ClinicalImpression.xml
1 <?xml version="1.0" encoding="utf-8"?>
2 <StructureDefinition xmlns="http://hl7.org/fhir">
3 <id value="ClinicalImpression" />
4 <meta>
5 <lastUpdated value="2023-03-26T06:21:02.749+02:00" />
6 </meta>
7 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-category">
8 <valueString value="Clinical.Summary" />
9 </extension>
10 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
11 <valueCode value="trial-use" />
12 </extension>
13 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
14 <valueInteger value="1" />
15 </extension>
16 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category">
17 <valueCode value="patient" />
18 </extension>
19 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
20 <valueCode value="pc" />
21 </extension>
22 <url value="http://hl7.org/fhir/StructureDefinition/ClinicalImpression" />
23 <version value="5.0.0" />
24 <name value="ClinicalImpression" />
25 <status value="draft" />
26 <experimental value="false" />
27 <date value="2023-03-26T06:21:02.0000000+02:00" />
28 <publisher value="Health Level Seven International (Patient Care)" />
29 <contact>
30 <telecom>
31 <system value="url" />
32 <value value="http://hl7.org/fhir" />
33 </telecom>
34 </contact>
35 <contact>
36 <telecom>
37 <system value="url" />
38 <value value="http://www.hl7.org/Special/committees/patientcare/index.cfm" />
39 </telecom>
40 </contact>
41 <description value="A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score." />
42 <jurisdiction>
43 <coding>
44 <system value="http://unstats.un.org/unsd/methods/m49/m49.htm" />
45 <code value="001" />
46 <display value="World" />
47 </coding>
48 </jurisdiction>
49 <fhirVersion value="5.0.0" />
50 <mapping>
51 <identity value="workflow" />
52 <uri value="http://hl7.org/fhir/workflow" />
53 <name value="Workflow Pattern" />
54 </mapping>
55 <mapping>
56 <identity value="w5" />
57 <uri value="http://hl7.org/fhir/fivews" />
58 <name value="FiveWs Pattern Mapping" />
59 </mapping>
60 <mapping>
61 <identity value="v2" />
62 <uri value="http://hl7.org/v2" />
63 <name value="HL7 V2 Mapping" />
64 </mapping>
65 <mapping>
66 <identity value="rim" />
67 <uri value="http://hl7.org/v3" />
68 <name value="RIM Mapping" />
69 </mapping>
70 <kind value="resource" />
71 <abstract value="false" />
72 <type value="ClinicalImpression" />
73 <baseDefinition value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
74 <derivation value="specialization" />
75 <snapshot>
76 <element id="ClinicalImpression">
77 <path value="ClinicalImpression" />
78 <short value="A clinical assessment performed when planning treatments and management strategies for a patient" />
79 <definition value="A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score." />
80 <min value="0" />
81 <max value="*" />
82 <base>
83 <path value="ClinicalImpression" />
84 <min value="0" />
85 <max value="*" />
86 </base>
87 <constraint>
88 <key value="dom-2" />
89 <severity value="error" />
90 <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
91 <expression value="contained.contained.empty()" />
92 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
93 </constraint>
94 <constraint>
95 <key value="dom-3" />
96 <severity value="error" />
97 <human value="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" />
98 <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" />
99 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
100 </constraint>
101 <constraint>
102 <key value="dom-4" />
103 <severity value="error" />
104 <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
105 <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
106 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
107 </constraint>
108 <constraint>
109 <key value="dom-5" />
110 <severity value="error" />
111 <human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
112 <expression value="contained.meta.security.empty()" />
113 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
114 </constraint>
115 <constraint>
116 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
117 <valueBoolean value="true" />
118 </extension>
119 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
120 <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
121 </extension>
122 <key value="dom-6" />
123 <severity value="warning" />
124 <human value="A resource should have narrative for robust management" />
125 <expression value="text.`div`.exists()" />
126 <source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
127 </constraint>
128 <mustSupport value="false" />
129 <isModifier value="false" />
130 <isSummary value="false" />
131 <mapping>
132 <identity value="rim" />
133 <map value="Entity, Role, or Act" />
134 </mapping>
135 <mapping>
136 <identity value="workflow" />
137 <map value="Event" />
138 </mapping>
139 <mapping>
140 <identity value="w5" />
141 <map value="clinical.general" />
142 </mapping>
143 <mapping>
144 <identity value="v2" />
145 <map value="Partial mapping for problem evaluation" />
146 </mapping>
147 </element>
148 <element id="ClinicalImpression.id">
149 <path value="ClinicalImpression.id" />
150 <short value="Logical id of this artifact" />
151 <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
152 <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case." />
153 <min value="0" />
154 <max value="1" />
155 <base>
156 <path value="Resource.id" />
157 <min value="0" />
158 <max value="1" />
159 </base>
160 <type>
161 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
162 <valueUrl value="id" />
163 </extension>
164 <code value="http://hl7.org/fhirpath/System.String" />
165 </type>
166 <mustSupport value="false" />
167 <isModifier value="false" />
168 <isSummary value="true" />
169 </element>
170 <element id="ClinicalImpression.meta">
171 <path value="ClinicalImpression.meta" />
172 <short value="Metadata about the resource" />
173 <definition value="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." />
174 <min value="0" />
175 <max value="1" />
176 <base>
177 <path value="Resource.meta" />
178 <min value="0" />
179 <max value="1" />
180 </base>
181 <type>
182 <code value="Meta" />
183 </type>
184 <constraint>
185 <key value="ele-1" />
186 <severity value="error" />
187 <human value="All FHIR elements must have a @value or children" />
188 <expression value="hasValue() or (children().count() > id.count())" />
189 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
190 </constraint>
191 <mustSupport value="false" />
192 <isModifier value="false" />
193 <isSummary value="true" />
194 </element>
195 <element id="ClinicalImpression.implicitRules">
196 <path value="ClinicalImpression.implicitRules" />
197 <short value="A set of rules under which this content was created" />
198 <definition value="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." />
199 <comment value="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 its narrative along with other profiles, value sets, etc." />
200 <min value="0" />
201 <max value="1" />
202 <base>
203 <path value="Resource.implicitRules" />
204 <min value="0" />
205 <max value="1" />
206 </base>
207 <type>
208 <code value="uri" />
209 </type>
210 <constraint>
211 <key value="ele-1" />
212 <severity value="error" />
213 <human value="All FHIR elements must have a @value or children" />
214 <expression value="hasValue() or (children().count() > id.count())" />
215 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
216 </constraint>
217 <mustSupport value="false" />
218 <isModifier value="true" />
219 <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation" />
220 <isSummary value="true" />
221 </element>
222 <element id="ClinicalImpression.language">
