Release 4B 5 Ballot

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-ballot: R5 Ballot - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

9.2 Resource Condition - Content

Patient Care icon Work Group Maturity Level : 3   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner , RelatedPerson

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

9.2.1 Scope and Usage

Condition is one of the event resources in the FHIR workflow specification. This resource is used to record detailed information about a condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern. The condition could be a point in time diagnosis in context of an encounter, it could be an item on the practitioner’s Problem List, or it could be a concern that doesn’t exist on the practitioner’s Problem List. Often times, a condition is about a clinician's assessment and assertion of a particular aspect of a patient's state of health. It can be used to record information about a disease/illness identified from application of clinical reasoning over the pathologic and pathophysiologic findings (diagnosis), or identification of health issues/situations that a practitioner considers harmful, potentially harmful and may be investigated and managed (problem), or other health issue/situation that may require ongoing monitoring and/or management (health issue/concern).

The condition resource may be used to record a certain health state of a patient which does not normally present a negative outcome, e.g. pregnancy. The condition resource may be used to record a condition following a procedure, such as the condition of Amputee-BKA following an amputation procedure.

While conditions are frequently a result of a clinician's assessment and assertion of a particular aspect of a patient's state of health, conditions can also be expressed by the patient, related person, or any care team member. A clinician may have a concern about a patient condition (e.g. anorexia) that the patient is not concerned about. Likewise, the patient may have a condition (e.g. hair loss) that does not rise to the level of importance such that it belongs on a practitioner’s Problem List.

For example, each of the following conditions could rise to the level of importance such that it belongs on a problem or concern list due to its direct or indirect impact on the patient’s health. These examples may also be represented using other resources, such as FamilyMemberHistory , Observation , RiskAssessment , or Procedure .

  • Unemployed
  • Without transportation (or other barriers)
  • Susceptibility to falls
  • Exposure to communicable disease
  • Family History of cardiovascular disease
  • Fear of cancer
  • Cardiac pacemaker
  • Amputee-BKA
  • Risk of Zika virus following travel to a country
  • Former smoker
  • Travel to a country planned (that warrants immunizations)
  • Motor Vehicle Accident
  • Patient has had coronary bypass graft

9.2.2 Boundaries and Relationships

The condition resource may be referenced by other resources as "reasons" for an action (e.g. MedicationRequest , Procedure , ServiceRequest , etc.)

This resource is not typically used to record information about subjective and objective information that might lead to the recording of a Condition resource. Such signs and symptoms are typically captured using the Observation resource; although in some cases a persistent symptom, e.g. fever, headache may be captured as a condition before a definitive diagnosis can be discerned by a clinician. In an inpatient scenario, a nursing problem list may document symptoms (such as respiratory alteration) as conditions if they are the focus of care provision. It became a problem because the nurse (clinician) wants to manage it. By contrast, headache may be captured as an Observation when it contributes to the establishment of a meningitis Condition.

Use the Observation resource when a symptom is resolved without long term management, tracking, or when a symptom contributes to the establishment of a condition.

Use Condition when a symptom requires long term management, tracking, or is used as a proxy for a diagnosis or problem that is not yet determined.

Note that a Condition represents an instance of a condition, not the categorical patient state. This can be a subtle distinction for systemic conditions, but it is easier to see with conditions that can happen more than once, e.g. refuting one record of a wound does not mean that the patient does not have any other wounds, and resolving one case of otitis media does not rule out recurrence. An observation that the patient doesn't have any wounds means the patient doesn't have any wounds at that point in time.

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

9.2.3 References to this Resource

This resource is referenced by

9.2.4 Resource Content

Structure

Person who asserts this
Name Flags Card. Type Description & Constraints doco
. . Condition TU DomainResource Detailed information about conditions, problems or diagnoses
+ Guideline: Condition.clinicalStatus SHOULD be present if verificationStatus is not entered-in-error and Warning: If category is problem-list-item problems list item, the clinicalStatus should not be unknown
+ Rule: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission remission.
+ Rule: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Ids for this condition

. . . clinicalStatus ?! Σ I C 0..1 1..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Condition Clinical Status Codes ( Required )
. . . verificationStatus ?! Σ I 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
ConditionVerificationStatus ( Required )
. . . severity 0..1 CodeableConcept Subjective severity of condition
Condition/Diagnosis Severity ( Preferred )
. . . code Σ 0..1 CodeableConcept Identification of the condition, problem or diagnosis
Condition/Problem/Diagnosis Codes ( Example )
. . . bodySite Σ 0..* CodeableConcept Anatomical location, if relevant
SNOMED CT Body Structures ( Example )

