14. CarePlan.text.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.text.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. CarePlan.text.status
          Definition

          The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

          Shortgenerated | additional
          Control1..1
          BindingThe codes SHALL be taken from 臺灣衛福部資訊處Narrative狀態值集
          (required to https://twcore.mohw.gov.tw/ig/twcore/ValueSet/narrative-status)

          Constrained value set of narrative statuses.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. CarePlan.text.div
          Definition

          The actual narrative content, a stripped down version of XHTML.

          ShortLimited xhtml content
          Comments

          The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

          Control1..1
          Typexhtml
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
          txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
          20. 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
          22. 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())
          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
          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.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()))
          30. 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()))
          32. CarePlan.basedOn
          Definition

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

          ShortFulfills CarePlan
          Control0..*
          TypeReference(TW Core 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()))
          34. 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(TW Core 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()))
          36. 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(TW Core CarePlan)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. 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)

          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

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

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

          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()))
          42. CarePlan.category
          Definition

          Type of plan.

          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.

          Control1..*
          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 Supporttrue
          Summarytrue
          Requirements

          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.

          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:
          • pattern @ $this
          • 44. CarePlan.category:AssessPlan
            Slice NameAssessPlan
            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.

            Control1..1
            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 Supporttrue
            Summarytrue
            Requirements

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

            Pattern Value{
              "coding" : [{
                "system" : "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw",
                "code" : "assess-plan"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. 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()))
            48. 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
            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()))
            50. CarePlan.subject
            Definition

            Who care plan is for.

            ShortWho the care plan is for
            Control1..1
            TypeReference(TW Core Patient, Group)
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(TW Core Patient)
            Summarytrue
            Requirements

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

            Alternate Namespatient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. 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(TW Core Encounter)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. 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
            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()))
            56. 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
            Summarytrue
            Alternate NamesauthoredOn
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. 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(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            60. 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(TW Core Patient, TW Core Practitioner, TW Core PractitionerRole, TW Core Implantable Device, TW Core RelatedPerson, TW Core Organization, TW Core CareTeam)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. 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(TW Core CareTeam)
            Is Modifierfalse
            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()))
            64. 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(TW Core Condition)
            Is Modifierfalse
            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()))
            66. 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()))
            68. 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
            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()))
            70. 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
            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()))
            72. 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
            74. 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())
            76. 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())
            78. 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()))
            80. 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()))
            82. 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()))
            84. 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, TW Core 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()))
            86. 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()))
            88. 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
            90. 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())
            92. 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())
            94. 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()))
            96. 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()))
            98. 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()))
            100. 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()))
            102. 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()))
            104. 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(TW Core Condition, TW Core Observation Clinical Result, TW Core DiagnosticReport, TW Core DocumentReference)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            106. 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()))
            108. 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()))
            110. 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()))
            112. 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()))
            114. 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()))
            116. 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(TW Core 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()))
            118. 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(TW Core Practitioner, TW Core PractitionerRole, TW Core Organization, TW Core RelatedPerson, TW Core Patient, TW Core CareTeam, HealthcareService, TW Core Implantable 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()))
            120. 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()))
            SlicingThis element introduces a set of slices on CarePlan.activity.detail.product[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 122. CarePlan.activity.detail.product[x]:productReference
              Slice NameproductReference
              Definition

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

              ShortWhat is to be administered/supplied
              Control0..1
              TypeReference(TW Core 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()))
              124. 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()))
              126. 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()))
              128. 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()))
              130. CarePlan.note
              Definition

              General notes about the care plan not covered elsewhere.

              ShortComments about the plan
              Control0..*
              TypeAnnotation
              Is Modifierfalse
              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()))