223 <path value="ClinicalImpression.language" />
224 <short value="Language of the resource content" />
225 <definition value="The base language in which the resource is written." />
226 <comment value="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)." />
227 <min value="0" />
228 <max value="1" />
229 <base>
230 <path value="Resource.language" />
231 <min value="0" />
232 <max value="1" />
233 </base>
234 <type>
235 <code value="code" />
236 </type>
237 <constraint>
238 <key value="ele-1" />
239 <severity value="error" />
240 <human value="All FHIR elements must have a @value or children" />
241 <expression value="hasValue() or (children().count() > id.count())" />
242 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
243 </constraint>
244 <mustSupport value="false" />
245 <isModifier value="false" />
246 <isSummary value="false" />
247 <binding>
248 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
249 <valueString value="Language" />
250 </extension>
251 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
252 <valueBoolean value="true" />
253 </extension>
254 <strength value="required" />
255 <description value="IETF language tag for a human language" />
256 <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|5.0.0" />
257 </binding>
258 </element>
259 <element id="ClinicalImpression.text">
260 <path value="ClinicalImpression.text" />
261 <short value="Text summary of the resource, for human interpretation" />
262 <definition value="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." />
263 <comment value="Contained resources do not have a 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." />
264 <alias value="narrative" />
265 <alias value="html" />
266 <alias value="xhtml" />
267 <alias value="display" />
268 <min value="0" />
269 <max value="1" />
270 <base>
271 <path value="DomainResource.text" />
272 <min value="0" />
273 <max value="1" />
274 </base>
275 <type>
276 <code value="Narrative" />
277 </type>
278 <condition value="dom-6" />
279 <constraint>
280 <key value="ele-1" />
281 <severity value="error" />
282 <human value="All FHIR elements must have a @value or children" />
283 <expression value="hasValue() or (children().count() > id.count())" />
284 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
285 </constraint>
286 <mustSupport value="false" />
287 <isModifier value="false" />
288 <isSummary value="false" />
289 <mapping>
290 <identity value="rim" />
291 <map value="Act.text?" />
292 </mapping>
293 </element>
294 <element id="ClinicalImpression.contained">
295 <path value="ClinicalImpression.contained" />
296 <short value="Contained, inline Resources" />
297 <definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning." />
298 <comment value="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." />
299 <alias value="inline resources" />
300 <alias value="anonymous resources" />
301 <alias value="contained resources" />
302 <min value="0" />
303 <max value="*" />
304 <base>
305 <path value="DomainResource.contained" />
306 <min value="0" />
307 <max value="*" />
308 </base>
309 <type>
310 <code value="Resource" />
311 </type>
312 <condition value="dom-2" />
313 <condition value="dom-4" />
314 <condition value="dom-3" />
315 <condition value="dom-5" />
316 <mustSupport value="false" />
317 <isModifier value="false" />
318 <isSummary value="false" />
319 <mapping>
320 <identity value="rim" />
321 <map value="N/A" />
322 </mapping>
323 </element>
324 <element id="ClinicalImpression.extension">
325 <path value="ClinicalImpression.extension" />
326 <short value="Additional content defined by implementations" />
327 <definition value="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 managable, 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." />
328 <comment value="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." />
329 <alias value="extensions" />
330 <alias value="user content" />
331 <min value="0" />
332 <max value="*" />
333 <base>
334 <path value="DomainResource.extension" />
335 <min value="0" />
336 <max value="*" />
337 </base>
338 <type>
339 <code value="Extension" />
340 </type>
341 <constraint>
342 <key value="ele-1" />
343 <severity value="error" />
344 <human value="All FHIR elements must have a @value or children" />
345 <expression value="hasValue() or (children().count() > id.count())" />
346 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
347 </constraint>
348 <constraint>
349 <key value="ext-1" />
350 <severity value="error" />
351 <human value="Must have either extensions or value[x], not both" />
352 <expression value="extension.exists() != value.exists()" />
353 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
354 </constraint>
355 <mustSupport value="false" />
356 <isModifier value="false" />
357 <isSummary value="false" />
358 <mapping>
359 <identity value="rim" />
360 <map value="N/A" />
361 </mapping>
362 </element>
363 <element id="ClinicalImpression.modifierExtension">
364 <path value="ClinicalImpression.modifierExtension" />
365 <short value="Extensions that cannot be ignored" />
366 <definition value="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 managable, 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)." />
367 <comment value="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." />
368 <requirements value="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](extensibility.html#modifierExtension)." />
369 <alias value="extensions" />
370 <alias value="user content" />
371 <min value="0" />
372 <max value="*" />
373 <base>
374 <path value="DomainResource.modifierExtension" />
375 <min value="0" />
376 <max value="*" />
377 </base>
378 <type>
379 <code value="Extension" />
380 </type>
381 <constraint>
382 <key value="ele-1" />
383 <severity value="error" />
384 <human value="All FHIR elements must have a @value or children" />
385 <expression value="hasValue() or (children().count() > id.count())" />
386 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
387 </constraint>
388 <constraint>
389 <key value="ext-1" />
390 <severity value="error" />
391 <human value="Must have either extensions or value[x], not both" />
392 <expression value="extension.exists() != value.exists()" />
393 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
394 </constraint>
395 <mustSupport value="false" />
396 <isModifier value="true" />
397 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
398 <isSummary value="true" />
399 <mapping>
400 <identity value="rim" />
401 <map value="N/A" />
402 </mapping>
403 </element>
404 <element id="ClinicalImpression.identifier">
405 <path value="ClinicalImpression.identifier" />
406 <short value="Business identifier" />
407 <definition value="Business identifiers assigned to this clinical impression by the performer or other systems which remain constant as the resource is updated and propagates from server to server." />
408 <comment value="This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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." />
409 <requirements value="Allows identification of the clinical impression as it is known by various participating systems and in a way that remains consistent across servers." />
410 <min value="0" />
411 <max value="*" />
412 <base>
413 <path value="ClinicalImpression.identifier" />
414 <min value="0" />
415 <max value="*" />
416 </base>
417 <type>
418 <code value="Identifier" />
419 </type>
420 <constraint>
421 <key value="ele-1" />
422 <severity value="error" />
423 <human value="All FHIR elements must have a @value or children" />
424 <expression value="hasValue() or (children().count() > id.count())" />
425 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
