CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
2.0.0-cibuild - Release 2 ci-build United States of America flag

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v2.0.0-cibuild) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: AcuteCareHospitalMonthlyReportingCondition - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the ach-monthly-condition resource profile.

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

0. Condition
Definition

-


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

Short Detailed information about conditions, problems or diagnoses
Comments

-

Control 0..*
Is Modifier false
Must Support false
Summary false
Invariants con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
Condition-coding-from-common-codesystems: Condition: code must contains a SNOMED CT, ICD-10-CM, or ICD-9-CM coding (code.coding.where(system='http://snomed.info/sct').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-9-cm').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-10-cm').exists())
dqm-Con-2: At least one Condition.category SHALL be encounter-diagnosis, problem-list-item, or health-concern (category.where(coding.where(system = 'http://terminology.hl7.org/CodeSystem/condition-category' and code='encounter-diagnosis').exists()).exists() or category.where(coding.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern')).exists())
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
2. Condition.id
Definition

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

Short (NHSN-MS) Logical id of this artifactLogical 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.

Control 10..1
Type idstring
Is Modifier false
Must Support true
Summary true
4. Condition.implicitRules
Definition

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

Short A 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.

Control 0..1
Type uri
Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
Summary true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Condition.extension:assertedDate
Slice Name assertedDate
Definition

The date on which the existence of the Condition was first asserted or acknowledged.

Short (NHSN-MS)(USCDI) Date the condition was first asserted
Comments

The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.

Control 0..1
This element is affected by the following invariants: ele-1
Type Extension(Condition Asserted Date) (Extension Type: dateTime)
Is Modifier false
Must Support true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Condition.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Short Extensions 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.

Control 0..*
Type Extension
Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary false
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 Names extensions, user content
Invariants ele-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())
10. Condition.clinicalStatus
Definition

The clinical status of the condition.

Short (NHSN-MS)(USCDI) active | recurrence | relapse | inactive | remission | resolvedactive | recurrence | relapse | inactive | remission | resolved
Comments

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

Control 0..1
This element is affected by the following invariants: con-3, con-4, con-5
Binding The codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
(required to http://hl7.org/fhir/ValueSet/condition-clinical)
Type CodeableConcept
Is Modifier true because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
Must Support true
Summary true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Condition.verificationStatus
Definition

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

Short (NHSN-MS)(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-errorunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
Comments

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

Control 0..1
This element is affected by the following invariants: con-3, con-5
Binding The codes SHALL be taken from ConditionVerificationStatushttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/condition-ver-status)
Type CodeableConcept
Is Modifier true because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
Must Support true
Summary true
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Condition.category
Definition

A category assigned to the condition.

Short (NHSN-MS)(USCDI) category codesproblem-list-item | encounter-diagnosis
Comments

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

Control 10..*
Binding Unless not suitable, these codes SHALL be taken from ConditionCategoryCodeshttp://hl7.org/fhir/ValueSet/condition-category|4.0.1
(extensible to http://hl7.org/fhir/ValueSet/condition-category)

A category assigned to the condition.

Type CodeableConcept
Is Modifier false
Must Support true
Summary false
Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing This element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
  • 16. Condition.category:us-core
    Slice Name us-core
    Definition

    A category assigned to the condition.

    Short (NHSN-MS)(USCDI) encounter-diagnosisproblem-list-item | encounter-diagnosis
    Comments

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

    Control 10..1*
    Binding Unless not suitable, these codes SHALL be taken from ConditionCategoryCodeshttp://hl7.org/fhir/ValueSet/condition-category|4.0.1
    (extensible to http://hl7.org/fhir/ValueSet/condition-category)

    A category assigned to the condition.

    Type CodeableConcept
    Is Modifier false
    Must Support true
    Summary false
    Pattern Value {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
        "code" : "encounter-diagnosis"
      }]
    }
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. Condition.category:us-core.coding
    Definition

    A reference to a code defined by a terminology system.