. . . subject Σ 1..1 Reference ( Patient | Group ) Who has the condition?
. . . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Condition was created as part of
. . . onset[x] Σ 0..1 Estimated or actual date, date-time, or age
. . . . onsetDateTime dateTime
. . . . onsetAge Age
. . . . onsetPeriod Period
. . . . onsetRange Range
. . . . onsetString string
. . . abatement[x] I C 0..1 When in resolution/remission
. . . . abatementDateTime dateTime
. . . . abatementAge Age
. . . . abatementPeriod Period
. . . . abatementRange Range
. . . . abatementString string
. . . recordedDate Σ 0..1 dateTime Date record condition was first recorded
. . recorder . participant Σ 0..1 0..* Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson BackboneElement ) Who recorded or what participated in the activities related to the condition and how they were involved

. . . asserter . function Σ 0..1 CodeableConcept Type of involvement
ParticipationRoleType ( Extensible )
.... actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam ) Who or what participated in the activities related to the condition
. . . stage I C TU 0..* BackboneElement Stage/grade, usually assessed formally
+ Rule: Stage SHALL have summary or assessment

. . . . summary I C 0..1 CodeableConcept Simple summary (disease specific)
Condition Stage ( Example )
. . . . assessment I C 0..* Reference ( ClinicalImpression | DiagnosticReport | Observation ) Formal record of assessment

. . . . type 0..1 CodeableConcept Kind of staging
Condition Stage Type ( Example ) evidence I 0..* BackboneElement Supporting evidence + Rule: evidence SHALL have code or details
. . code . evidence Σ I TU 0..* CodeableConcept CodeableReference ( Any ) Manifestation/symptom Supporting evidence for the verification status
Manifestation and Symptom Codes SNOMED CT Clinical Findings ( Example )
detail Σ I 0..* Reference ( Any ) Supporting information found elsewhere
. . . note 0..* Annotation Additional information about the Condition


doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

Condition ( DomainResource ) 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 identifier : Identifier [0..*] The clinical status of the condition (this element modifies the meaning of other elements) clinicalStatus : CodeableConcept [0..1] [1..1] « null (Strength=Required) ConditionClinicalStatusCodes ! » « This element has or is affected by some invariants C » The verification status to support the clinical status of the condition. The verification status pertains to the condition, itself, not to any specific condition attribute (this element modifies the meaning of other elements) verificationStatus : CodeableConcept [0..1] « null (Strength=Required) ConditionVerificationStatus ! » A category assigned to the condition category : CodeableConcept [0..*] « null (Strength=Extensible) (Strength=Preferred) ConditionCategoryCodes + ? » « This element has or is affected by some invariants C » A subjective assessment of the severity of the condition as evaluated by the clinician severity : CodeableConcept [0..1] « null (Strength=Preferred) Condition/DiagnosisSeverity ? » Identification of the condition, problem or diagnosis code : CodeableConcept [0..1] « null (Strength=Example) Condition/Problem/DiagnosisCo... ?? » The anatomical location where this condition manifests itself bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Indicates the patient or group who the condition record is associated with subject : Reference [1..1] « Patient | Group » The Encounter during which this Condition was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Estimated or actual date or date-time the condition began, in the opinion of the clinician onset[x] : Element DataType [0..1] « dateTime | Age | Period | Range | string » 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 Some conditions, such as chronic conditions, are never really resolved, but they can abate abatement[x] : Element DataType [0..1] « dateTime | Age | Period | Range | string » « This element has or is affected by some invariants C » The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date recordedDate : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson » Individual who is making Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition statement asserter evidence : Reference CodeableReference [0..1] [0..*] « Practitioner | PractitionerRole | Patient Any | ; RelatedPerson null (Strength=Example) SNOMEDCTClinicalFindings ?? » Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis note : Annotation [0..*] Participant Distinguishes the type of involvement of the actor in the activities related to the condition function : CodeableConcept [0..1] « null (Strength=Extensible) ParticipationRoleType + » Indicates who or what participated in the activities related to the condition actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam » Stage A simple summary of the stage such as "Stage 3". 3" or "Early Onset". The determination of the stage is disease-specific disease-specific, such as cancer, retinopathy of prematurity, kidney diseases, Alzheimer's, or Parkinson disease summary : CodeableConcept [0..1] « null (Strength=Example) ConditionStage ?? » « This element has or is affected by some invariants C » Reference to a formal record of the evidence on which the staging assessment is based assessment : Reference [0..*] « ClinicalImpression | DiagnosticReport | Observation » « This element has or is affected by some invariants C » The kind of staging, such as pathological or clinical staging type : CodeableConcept [0..1] « null (Strength=Example) ConditionStageType ?? » Evidence A manifestation Indicates who or symptom that led what participated in the activities related to the recording of this condition and how they were involved code : CodeableConcept participant [0..*] « null (Strength=Example) ManifestationAndSymptomCodes ?? » Links to other relevant information, including pathology reports detail : Reference [0..*] « Any » Clinical stage or grade A simple summary of a condition. May include formal severity assessments stage [0..*] Supporting evidence / manifestations that are the basis stage such as "Stage 3" or "Early Onset". The determination of the Condition's verification status, stage is disease-specific, such as evidence that confirmed cancer, retinopathy of prematurity, kidney diseases, Alzheimer's, or refuted the condition Parkinson disease evidence stage [0..*]