426 </constraint>
427 <mustSupport value="false" />
428 <isModifier value="false" />
429 <isSummary value="true" />
430 <mapping>
431 <identity value="workflow" />
432 <map value="Event.identifier" />
433 </mapping>
434 <mapping>
435 <identity value="w5" />
436 <map value="FiveWs.identifier" />
437 </mapping>
438 <mapping>
439 <identity value="v2" />
440 <map value="PID-3" />
441 </mapping>
442 </element>
443 <element id="ClinicalImpression.status">
444 <path value="ClinicalImpression.status" />
445 <short value="preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown" />
446 <definition value="Identifies the workflow status of the assessment." />
447 <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid." />
448 <min value="1" />
449 <max value="1" />
450 <base>
451 <path value="ClinicalImpression.status" />
452 <min value="1" />
453 <max value="1" />
454 </base>
455 <type>
456 <code value="code" />
457 </type>
458 <constraint>
459 <key value="ele-1" />
460 <severity value="error" />
461 <human value="All FHIR elements must have a @value or children" />
462 <expression value="hasValue() or (children().count() > id.count())" />
463 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
464 </constraint>
465 <mustSupport value="false" />
466 <isModifier value="true" />
467 <isModifierReason value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
468 <isSummary value="true" />
469 <binding>
470 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
471 <valueString value="ClinicalImpressionStatus" />
472 </extension>
473 <strength value="required" />
474 <description value="The workflow state of a clinical impression." />
475 <valueSet value="http://hl7.org/fhir/ValueSet/event-status|5.0.0" />
476 </binding>
477 <mapping>
478 <identity value="workflow" />
479 <map value="Event.status" />
480 </mapping>
481 <mapping>
482 <identity value="w5" />
483 <map value="FiveWs.status" />
484 </mapping>
485 <mapping>
486 <identity value="v2" />
487 <map value="PRB-14" />
488 </mapping>
489 </element>
490 <element id="ClinicalImpression.statusReason">
491 <path value="ClinicalImpression.statusReason" />
492 <short value="Reason for current status" />
493 <definition value="Captures the reason for the current state of the ClinicalImpression." />
494 <comment value="This is generally only used for "exception" statuses such as "not-done", "on-hold" or "stopped"." />
495 <alias value="Suspended Reason" />
496 <alias value="Cancelled Reason" />
497 <min value="0" />
498 <max value="1" />
499 <base>
500 <path value="ClinicalImpression.statusReason" />
501 <min value="0" />
502 <max value="1" />
503 </base>
504 <type>
505 <code value="CodeableConcept" />
506 </type>
507 <constraint>
508 <key value="ele-1" />
509 <severity value="error" />
510 <human value="All FHIR elements must have a @value or children" />
511 <expression value="hasValue() or (children().count() > id.count())" />
512 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
513 </constraint>
514 <mustSupport value="false" />
515 <isModifier value="false" />
516 <isSummary value="false" />
517 <binding>
518 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
519 <valueString value="ClinicalImpressionStatusReason" />
520 </extension>
521 <strength value="example" />
522 <description value="Codes identifying the reason for the current state of a clinical impression." />
523 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-status-reason" />
524 </binding>
525 <mapping>
526 <identity value="workflow" />
527 <map value="Event.statusReason" />
528 </mapping>
529 <mapping>
530 <identity value="rim" />
531 <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde" />
532 </mapping>
533 </element>
534 <element id="ClinicalImpression.description">
535 <path value="ClinicalImpression.description" />
536 <short value="Why/how the assessment was performed" />
537 <definition value="A summary of the context and/or cause of the assessment - why / where it was performed, and what patient events/status prompted it." />
538 <min value="0" />
539 <max value="1" />
540 <base>
541 <path value="ClinicalImpression.description" />
542 <min value="0" />
543 <max value="1" />
544 </base>
545 <type>
546 <code value="string" />
547 </type>
548 <constraint>
549 <key value="ele-1" />
550 <severity value="error" />
551 <human value="All FHIR elements must have a @value or children" />
552 <expression value="hasValue() or (children().count() > id.count())" />
553 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
554 </constraint>
555 <mustSupport value="false" />
556 <isModifier value="false" />
557 <isSummary value="true" />
558 </element>
559 <element id="ClinicalImpression.subject">
560 <path value="ClinicalImpression.subject" />
561 <short value="Patient or group assessed" />
562 <definition value="The patient or group of individuals assessed as part of this record." />
563 <requirements value="Group is typically for veterinary and/or public health purposes." />
564 <min value="1" />
565 <max value="1" />
566 <base>
567 <path value="ClinicalImpression.subject" />
568 <min value="1" />
569 <max value="1" />
570 </base>
571 <type>
572 <code value="Reference" />
573 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
574 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group" />
575 </type>
576 <constraint>
577 <key value="ele-1" />
578 <severity value="error" />
579 <human value="All FHIR elements must have a @value or children" />
580 <expression value="hasValue() or (children().count() > id.count())" />
581 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
582 </constraint>
583 <mustSupport value="false" />
584 <isModifier value="false" />
585 <isSummary value="true" />
586 <mapping>
587 <identity value="workflow" />
588 <map value="Event.subject" />
589 </mapping>
590 <mapping>
591 <identity value="w5" />
592 <map value="FiveWs.subject[x]" />
593 </mapping>
594 <mapping>
595 <identity value="v2" />
596 <map value="PID-3" />
597 </mapping>
598 </element>
599 <element id="ClinicalImpression.encounter">
600 <path value="ClinicalImpression.encounter" />
601 <short value="The Encounter during which this ClinicalImpression was created" />
602 <definition value="The Encounter during which this ClinicalImpression was created or to which the creation of this record is tightly associated." />
603 <comment value="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." />
604 <min value="0" />
605 <max value="1" />
606 <base>
607 <path value="ClinicalImpression.encounter" />
608 <min value="0" />
609 <max value="1" />
610 </base>
611 <type>
612 <code value="Reference" />
613 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
614 </type>
615 <constraint>
616 <key value="ele-1" />
617 <severity value="error" />
618 <human value="All FHIR elements must have a @value or children" />
619 <expression value="hasValue() or (children().count() > id.count())" />
620 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
621 </constraint>
622 <mustSupport value="false" />
623 <isModifier value="false" />
624 <isSummary value="true" />
625 <mapping>
626 <identity value="workflow" />
627 <map value="Event.encounter" />
628 </mapping>
629 <mapping>
630 <identity value="w5" />
631 <map value="FiveWs.context" />
632 </mapping>
633 </element>
634 <element id="ClinicalImpression.effective[x]">
635 <path value="ClinicalImpression.effective[x]" />
636 <short value="Time of assessment" />
637 <definition value="The point in time or period over which the subject was assessed." />
638 <comment value="This SHOULD be accurate to at least the minute, though some assessments only have a known date." />