    Short (NHSN-MS) Code defined by a terminology systemCode defined by a terminology system
    Comments

    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control 0..*
    Type Coding
    Is Modifier false
    Must Support true
    Summary true
    Requirements

    Allows for alternative encodings within a code system, and translations to other code systems.

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. Condition.category:us-core.coding.system
    Definition

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

    Short (NHSN-MS) Identity of the terminology systemIdentity 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.

    Control 0..1
    Type uri
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

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

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. Condition.category:us-core.coding.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).

    Short (NHSN-MS) Symbol in syntax defined by the systemSymbol in syntax defined by the system
    Control 0..1
    Type code
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Requirements

    Need to refer to a particular code in the system.

    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. Condition.code
    Definition

    Identification of the condition, problem or diagnosis.

    Short (NHSN-MS)(USCDI) Identification of the condition, problem or diagnosisIdentification of the condition, problem or diagnosis
    Control 10..1
    Binding Unless not suitable, these codes SHALL be taken from For example codes, see USCoreConditionCodes (6.1.0)http://hl7.org/fhir/ValueSet/condition-code|4.0.1
    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|6.1.0)

    Valueset to describe the actual problem experienced by the patient


    Identification of the condition or diagnosis.

    Type CodeableConcept
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Alternate Names type
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. Condition.subject
    Definition

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

    Short (NHSN-MS) Literal reference, Relative, internal or absolute URLWho has the condition?
    Control 1..1
    Type Reference(Cross-Measure Patient Profile, Patient, Group)bundled
    Is Modifier false
    Must Support true
    Summary true
    Requirements

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

    Alternate Names patient
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. Condition.subject.reference
    Definition

    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

    Short Literal reference, Relative, internal or absolute URL
    Comments

    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

    Control 10..1
    This element is affected by the following invariants: ref-1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Condition.encounter
    Definition

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

    Short (NHSN-MS)(QI-Core)(USCDI) Encounter created as part ofEncounter created as part of
    Comments

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

    Control 0..1
    Type Reference(QICore Encounter, Encounter)bundled
    Is Modifier false
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. Condition.encounter.reference
    Definition

    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

    Short (NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
    Comments

    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

    Control 10..1
    This element is affected by the following invariants: ref-1
    Type string
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. Condition.onset[x]
    Definition

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

    Short (NHSN-MS)(QI-Core)(USCDI) Estimated or actual date, date-time, or ageEstimated or actual date, date-time, or age
    Comments

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

    Control 0..1
    Type Choice of: dateTime, Age, Period, Range, string
    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Must Support Types dateTime
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. Condition.abatement[x]
    Definition

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

    Short (NHSN-MS)(QI-Core)(USCDI) When in resolution/remissionWhen in resolution/remission
    Comments

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

    Control 0..1
    This element is affected by the following invariants: con-4
    Type Choice of: dateTime, Age, Period, Range, string
    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Must Support Types dateTime
    Summary false
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. Condition.recordedDate
    Definition

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

    Short (NHSN-MS)(USCDI) Date record was first recordedDate record was first recorded
    Control 0..1
    Type dateTime
    Is Modifier false
    Primitive Value This primitive element may be present, or absent, or replaced by an extension
    Must Support true
    Summary true
    Invariants ele-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 foundhere

