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
Complies with Profile This profile complies with the profile
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
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

Short ExtensionAdditional 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
Must Support true
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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. 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())
    10. 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())
    12. 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()))
    14. 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()))
    16. 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
    • 18. 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()))
      20. 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()))
      22. 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)
      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()))
      24. 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()))
      26. 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)
      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()))
      28. 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()))
      30. 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()))
      32. 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()))
      34. 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
      Complies with Profile This profile complies with the profile
      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
      Must Support true
      10. Condition.extension:assertedDate
      Slice Name assertedDate
      Short (NHSN-MS)(USCDI) Date the condition was first asserted
      12. Condition.clinicalStatus
      Short (NHSN-MS)(USCDI) active | recurrence | relapse | inactive | remission | resolved
      14. Condition.verificationStatus
      Short (NHSN-MS)(USCDI) unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
      16. Condition.category
      Short (NHSN-MS)(USCDI) category codes
      18. Condition.category:us-core
      Slice Name us-core
      Short (NHSN-MS)(USCDI) encounter-diagnosis
      20. Condition.code
      Short (NHSN-MS)(USCDI) Identification of the condition, problem or diagnosis
      22. Condition.subject
      Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
      Type Reference(Cross-Measure Patient Profile)
      24. Condition.subject.reference
      Control 1..?
      Must Support true
      26. Condition.encounter
      Short (NHSN-MS)(QI-Core)(USCDI) Encounter created as part of
      28. Condition.encounter.reference
      Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
      Control 1..?
      Must Support true
      30. 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]
      32. 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]
      34. 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
      Complies with Profile This profile complies with the profile
      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
        Must Support true
        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.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()))
            50. 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()))
            52. 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()))
            54. 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)
            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()))
            56. 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
            58. 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
            • 60. 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()))
              62. 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()))
              64. 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()))
              66. 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()))
              68. 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)
              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()))
              70. 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
              72. 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
              • 74. 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()))
                76. 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()))
                78. 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()))
                80. 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()))
                82. 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()))
                84. 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()))
                86. 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()))
                88. 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()))
                90. 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()))
                92. 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()))
                94. 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
                96. 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())
                98. 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())
                100. 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()))
                102. 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()))
                104. 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()))
                106. 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()))
                108. 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
                110. 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())
                112. 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())
                114. 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()))
                116. 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()))
                118. 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()))