639 <min value="0" />
640 <max value="1" />
641 <base>
642 <path value="ClinicalImpression.effective[x]" />
643 <min value="0" />
644 <max value="1" />
645 </base>
646 <type>
647 <code value="dateTime" />
648 </type>
649 <type>
650 <code value="Period" />
651 </type>
652 <constraint>
653 <key value="ele-1" />
654 <severity value="error" />
655 <human value="All FHIR elements must have a @value or children" />
656 <expression value="hasValue() or (children().count() > id.count())" />
657 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
658 </constraint>
659 <mustSupport value="false" />
660 <isModifier value="false" />
661 <isSummary value="true" />
662 <mapping>
663 <identity value="workflow" />
664 <map value="Event.occurrence[x]" />
665 </mapping>
666 <mapping>
667 <identity value="w5" />
668 <map value="FiveWs.done[x]" />
669 </mapping>
670 <mapping>
671 <identity value="v2" />
672 <map value="PRB-2" />
673 </mapping>
674 </element>
675 <element id="ClinicalImpression.date">
676 <path value="ClinicalImpression.date" />
677 <short value="When the assessment was documented" />
678 <definition value="Indicates when the documentation of the assessment was complete." />
679 <min value="0" />
680 <max value="1" />
681 <base>
682 <path value="ClinicalImpression.date" />
683 <min value="0" />
684 <max value="1" />
685 </base>
686 <type>
687 <code value="dateTime" />
688 </type>
689 <constraint>
690 <key value="ele-1" />
691 <severity value="error" />
692 <human value="All FHIR elements must have a @value or children" />
693 <expression value="hasValue() or (children().count() > id.count())" />
694 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
695 </constraint>
696 <mustSupport value="false" />
697 <isModifier value="false" />
698 <isSummary value="true" />
699 <mapping>
700 <identity value="w5" />
701 <map value="FiveWs.recorded" />
702 </mapping>
703 </element>
704 <element id="ClinicalImpression.performer">
705 <path value="ClinicalImpression.performer" />
706 <short value="The clinician performing the assessment" />
707 <definition value="The clinician performing the assessment." />
708 <min value="0" />
709 <max value="1" />
710 <base>
711 <path value="ClinicalImpression.performer" />
712 <min value="0" />
713 <max value="1" />
714 </base>
715 <type>
716 <code value="Reference" />
717 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
718 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
719 </type>
720 <constraint>
721 <key value="ele-1" />
722 <severity value="error" />
723 <human value="All FHIR elements must have a @value or children" />
724 <expression value="hasValue() or (children().count() > id.count())" />
725 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
726 </constraint>
727 <mustSupport value="false" />
728 <isModifier value="false" />
729 <isSummary value="true" />
730 <mapping>
731 <identity value="workflow" />
732 <map value="Event.performer.actor" />
733 </mapping>
734 <mapping>
735 <identity value="w5" />
736 <map value="FiveWs.actor" />
737 </mapping>
738 <mapping>
739 <identity value="v2" />
740 <map value="ROL-4" />
741 </mapping>
742 </element>
743 <element id="ClinicalImpression.previous">
744 <path value="ClinicalImpression.previous" />
745 <short value="Reference to last assessment" />
746 <definition value="A reference to the last assessment that was conducted on this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changes." />
747 <comment value="It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved)." />
748 <min value="0" />
749 <max value="1" />
750 <base>
751 <path value="ClinicalImpression.previous" />
752 <min value="0" />
753 <max value="1" />
754 </base>
755 <type>
756 <code value="Reference" />
757 <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClinicalImpression" />
758 </type>
759 <constraint>
760 <key value="ele-1" />
761 <severity value="error" />
762 <human value="All FHIR elements must have a @value or children" />
763 <expression value="hasValue() or (children().count() > id.count())" />
764 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
765 </constraint>
766 <mustSupport value="false" />
767 <isModifier value="false" />
768 <isSummary value="false" />
769 </element>
770 <element id="ClinicalImpression.problem">
771 <path value="ClinicalImpression.problem" />
772 <short value="Relevant impressions of patient state" />
773 <definition value="A list of the relevant problems/conditions for a patient." />
774 <comment value="e.g. The patient is a pregnant, has congestive heart failure, has an ‎Adenocarcinoma, and is allergic to penicillin." />
775 <min value="0" />
776 <max value="*" />
777 <base>
778 <path value="ClinicalImpression.problem" />
779 <min value="0" />
780 <max value="*" />
781 </base>
782 <type>
783 <code value="Reference" />
784 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
785 <targetProfile value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" />
786 </type>
787 <constraint>
788 <key value="ele-1" />
789 <severity value="error" />
790 <human value="All FHIR elements must have a @value or children" />
791 <expression value="hasValue() or (children().count() > id.count())" />
792 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
793 </constraint>
794 <mustSupport value="false" />
795 <isModifier value="false" />
796 <isSummary value="true" />
797 <mapping>
798 <identity value="w5" />
799 <map value="FiveWs.why[x]" />
800 </mapping>
801 <mapping>
802 <identity value="v2" />
803 <map value="PRB-3 / IAM-7" />
804 </mapping>
805 </element>
806 <element id="ClinicalImpression.changePattern">
807 <path value="ClinicalImpression.changePattern" />
808 <short value="Change in the status/pattern of a subject's condition since previously assessed, such as worsening, improving, or no change" />
809 <definition value="Change in the status/pattern of a subject's condition since previously assessed, such as worsening, improving, or no change. It is a subjective assessment of the direction of the change." />
810 <min value="0" />
811 <max value="1" />
812 <base>
813 <path value="ClinicalImpression.changePattern" />
814 <min value="0" />
815 <max value="1" />
816 </base>
817 <type>
818 <code value="CodeableConcept" />
819 </type>
820 <constraint>
821 <key value="ele-1" />
822 <severity value="error" />
823 <human value="All FHIR elements must have a @value or children" />
824 <expression value="hasValue() or (children().count() > id.count())" />
825 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
826 </constraint>
827 <mustSupport value="false" />
828 <isModifier value="false" />
829 <isSummary value="false" />
830 <binding>
831 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
832 <valueString value="ClinicalImpressionChangePattern" />
833 </extension>
834 <strength value="example" />
835 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-change-pattern" />
836 </binding>
837 </element>
838 <element id="ClinicalImpression.protocol">
839 <path value="ClinicalImpression.protocol" />
840 <short value="Clinical Protocol followed" />
841 <definition value="Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosis." />
842 <min value="0" />
843 <max value="*" />
844 <base>
845 <path value="ClinicalImpression.protocol" />
846 <min value="0" />
847 <max value="*" />
848 </base>
849 <type>
850 <code value="uri" />
851 </type>
852 <constraint>
853 <key value="ele-1" />
854 <severity value="error" />
855 <human value="All FHIR elements must have a @value or children" />
856 <expression value="hasValue() or (children().count() > id.count())" />
857 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
858 </constraint>