    0. Condition
    Invariants Condition-coding-from-common-codesystems: Condition: code must contains a SNOMED CT, ICD-10-CM, or ICD-9-CM coding (code.coding.where(system='http://snomed.info/sct').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-9-cm').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-10-cm').exists())
    dqm-Con-2: At least one Condition.category SHALL be encounter-diagnosis, problem-list-item, or health-concern (category.where(coding.where(system = 'http://terminology.hl7.org/CodeSystem/condition-category' and code='encounter-diagnosis').exists()).exists() or category.where(coding.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern')).exists())
    2. Condition.id
    Short (NHSN-MS) Logical id of this artifact
    Control 1..?
    Must Support true
    4. Condition.meta
    6. Condition.meta.extension:link-received-date-extension
    Slice Name link-received-date-extension
    Control 0..1
    Type Extension(Received Date) (Extension Type: dateTime)
    8. Condition.extension:assertedDate
    Slice Name assertedDate
    Short (NHSN-MS)(USCDI) Date the condition was first asserted
    10. Condition.clinicalStatus
    Short (NHSN-MS)(USCDI) active | recurrence | relapse | inactive | remission | resolved
    12. Condition.verificationStatus
    Short (NHSN-MS)(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
    14. Condition.category
    Short (NHSN-MS)(USCDI) category codes
    16. Condition.category:us-core
    Slice Name us-core
    Short (NHSN-MS)(USCDI) encounter-diagnosis
    18. Condition.category:us-core.coding
    Short (NHSN-MS) Code defined by a terminology system
    Must Support true
    20. Condition.category:us-core.coding.system
    Short (NHSN-MS) Identity of the terminology system
    Must Support true
    22. Condition.category:us-core.coding.code
    Short (NHSN-MS) Symbol in syntax defined by the system
    Must Support true
    24. Condition.code
    Short (NHSN-MS)(USCDI) Identification of the condition, problem or diagnosis
    26. Condition.subject
    Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
    Type Reference(Cross-Measure Patient Profile)bundled
    28. Condition.subject.reference
    Control 1..?
    Must Support true
    30. Condition.encounter
    Short (NHSN-MS)(QI-Core)(USCDI) Encounter created as part of
    Type Reference(QICore Encounter)bundled
    32. Condition.encounter.reference
    Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
    Control 1..?
    Must Support true
    34. Condition.onset[x]
    Short (NHSN-MS)(QI-Core)(USCDI) Estimated or actual date, date-time, or age
    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
    36. Condition.abatement[x]
    Short (NHSN-MS)(QI-Core)(USCDI) When in resolution/remission
    [x] Note SeeChoice of Data Typesfor further information about how to use [x]
    38. Condition.recordedDate
    Short (NHSN-MS)(USCDI) Date record was first recorded

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

    0. Condition
    Definition

    -

    Short Detailed information about conditions, problems or diagnoses
    Comments

    -

    Control 0..*
    Is Modifier false
    Must Support false
    Summary false
    Invariants con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    Condition-coding-from-common-codesystems: Condition: code must contains a SNOMED CT, ICD-10-CM, or ICD-9-CM coding (code.coding.where(system='http://snomed.info/sct').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-9-cm').exists() or code.coding.where(system='http://hl7.org/fhir/sid/icd-10-cm').exists())
    dqm-Con-2: At least one Condition.category SHALL be encounter-diagnosis, problem-list-item, or health-concern (category.where(coding.where(system = 'http://terminology.hl7.org/CodeSystem/condition-category' and code='encounter-diagnosis').exists()).exists() or category.where(coding.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-problem-or-health-concern')).exists())
    2. Condition.id
    Definition

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

    Short (NHSN-MS) Logical 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.

    Control 1..1
    Type id
    Is Modifier false
    Must Support true
    Summary true
    4. Condition.meta
    Definition

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

    Short Metadata about the resource
    Control 0..1
    Type Meta
    Is Modifier false
    Summary true
    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. Condition.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.

    Short Unique id for inter-element referencing
    Control 0..1
    Type string
    Is Modifier false
    XML Format In the XML format, this property is represented as an attribute.
    Summary false
    8. Condition.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.

    Short Additional 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.

    Control 0..*
    Type Extension
    Is Modifier false
    Summary false
    Alternate Names extensions, user content
    Invariants ele-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())
    Slicing This element introduces a set of slices on Condition.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 10. Condition.meta.extension:link-received-date-extension
      Slice Name link-received-date-extension
      Definition

      This extension stores the date and time a Resource was received by the processing system (e.g., NHSNLink).