859 <mustSupport value="false" />
860 <isModifier value="false" />
861 <isSummary value="false" />
862 </element>
863 <element id="ClinicalImpression.summary">
864 <path value="ClinicalImpression.summary" />
865 <short value="Summary of the assessment" />
866 <definition value="A text summary of the investigations and the diagnosis." />
867 <min value="0" />
868 <max value="1" />
869 <base>
870 <path value="ClinicalImpression.summary" />
871 <min value="0" />
872 <max value="1" />
873 </base>
874 <type>
875 <code value="string" />
876 </type>
877 <constraint>
878 <key value="ele-1" />
879 <severity value="error" />
880 <human value="All FHIR elements must have a @value or children" />
881 <expression value="hasValue() or (children().count() > id.count())" />
882 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
883 </constraint>
884 <mustSupport value="false" />
885 <isModifier value="false" />
886 <isSummary value="false" />
887 <mapping>
888 <identity value="v2" />
889 <map value="OBX" />
890 </mapping>
891 </element>
892 <element id="ClinicalImpression.finding">
893 <path value="ClinicalImpression.finding" />
894 <short value="Possible or likely findings and diagnoses" />
895 <definition value="Specific findings or diagnoses that were considered likely or relevant to ongoing treatment." />
896 <min value="0" />
897 <max value="*" />
898 <base>
899 <path value="ClinicalImpression.finding" />
900 <min value="0" />
901 <max value="*" />
902 </base>
903 <type>
904 <code value="BackboneElement" />
905 </type>
906 <constraint>
907 <key value="ele-1" />
908 <severity value="error" />
909 <human value="All FHIR elements must have a @value or children" />
910 <expression value="hasValue() or (children().count() > id.count())" />
911 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
912 </constraint>
913 <mustSupport value="false" />
914 <isModifier value="false" />
915 <isSummary value="false" />
916 </element>
917 <element id="ClinicalImpression.finding.id">
918 <path value="ClinicalImpression.finding.id" />
919 <representation value="xmlAttr" />
920 <short value="Unique id for inter-element referencing" />
921 <definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
922 <min value="0" />
923 <max value="1" />
924 <base>
925 <path value="Element.id" />
926 <min value="0" />
927 <max value="1" />
928 </base>
929 <type>
930 <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
931 <valueUrl value="string" />
932 </extension>
933 <code value="http://hl7.org/fhirpath/System.String" />
934 </type>
935 <condition value="ele-1" />
936 <isModifier value="false" />
937 <isSummary value="false" />
938 <mapping>
939 <identity value="rim" />
940 <map value="n/a" />
941 </mapping>
942 </element>
943 <element id="ClinicalImpression.finding.extension">
944 <path value="ClinicalImpression.finding.extension" />
945 <short value="Additional content defined by implementations" />
946 <definition value="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 managable, 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." />
947 <comment value="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." />
948 <alias value="extensions" />
949 <alias value="user content" />
950 <min value="0" />
951 <max value="*" />
952 <base>
953 <path value="Element.extension" />
954 <min value="0" />
955 <max value="*" />
956 </base>
957 <type>
958 <code value="Extension" />
959 </type>
960 <constraint>
961 <key value="ele-1" />
962 <severity value="error" />
963 <human value="All FHIR elements must have a @value or children" />
964 <expression value="hasValue() or (children().count() > id.count())" />
965 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
966 </constraint>
967 <constraint>
968 <key value="ext-1" />
969 <severity value="error" />
970 <human value="Must have either extensions or value[x], not both" />
971 <expression value="extension.exists() != value.exists()" />
972 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
973 </constraint>
974 <isModifier value="false" />
975 <isSummary value="false" />
976 <mapping>
977 <identity value="rim" />
978 <map value="n/a" />
979 </mapping>
980 </element>
981 <element id="ClinicalImpression.finding.modifierExtension">
982 <path value="ClinicalImpression.finding.modifierExtension" />
983 <short value="Extensions that cannot be ignored even if unrecognized" />
984 <definition value="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 managable, 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)." />
985 <comment value="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." />
986 <requirements value="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](extensibility.html#modifierExtension)." />
987 <alias value="extensions" />
988 <alias value="user content" />
989 <alias value="modifiers" />
990 <min value="0" />
991 <max value="*" />
992 <base>
993 <path value="BackboneElement.modifierExtension" />
994 <min value="0" />
995 <max value="*" />
996 </base>
997 <type>
998 <code value="Extension" />
999 </type>
1000 <constraint>
1001 <key value="ele-1" />
1002 <severity value="error" />
1003 <human value="All FHIR elements must have a @value or children" />
1004 <expression value="hasValue() or (children().count() > id.count())" />
1005 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1006 </constraint>
1007 <constraint>
1008 <key value="ext-1" />
1009 <severity value="error" />
1010 <human value="Must have either extensions or value[x], not both" />
1011 <expression value="extension.exists() != value.exists()" />
1012 <source value="http://hl7.org/fhir/StructureDefinition/Extension" />
1013 </constraint>
1014 <isModifier value="true" />
1015 <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
1016 <isSummary value="true" />
1017 <mapping>
1018 <identity value="rim" />
1019 <map value="N/A" />
1020 </mapping>
1021 </element>
1022 <element id="ClinicalImpression.finding.item">
1023 <path value="ClinicalImpression.finding.item" />
1024 <short value="What was found" />
1025 <definition value="Specific text, code or reference for finding or diagnosis, which may include ruled-out or resolved conditions." />
1026 <min value="0" />
1027 <max value="1" />
1028 <base>
1029 <path value="ClinicalImpression.finding.item" />
1030 <min value="0" />
1031 <max value="1" />
1032 </base>
1033 <type>
1034 <code value="CodeableReference" />
1035 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
1036 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
1037 <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference" />
1038 </type>
1039 <constraint>
1040 <key value="ele-1" />
1041 <severity value="error" />
1042 <human value="All FHIR elements must have a @value or children" />
1043 <expression value="hasValue() or (children().count() > id.count())" />
1044 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1045 </constraint>
1046 <mustSupport value="false" />
1047 <isModifier value="false" />
1048 <isSummary value="false" />
1049 <binding>
1050 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1051 <valueString value="ConditionKind" />
1052 </extension>
1053 <strength value="example" />
1054 <description value="Identification of the Condition or diagnosis." />
1055 <valueSet value="http://hl7.org/fhir/ValueSet/condition-code" />
1056 </binding>
1057 <mapping>
1058 <identity value="v2" />
1059 <map value="OBX" />
1060 </mapping>
1061 </element>
1062 <element id="ClinicalImpression.finding.basis">
1063 <path value="ClinicalImpression.finding.basis" />
1064 <short value="Which investigations support finding" />
1065 <definition value="Which investigations support finding or diagnosis." />
1066 <min value="0" />