      Short Received Date
      Control 0..1
      Type Extension(Received Date) (Extension Type: dateTime)
      Is Modifier false
      Summary false
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      12. Condition.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.

      Short Version 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.

      Control 0..1
      Type id
      Is Modifier false
      Primitive Value This primitive element may be present, or absent, or replaced by an extension
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. Condition.meta.lastUpdated
      Definition

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

      Short When 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.

      Control 0..1
      Type instant
      Is Modifier false
      Primitive Value This primitive element may be present, or absent, or replaced by an extension
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. Condition.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.

      Short Identifies 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.

      Control 0..1
      Type uri
      Is Modifier false
      Primitive Value This primitive element may be present, or absent, or replaced by an extension
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Condition.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.

      Short Profiles 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.

      Control 0..*
      Type canonical(StructureDefinition)
      Is Modifier false
      Primitive Value This primitive element may be present, or absent, or replaced by an extension
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Condition.meta.security
      Definition

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

      Short Security 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.

      Control 0..*
      Binding Unless not suitable, these codes SHALL be taken from All Security Labels
      (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

      Security Labels from the Healthcare Privacy and Security Classification System.

      Type Coding
      Is Modifier false
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Condition.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.

      Short Tags 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.

      Control 0..*
      Binding For example codes, see CommonTags
      (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

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

      Type Coding
      Is Modifier false
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Condition.implicitRules
      Definition

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

      Short A 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.

      Control 0..1
      Type uri
      Is Modifier true 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 Value This primitive element may be present, or absent, or replaced by an extension
      Summary true
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Condition.language
      Definition

      The base language in which the resource is written.

      Short Language 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).

      Control 0..1
      Binding The codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional Bindings Purpose
      AllLanguages Max Binding
      Type code
      Is Modifier false
      Primitive Value This primitive element may be present, or absent, or replaced by an extension
      Summary false
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Condition.text
      Definition

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

      Short 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.

      Control 0..1
      Type Narrative
      Is Modifier false
      Summary false
      Alternate Names narrative, html, xhtml, display
      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Condition.contained
      Definition

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

      Short Contained, 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.

      Control 0..*
      Type Resource
      Is Modifier false
      Summary false
      Alternate Names inline resources, anonymous resources, contained resources
      32. Condition.extension
      Definition

      An Extension

      Short Extension
      Control 0..*
      Type Extension
      Is Modifier false
      Summary false
      Invariants ele-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())
      Slicing This element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 34. Condition.extension:assertedDate
        Slice Name assertedDate
        Definition

        The date on which the existence of the Condition was first asserted or acknowledged.

        Short (NHSN-MS)(USCDI) Date the condition was first asserted
        Comments

        The assertedDate is in the context of the recording practitioner and might not be the same as the recordedDate.

        Control 0..1
        This element is affected by the following invariants: ele-1
        Type Extension(Condition Asserted Date) (Extension Type: dateTime)
        Is Modifier false
        Must Support true
        Invariants ele-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())
        36. Condition.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions 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.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summary false
        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 Names extensions, user content
        Invariants ele-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())
        38. Condition.identifier
        Definition

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

        Short External Ids for this condition
        Comments

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

        Note This is a business identifier, not a resource identifier (see discussion)
        Control 0..*
        Type Identifier
        Is Modifier false
        Summary true
        Requirements

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

        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Condition.clinicalStatus
        Definition

        The clinical status of the condition.

        Short (NHSN-MS)(USCDI) active | recurrence | relapse | inactive | remission | resolved
        Comments

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

        Control 0..1
        This element is affected by the following invariants: con-3, con-4, con-5
        Binding The codes SHALL be taken from ConditionClinicalStatusCodes
        (required to http://hl7.org/fhir/ValueSet/condition-clinical)
        Type CodeableConcept
        Is Modifier true because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Condition.verificationStatus
        Definition

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

        Short (NHSN-MS)(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
        Comments

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

        Control 0..1
        This element is affected by the following invariants: con-3, con-5
        Binding The codes SHALL be taken from ConditionVerificationStatus
        (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
        Type CodeableConcept
        Is Modifier true because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Condition.category
        Definition

        A category assigned to the condition.

        Short (NHSN-MS)(USCDI) category codes
        Comments

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

        Control 1..*
        Binding Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes
        (extensible to http://hl7.org/fhir/ValueSet/condition-category)

        A category assigned to the condition.

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        Slicing This element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ $this
        • 46. Condition.category:us-core
          Slice Name us-core
          Definition

          A category assigned to the condition.

          Short (NHSN-MS)(USCDI) encounter-diagnosis
          Comments

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

          Control 1..1
          Binding Unless not suitable, these codes SHALL be taken from ConditionCategoryCodes
          (extensible to http://hl7.org/fhir/ValueSet/condition-category)

          A category assigned to the condition.

          Type CodeableConcept
          Is Modifier false
          Must Support true
          Summary false
          Pattern Value {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
              "code" : "encounter-diagnosis"
            }]
          }
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. Condition.category:us-core.id
          Definition

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

          Short Unique id for inter-element referencing
          Control 0..1
          Type string
          Is Modifier false
          XML Format In the XML format, this property is represented as an attribute.
          Summary false
          50. Condition.category:us-core.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.

          Short Additional 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.

          Control 0..*
          Type Extension
          Is Modifier false
          Summary false
          Alternate Names extensions, user content
          Invariants ele-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())
          Slicing This element introduces a set of slices on Condition.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 52. Condition.category:us-core.coding
            Definition

            A reference to a code defined by a terminology system.

            Short (NHSN-MS) Code defined by a terminology system
            Comments

            Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

            Control 0..*
            Type Coding
            Is Modifier false
            Must Support true
            Summary true
            Requirements

            Allows for alternative encodings within a code system, and translations to other code systems.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. Condition.category:us-core.coding.id
            Definition

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

            Short Unique id for inter-element referencing
            Control 0..1
            Type string
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            56. Condition.category:us-core.coding.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.

            Short Additional 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.

            Control 0..*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-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())
            Slicing This element introduces a set of slices on Condition.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 58. Condition.category:us-core.coding.system
              Definition

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

              Short (NHSN-MS) Identity 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.

              Control 0..1
              Type uri
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Requirements

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

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              60. Condition.category:us-core.coding.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.

              Short Version 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.

              Note This is a business version Id, not a resource version Id (see discussion)
              Control 0..1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. Condition.category:us-core.coding.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).

              Short (NHSN-MS) Symbol in syntax defined by the system
              Control 0..1
              Type code
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Requirements

              Need to refer to a particular code in the system.

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. Condition.category:us-core.coding.display
              Definition

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

              Short Representation defined by the system
              Control 0..1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Requirements

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

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. Condition.category:us-core.coding.userSelected
              Definition

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

              Short If 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.

              Control 0..1
              Type boolean
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              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.

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. Condition.category:us-core.text
              Definition

              A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

              Short Plain text representation of the concept
              Comments

              Very often the text is the same as a displayName of one of the codings.

              Control 0..1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Requirements

              The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. Condition.severity
              Definition

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

              Short Subjective severity of condition
              Comments

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

              Control 0..1
              Binding The codes SHOULD be taken from Condition/DiagnosisSeverity
              (preferred to http://hl7.org/fhir/ValueSet/condition-severity)

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

              Type CodeableConcept
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. Condition.code
              Definition

              Identification of the condition, problem or diagnosis.

              Short (NHSN-MS)(USCDI) Identification of the condition, problem or diagnosis
              Control 1..1
              Binding Unless not suitable, these codes SHALL be taken from USCoreConditionCodes (6.1.0)
              (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code|6.1.0)

              Valueset to describe the actual problem experienced by the patient

              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary true
              Requirements

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

              Alternate Names type
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              74. Condition.bodySite
              Definition

              The anatomical location where this condition manifests itself.