1067 <max value="1" />
1068 <base>
1069 <path value="ClinicalImpression.finding.basis" />
1070 <min value="0" />
1071 <max value="1" />
1072 </base>
1073 <type>
1074 <code value="string" />
1075 </type>
1076 <constraint>
1077 <key value="ele-1" />
1078 <severity value="error" />
1079 <human value="All FHIR elements must have a @value or children" />
1080 <expression value="hasValue() or (children().count() > id.count())" />
1081 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1082 </constraint>
1083 <mustSupport value="false" />
1084 <isModifier value="false" />
1085 <isSummary value="false" />
1086 </element>
1087 <element id="ClinicalImpression.prognosisCodeableConcept">
1088 <path value="ClinicalImpression.prognosisCodeableConcept" />
1089 <short value="Estimate of likely outcome" />
1090 <definition value="Estimate of likely outcome." />
1091 <min value="0" />
1092 <max value="*" />
1093 <base>
1094 <path value="ClinicalImpression.prognosisCodeableConcept" />
1095 <min value="0" />
1096 <max value="*" />
1097 </base>
1098 <type>
1099 <code value="CodeableConcept" />
1100 </type>
1101 <constraint>
1102 <key value="ele-1" />
1103 <severity value="error" />
1104 <human value="All FHIR elements must have a @value or children" />
1105 <expression value="hasValue() or (children().count() > id.count())" />
1106 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1107 </constraint>
1108 <mustSupport value="false" />
1109 <isModifier value="false" />
1110 <isSummary value="false" />
1111 <binding>
1112 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1113 <valueString value="ClinicalImpressionPrognosis" />
1114 </extension>
1115 <strength value="example" />
1116 <description value="Prognosis or outlook findings." />
1117 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-prognosis" />
1118 </binding>
1119 <mapping>
1120 <identity value="v2" />
1121 <map value="PRB-22" />
1122 </mapping>
1123 </element>
1124 <element id="ClinicalImpression.prognosisReference">
1125 <path value="ClinicalImpression.prognosisReference" />
1126 <short value="RiskAssessment expressing likely outcome" />
1127 <definition value="RiskAssessment expressing likely outcome." />
1128 <min value="0" />
1129 <max value="*" />
1130 <base>
1131 <path value="ClinicalImpression.prognosisReference" />
1132 <min value="0" />
1133 <max value="*" />
1134 </base>
1135 <type>
1136 <code value="Reference" />
1137 <targetProfile value="http://hl7.org/fhir/StructureDefinition/RiskAssessment" />
1138 </type>
1139 <constraint>
1140 <key value="ele-1" />
1141 <severity value="error" />
1142 <human value="All FHIR elements must have a @value or children" />
1143 <expression value="hasValue() or (children().count() > id.count())" />
1144 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1145 </constraint>
1146 <mustSupport value="false" />
1147 <isModifier value="false" />
1148 <isSummary value="false" />
1149 </element>
1150 <element id="ClinicalImpression.supportingInfo">
1151 <path value="ClinicalImpression.supportingInfo" />
1152 <short value="Information supporting the clinical impression" />
1153 <definition value="Information supporting the clinical impression, which can contain investigation results." />
1154 <min value="0" />
1155 <max value="*" />
1156 <base>
1157 <path value="ClinicalImpression.supportingInfo" />
1158 <min value="0" />
1159 <max value="*" />
1160 </base>
1161 <type>
1162 <code value="Reference" />
1163 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
1164 </type>
1165 <constraint>
1166 <key value="ele-1" />
1167 <severity value="error" />
1168 <human value="All FHIR elements must have a @value or children" />
1169 <expression value="hasValue() or (children().count() > id.count())" />
1170 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1171 </constraint>
1172 <mustSupport value="false" />
1173 <isModifier value="false" />
1174 <isSummary value="false" />
1175 </element>
1176 <element id="ClinicalImpression.note">
1177 <path value="ClinicalImpression.note" />
1178 <short value="Comments made about the ClinicalImpression" />
1179 <definition value="Commentary about the impression, typically recorded after the impression itself was made, though supplemental notes by the original author could also appear." />
1180 <comment value="Don't use this element for content that should more properly appear as one of the specific elements of the impression." />
1181 <min value="0" />
1182 <max value="*" />
1183 <base>
1184 <path value="ClinicalImpression.note" />
1185 <min value="0" />
1186 <max value="*" />
1187 </base>
1188 <type>
1189 <code value="Annotation" />
1190 </type>
1191 <constraint>
1192 <key value="ele-1" />
1193 <severity value="error" />
1194 <human value="All FHIR elements must have a @value or children" />
1195 <expression value="hasValue() or (children().count() > id.count())" />
1196 <source value="http://hl7.org/fhir/StructureDefinition/Element" />
1197 </constraint>
1198 <mustSupport value="false" />
1199 <isModifier value="false" />
1200 <isSummary value="false" />
1201 <mapping>
1202 <identity value="workflow" />
1203 <map value="Event.note" />
1204 </mapping>
1205 </element>
1206 </snapshot>
1207 <differential>
1208 <element id="ClinicalImpression">
1209 <path value="ClinicalImpression" />
1210 <short value="A clinical assessment performed when planning treatments and management strategies for a patient" />
1211 <definition value="A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score." />
1212 <min value="0" />
1213 <max value="*" />
1214 <mustSupport value="false" />
1215 <isModifier value="false" />
1216 <mapping>
1217 <identity value="workflow" />
1218 <map value="Event" />
1219 </mapping>
1220 <mapping>
1221 <identity value="w5" />
1222 <map value="clinical.general" />
1223 </mapping>
1224 <mapping>
1225 <identity value="v2" />
1226 <map value="Partial mapping for problem evaluation" />
1227 </mapping>
1228 </element>
1229 <element id="ClinicalImpression.identifier">
1230 <path value="ClinicalImpression.identifier" />
1231 <short value="Business identifier" />
1232 <definition value="Business identifiers assigned to this clinical impression by the performer or other systems which remain constant as the resource is updated and propagates from server to server." />
1233 <comment value="This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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." />
1234 <requirements value="Allows identification of the clinical impression as it is known by various participating systems and in a way that remains consistent across servers." />
1235 <min value="0" />
1236 <max value="*" />
1237 <type>
1238 <code value="Identifier" />
1239 </type>
1240 <mustSupport value="false" />
1241 <isModifier value="false" />
1242 <isSummary value="true" />
1243 <mapping>
1244 <identity value="workflow" />
1245 <map value="Event.identifier" />
1246 </mapping>
1247 <mapping>
1248 <identity value="w5" />
1249 <map value="FiveWs.identifier" />
1250 </mapping>
1251 <mapping>
1252 <identity value="v2" />
1253 <map value="PID-3" />
1254 </mapping>
1255 </element>
1256 <element id="ClinicalImpression.status">
1257 <path value="ClinicalImpression.status" />
1258 <short value="preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown" />
1259 <definition value="Identifies the workflow status of the assessment." />
1260 <comment value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid." />
1261 <min value="1" />
1262 <max value="1" />
1263 <type>
1264 <code value="code" />
1265 </type>
1266 <mustSupport value="false" />
1267 <isModifier value="true" />
1268 <isModifierReason value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
1269 <isSummary value="true" />
1270 <binding>
1271 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1272 <valueString value="ClinicalImpressionStatus" />
1273 </extension>
1274 <strength value="required" />
1275 <description value="The workflow state of a clinical impression." />
1276 <valueSet value="http://hl7.org/fhir/ValueSet/event-status|5.0.0" />
1277 </binding>
1278 <mapping>
1279 <identity value="workflow" />
1280 <map value="Event.status" />
1281 </mapping>
1282 <mapping>
1283 <identity value="w5" />
1284 <map value="FiveWs.status" />
1285 </mapping>
1286 <mapping>
1287 <identity value="v2" />
1288 <map value="PRB-14" />
1289 </mapping>
1290 </element>
1291 <element id="ClinicalImpression.statusReason">
1292 <path value="ClinicalImpression.statusReason" />
1293 <short value="Reason for current status" />
1294 <definition value="Captures the reason for the current state of the ClinicalImpression." />
1295 <comment value="This is generally only used for "exception" statuses such as "not-done", "on-hold" or "stopped"." />
1296 <alias value="Suspended Reason" />
1297 <alias value="Cancelled Reason" />
1298 <min value="0" />
1299 <max value="1" />
1300 <type>
1301 <code value="CodeableConcept" />
1302 </type>
1303 <mustSupport value="false" />
1304 <isModifier value="false" />
1305 <isSummary value="false" />
1306 <binding>
1307 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1308 <valueString value="ClinicalImpressionStatusReason" />
1309 </extension>
1310 <strength value="example" />
1311 <description value="Codes identifying the reason for the current state of a clinical impression." />
1312 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-status-reason" />
1313 </binding>
1314 <mapping>
1315 <identity value="workflow" />
1316 <map value="Event.statusReason" />
1317 </mapping>
1318 <mapping>
1319 <identity value="rim" />
1320 <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde" />
1321 </mapping>
1322 </element>
1323 <element id="ClinicalImpression.description">
1324 <path value="ClinicalImpression.description" />
1325 <short value="Why/how the assessment was performed" />
1326 <definition value="A summary of the context and/or cause of the assessment - why / where it was performed, and what patient events/status prompted it." />
1327 <min value="0" />
1328 <max value="1" />
1329 <type>
1330 <code value="string" />
1331 </type>
1332 <mustSupport value="false" />
1333 <isModifier value="false" />
1334 <isSummary value="true" />
1335 </element>
1336 <element id="ClinicalImpression.subject">
1337 <path value="ClinicalImpression.subject" />
1338 <short value="Patient or group assessed" />
1339 <definition value="The patient or group of individuals assessed as part of this record." />
1340 <requirements value="Group is typically for veterinary and/or public health purposes." />
1341 <min value="1" />
1342 <max value="1" />
1343 <type>
1344 <code value="Reference" />
1345 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
1346 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group" />
1347 </type>
1348 <mustSupport value="false" />
1349 <isModifier value="false" />
1350 <isSummary value="true" />
1351 <mapping>
1352 <identity value="workflow" />
1353 <map value="Event.subject" />
1354 </mapping>
1355 <mapping>
1356 <identity value="w5" />
1357 <map value="FiveWs.subject[x]" />
1358 </mapping>
1359 <mapping>
1360 <identity value="v2" />
1361 <map value="PID-3" />
1362 </mapping>
1363 </element>
1364 <element id="ClinicalImpression.encounter">
1365 <path value="ClinicalImpression.encounter" />
1366 <short value="The Encounter during which this ClinicalImpression was created" />
1367 <definition value="The Encounter during which this ClinicalImpression was created or to which the creation of this record is tightly associated." />
1368 <comment value="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." />
1369 <min value="0" />
1370 <max value="1" />
1371 <type>
1372 <code value="Reference" />
1373 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
1374 </type>
1375 <mustSupport value="false" />
1376 <isModifier value="false" />
1377 <isSummary value="true" />
1378 <mapping>
1379 <identity value="workflow" />
1380 <map value="Event.encounter" />
1381 </mapping>
1382 <mapping>
1383 <identity value="w5" />
1384 <map value="FiveWs.context" />
1385 </mapping>
1386 </element>
1387 <element id="ClinicalImpression.effective[x]">
1388 <path value="ClinicalImpression.effective[x]" />
1389 <short value="Time of assessment" />
1390 <definition value="The point in time or period over which the subject was assessed." />
1391 <comment value="This SHOULD be accurate to at least the minute, though some assessments only have a known date." />
1392 <min value="0" />
1393 <max value="1" />
1394 <type>
1395 <code value="dateTime" />
1396 </type>
1397 <type>
1398 <code value="Period" />
1399 </type>
1400 <mustSupport value="false" />
1401 <isModifier value="false" />
1402 <isSummary value="true" />
1403 <mapping>
1404 <identity value="workflow" />
1405 <map value="Event.occurrence[x]" />
1406 </mapping>
1407 <mapping>
1408 <identity value="w5" />
1409 <map value="FiveWs.done[x]" />
1410 </mapping>
1411 <mapping>
1412 <identity value="v2" />
1413 <map value="PRB-2" />
1414 </mapping>
1415 </element>
1416 <element id="ClinicalImpression.date">
1417 <path value="ClinicalImpression.date" />
1418 <short value="When the assessment was documented" />
1419 <definition value="Indicates when the documentation of the assessment was complete." />
1420 <min value="0" />
1421 <max value="1" />
1422 <type>
1423 <code value="dateTime" />
1424 </type>
1425 <mustSupport value="false" />
1426 <isModifier value="false" />
1427 <isSummary value="true" />
1428 <mapping>
1429 <identity value="w5" />
1430 <map value="FiveWs.recorded" />
1431 </mapping>
1432 </element>
1433 <element id="ClinicalImpression.performer">
1434 <path value="ClinicalImpression.performer" />
1435 <short value="The clinician performing the assessment" />
1436 <definition value="The clinician performing the assessment." />
1437 <min value="0" />
1438 <max value="1" />
1439 <type>
1440 <code value="Reference" />
1441 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
1442 <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
1443 </type>
1444 <mustSupport value="false" />
1445 <isModifier value="false" />
1446 <isSummary value="true" />
1447 <mapping>
1448 <identity value="workflow" />
1449 <map value="Event.performer.actor" />
1450 </mapping>
1451 <mapping>
1452 <identity value="w5" />
1453 <map value="FiveWs.actor" />
1454 </mapping>
1455 <mapping>
1456 <identity value="v2" />
1457 <map value="ROL-4" />
1458 </mapping>
1459 </element>
1460 <element id="ClinicalImpression.previous">
1461 <path value="ClinicalImpression.previous" />
1462 <short value="Reference to last assessment" />
1463 <definition value="A reference to the last assessment that was conducted on this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changes." />
1464 <comment value="It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved)." />
1465 <min value="0" />
1466 <max value="1" />
1467 <type>
1468 <code value="Reference" />
1469 <targetProfile value="http://hl7.org/fhir/StructureDefinition/ClinicalImpression" />
1470 </type>
1471 <mustSupport value="false" />
1472 <isModifier value="false" />
1473 <isSummary value="false" />
1474 </element>
1475 <element id="ClinicalImpression.problem">
1476 <path value="ClinicalImpression.problem" />
1477 <short value="Relevant impressions of patient state" />
1478 <definition value="A list of the relevant problems/conditions for a patient." />