              Short Anatomical location, if relevant
              Comments

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

              Control 0..*
              Binding For example codes, see SNOMEDCTBodyStructures
              (example to http://hl7.org/fhir/ValueSet/body-site)

              Codes describing anatomical locations. May include laterality.

              Type CodeableConcept
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. Condition.subject
              Definition

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

              Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
              Control 1..1
              Type Reference(Cross-Measure Patient Profile)bundled
              Is Modifier false
              Must Support true
              Summary true
              Requirements

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

              Alternate Names patient
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              78. Condition.subject.id
              Definition

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

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              80. Condition.subject.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.

              Short Additional 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.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-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())
              Slicing This element introduces a set of slices on Condition.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 82. Condition.subject.reference
                Definition

                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                Short Literal reference, Relative, internal or absolute URL
                Comments

                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                Control 1..1
                This element is affected by the following invariants: ref-1
                Type string
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. Condition.subject.type
                Definition

                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                Short Type the reference refers to (e.g. "Patient")
                Comments

                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                Control 0..1
                Binding Unless not suitable, these codes SHALL be taken from ResourceType
                (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                Aa resource (or, for logical models, the URI of the logical model).

                Type uri
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. Condition.subject.identifier
                Definition

                An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                Short Logical reference, when literal reference is not known
                Comments

                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                Note This is a business identifier, not a resource identifier (see discussion)
                Control 0..1
                Type Identifier
                Is Modifier false
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. Condition.subject.display
                Definition

                Plain text narrative that identifies the resource in addition to the resource reference.

                Short Text alternative for the resource
                Comments

                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                Control 0..1
                Type string
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                90. Condition.encounter
                Definition

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

                Short (NHSN-MS)(QI-Core)(USCDI) Encounter created as part of
                Comments

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

                Control 0..1
                Type Reference(QICore Encounter)bundled
                Is Modifier false
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                92. Condition.encounter.id
                Definition

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

                Short Unique id for inter-element referencing
                Control 0..1
                Type string
                Is Modifier false
                XML Format In the XML format, this property is represented as an attribute.
                Summary false
                94. Condition.encounter.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.

                Short Additional 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.

                Control 0..*
                Type Extension
                Is Modifier false
                Summary false
                Alternate Names extensions, user content
                Invariants ele-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())
                Slicing This element introduces a set of slices on Condition.encounter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 96. Condition.encounter.reference
                  Definition

                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                  Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
                  Comments

                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                  Control 1..1
                  This element is affected by the following invariants: ref-1
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  98. Condition.encounter.type
                  Definition

                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                  Short Type the reference refers to (e.g. "Patient")
                  Comments

                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                  Control 0..1
                  Binding Unless not suitable, these codes SHALL be taken from ResourceType
                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                  Aa resource (or, for logical models, the URI of the logical model).

                  Type uri
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  100. Condition.encounter.identifier
                  Definition

                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                  Short Logical reference, when literal reference is not known
                  Comments

                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                  Note This is a business identifier, not a resource identifier (see discussion)
                  Control 0..1
                  Type Identifier
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  102. Condition.encounter.display
                  Definition

                  Plain text narrative that identifies the resource in addition to the resource reference.

                  Short Text alternative for the resource
                  Comments

                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                  Control 0..1
                  Type string
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  104. Condition.onset[x]
                  Definition

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

                  Short (NHSN-MS)(QI-Core)(USCDI) Estimated or actual date, date-time, or age
                  Comments

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

                  Control 0..1
                  Type Choice of: dateTime, Age, Period, Range
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Must Support Types dateTime
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  106. Condition.abatement[x]
                  Definition

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

                  Short (NHSN-MS)(QI-Core)(USCDI) When in resolution/remission
                  Comments

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

                  Control 0..1
                  This element is affected by the following invariants: con-4
                  Type Choice of: dateTime, Age, Period, Range
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Must Support Types dateTime
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  108. Condition.recordedDate
                  Definition

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

                  Short (NHSN-MS)(USCDI) Date record was first recorded
                  Control 0..1
                  Type dateTime
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  110. Condition.recorder
                  Definition

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

                  Short Who recorded the condition
                  Control 0..1
                  Type Reference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  112. Condition.asserter
                  Definition

                  Individual who is making the condition statement.