1479 <comment value="e.g. The patient is a pregnant, has congestive heart failure, has an ‎Adenocarcinoma, and is allergic to penicillin." />
1480 <min value="0" />
1481 <max value="*" />
1482 <type>
1483 <code value="Reference" />
1484 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
1485 <targetProfile value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" />
1486 </type>
1487 <mustSupport value="false" />
1488 <isModifier value="false" />
1489 <isSummary value="true" />
1490 <mapping>
1491 <identity value="w5" />
1492 <map value="FiveWs.why[x]" />
1493 </mapping>
1494 <mapping>
1495 <identity value="v2" />
1496 <map value="PRB-3 / IAM-7" />
1497 </mapping>
1498 </element>
1499 <element id="ClinicalImpression.changePattern">
1500 <path value="ClinicalImpression.changePattern" />
1501 <short value="Change in the status/pattern of a subject's condition since previously assessed, such as worsening, improving, or no change" />
1502 <definition value="Change in the status/pattern of a subject's condition since previously assessed, such as worsening, improving, or no change. It is a subjective assessment of the direction of the change." />
1503 <min value="0" />
1504 <max value="1" />
1505 <type>
1506 <code value="CodeableConcept" />
1507 </type>
1508 <mustSupport value="false" />
1509 <isModifier value="false" />
1510 <isSummary value="false" />
1511 <binding>
1512 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1513 <valueString value="ClinicalImpressionChangePattern" />
1514 </extension>
1515 <strength value="example" />
1516 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-change-pattern" />
1517 </binding>
1518 </element>
1519 <element id="ClinicalImpression.protocol">
1520 <path value="ClinicalImpression.protocol" />
1521 <short value="Clinical Protocol followed" />
1522 <definition value="Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosis." />
1523 <min value="0" />
1524 <max value="*" />
1525 <type>
1526 <code value="uri" />
1527 </type>
1528 <mustSupport value="false" />
1529 <isModifier value="false" />
1530 <isSummary value="false" />
1531 </element>
1532 <element id="ClinicalImpression.summary">
1533 <path value="ClinicalImpression.summary" />
1534 <short value="Summary of the assessment" />
1535 <definition value="A text summary of the investigations and the diagnosis." />
1536 <min value="0" />
1537 <max value="1" />
1538 <type>
1539 <code value="string" />
1540 </type>
1541 <mustSupport value="false" />
1542 <isModifier value="false" />
1543 <isSummary value="false" />
1544 <mapping>
1545 <identity value="v2" />
1546 <map value="OBX" />
1547 </mapping>
1548 </element>
1549 <element id="ClinicalImpression.finding">
1550 <path value="ClinicalImpression.finding" />
1551 <short value="Possible or likely findings and diagnoses" />
1552 <definition value="Specific findings or diagnoses that were considered likely or relevant to ongoing treatment." />
1553 <min value="0" />
1554 <max value="*" />
1555 <type>
1556 <code value="BackboneElement" />
1557 </type>
1558 <mustSupport value="false" />
1559 <isModifier value="false" />
1560 <isSummary value="false" />
1561 </element>
1562 <element id="ClinicalImpression.finding.item">
1563 <path value="ClinicalImpression.finding.item" />
1564 <short value="What was found" />
1565 <definition value="Specific text, code or reference for finding or diagnosis, which may include ruled-out or resolved conditions." />
1566 <min value="0" />
1567 <max value="1" />
1568 <type>
1569 <code value="CodeableReference" />
1570 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
1571 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
1572 <targetProfile value="http://hl7.org/fhir/StructureDefinition/DocumentReference" />
1573 </type>
1574 <mustSupport value="false" />
1575 <isModifier value="false" />
1576 <isSummary value="false" />
1577 <binding>
1578 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1579 <valueString value="ConditionKind" />
1580 </extension>
1581 <strength value="example" />
1582 <description value="Identification of the Condition or diagnosis." />
1583 <valueSet value="http://hl7.org/fhir/ValueSet/condition-code" />
1584 </binding>
1585 <mapping>
1586 <identity value="v2" />
1587 <map value="OBX" />
1588 </mapping>
1589 </element>
1590 <element id="ClinicalImpression.finding.basis">
1591 <path value="ClinicalImpression.finding.basis" />
1592 <short value="Which investigations support finding" />
1593 <definition value="Which investigations support finding or diagnosis." />
1594 <min value="0" />
1595 <max value="1" />
1596 <type>
1597 <code value="string" />
1598 </type>
1599 <mustSupport value="false" />
1600 <isModifier value="false" />
1601 <isSummary value="false" />
1602 </element>
1603 <element id="ClinicalImpression.prognosisCodeableConcept">
1604 <path value="ClinicalImpression.prognosisCodeableConcept" />
1605 <short value="Estimate of likely outcome" />
1606 <definition value="Estimate of likely outcome." />
1607 <min value="0" />
1608 <max value="*" />
1609 <type>
1610 <code value="CodeableConcept" />
1611 </type>
1612 <mustSupport value="false" />
1613 <isModifier value="false" />
1614 <isSummary value="false" />
1615 <binding>
1616 <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
1617 <valueString value="ClinicalImpressionPrognosis" />
1618 </extension>
1619 <strength value="example" />
1620 <description value="Prognosis or outlook findings." />
1621 <valueSet value="http://hl7.org/fhir/ValueSet/clinicalimpression-prognosis" />
1622 </binding>
1623 <mapping>
1624 <identity value="v2" />
1625 <map value="PRB-22" />
1626 </mapping>
1627 </element>
1628 <element id="ClinicalImpression.prognosisReference">
1629 <path value="ClinicalImpression.prognosisReference" />
1630 <short value="RiskAssessment expressing likely outcome" />
1631 <definition value="RiskAssessment expressing likely outcome." />
1632 <min value="0" />
1633 <max value="*" />
1634 <type>
1635 <code value="Reference" />
1636 <targetProfile value="http://hl7.org/fhir/StructureDefinition/RiskAssessment" />
1637 </type>
1638 <mustSupport value="false" />
1639 <isModifier value="false" />
1640 <isSummary value="false" />
1641 </element>
1642 <element id="ClinicalImpression.supportingInfo">
1643 <path value="ClinicalImpression.supportingInfo" />
1644 <short value="Information supporting the clinical impression" />
1645 <definition value="Information supporting the clinical impression, which can contain investigation results." />
1646 <min value="0" />
1647 <max value="*" />
1648 <type>
1649 <code value="Reference" />
1650 <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
1651 </type>
1652 <mustSupport value="false" />
1653 <isModifier value="false" />
1654 <isSummary value="false" />
1655 </element>
1656 <element id="ClinicalImpression.note">
1657 <path value="ClinicalImpression.note" />
1658 <short value="Comments made about the ClinicalImpression" />
1659 <definition value="Commentary about the impression, typically recorded after the impression itself was made, though supplemental notes by the original author could also appear." />
1660 <comment value="Don't use this element for content that should more properly appear as one of the specific elements of the impression." />
1661 <min value="0" />
1662 <max value="*" />
1663 <type>
1664 <code value="Annotation" />
1665 </type>
1666 <mustSupport value="false" />
1667 <isModifier value="false" />
1668 <isSummary value="false" />
1669 <mapping>
1670 <identity value="workflow" />
1671 <map value="Event.note" />
1672 </mapping>
1673 </element>
1674 </differential>
1675 </StructureDefinition>