                  Short Person who asserts this condition
                  Control 0..1
                  Type Reference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  114. Condition.stage
                  Definition

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

                  Short Stage/grade, usually assessed formally
                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Summary false
                  Invariants con-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  116. Condition.stage.id
                  Definition

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

                  Short Unique id for inter-element referencing
                  Control 0..1
                  Type string
                  Is Modifier false
                  XML Format In the XML format, this property is represented as an attribute.
                  Summary false
                  118. Condition.stage.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.

                  Short Additional 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.

                  Control 0..*
                  Type Extension
                  Is Modifier false
                  Summary false
                  Alternate Names extensions, user content
                  Invariants ele-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())
                  120. Condition.stage.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).

                  Short Extensions 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.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  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 Names extensions, user content, modifiers
                  Invariants ele-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())
                  122. Condition.stage.summary
                  Definition

                  A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

                  Short Simple summary (disease specific)
                  Control 0..1
                  This element is affected by the following invariants: con-1
                  Binding For example codes, see ConditionStage
                  (example to http://hl7.org/fhir/ValueSet/condition-stage)

                  Codes describing condition stages (e.g. Cancer stages).

                  Type CodeableConcept
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  124. Condition.stage.assessment
                  Definition

                  Reference to a formal record of the evidence on which the staging assessment is based.

                  Short Formal record of assessment
                  Control 0..*
                  This element is affected by the following invariants: con-1
                  Type Reference(ClinicalImpression, DiagnosticReport, Observation)
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  126. Condition.stage.type
                  Definition

                  The kind of staging, such as pathological or clinical staging.

                  Short Kind of staging
                  Control 0..1
                  Binding For example codes, see ConditionStageType
                  (example to http://hl7.org/fhir/ValueSet/condition-stage-type)

                  Codes describing the kind of condition staging (e.g. clinical or pathological).

                  Type CodeableConcept
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  128. Condition.evidence
                  Definition

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

                  Short Supporting evidence
                  Comments

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

                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Summary false
                  Invariants con-2: evidence SHALL have code or details (code.exists() or detail.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  130. Condition.evidence.id
                  Definition

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

                  Short Unique id for inter-element referencing
                  Control 0..1
                  Type string
                  Is Modifier false
                  XML Format In the XML format, this property is represented as an attribute.
                  Summary false
                  132. Condition.evidence.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.

                  Short Additional 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.

                  Control 0..*
                  Type Extension
                  Is Modifier false
                  Summary false
                  Alternate Names extensions, user content
                  Invariants ele-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())
                  134. Condition.evidence.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).

                  Short Extensions 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.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  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 Names extensions, user content, modifiers
                  Invariants ele-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())
                  136. Condition.evidence.code
                  Definition

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

                  Short Manifestation/symptom
                  Control 0..*
                  This element is affected by the following invariants: con-2
                  Binding For example codes, see ManifestationAndSymptomCodes
                  (example to http://hl7.org/fhir/ValueSet/manifestation-or-symptom)

                  Codes that describe the manifestation or symptoms of a condition.

                  Type CodeableConcept
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  138. Condition.evidence.detail
                  Definition

                  Links to other relevant information, including pathology reports.

                  Short Supporting information found elsewhere
                  Control 0..*
                  This element is affected by the following invariants: con-2
                  Type Reference(Resource)
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  140. Condition.note
                  Definition

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

                  Short Additional information about the Condition
                  Control 0..*
                  Type Annotation
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))