XML Template 

<Condition xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this condition --></identifier>
 <</clinicalStatus>
 <</verificationStatus>
 <</category>

 <clinicalStatus><!-- I 1..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved --></clinicalStatus>
 <verificationStatus><!-- 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error --></verificationStatus>
 <category><!-- I 0..* CodeableConcept problem-list-item | encounter-diagnosis --></category>

 <severity><!-- 0..1 CodeableConcept Subjective severity of condition --></severity>
 <code><!-- 0..1 CodeableConcept Identification of the condition, problem or diagnosis --></code>
 <bodySite><!-- 0..* CodeableConcept Anatomical location, if relevant --></bodySite>
 <subject><!-- 1..1 Reference(Group|Patient) Who has the condition? --></subject>
 <</encounter>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Condition was created --></encounter>

 <onset[x]><!-- 0..1 dateTime|Age|Period|Range|string Estimated or actual date,  date-time, or age --></onset[x]>
 <</abatement[x]>
 <
 <|
   </recorder>
 <|
   </asserter>
 <
  <</summary>
  <</assessment>

 <abatement[x]><!-- I 0..1 dateTime|Age|Period|Range|string When in resolution/remission --></abatement[x]>
 <recordedDate value="[dateTime]"/><!-- 0..1 Date condition was first recorded -->
 <participant>  <!-- 0..* Who or what participated in the activities related to the condition and how they were involved -->
  <function><!-- 0..1 CodeableConcept Type of involvement --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Who or what participated in the activities related to the condition --></actor>

 </participant>
 <stage>  <!-- 0..* Stage/grade, usually assessed formally -->
  <summary><!-- I 0..1 CodeableConcept Simple summary (disease specific) --></summary>
  <assessment><!-- I 0..* Reference(ClinicalImpression|DiagnosticReport|Observation) Formal record of assessment --></assessment>

  <type><!-- 0..1 CodeableConcept Kind of staging --></type>
 </stage>
 <
  <</code>
  <</detail>
 </evidence>

 <evidence><!-- 0..* CodeableReference(Any) Supporting evidence for the verification status --></evidence>

 <note><!-- 0..* Annotation Additional information about the Condition --></note>
</Condition>

JSON Template 

{doco
  "resourceType" : "Condition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this condition
  "
  "
  "

  "clinicalStatus" : { CodeableConcept }, // I R!  active | recurrence | relapse | inactive | remission | resolved
  "verificationStatus" : { CodeableConcept }, // unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
  "category" : [{ CodeableConcept }], // I problem-list-item | encounter-diagnosis

  "severity" : { CodeableConcept }, // Subjective severity of condition
  "code" : { CodeableConcept }, // Identification of the condition, problem or diagnosis
  "bodySite" : [{ CodeableConcept }], // Anatomical location, if relevant
  "subject" : { Reference(Group|Patient) }, // R!  Who has the condition?
  "

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Condition was created

  // onset[x]: Estimated or actual date,  date-time, or age. One of these 5:
  "onsetDateTime" : "<dateTime>",
  "onsetAge" : { Age },
  "onsetPeriod" : { Period },
  "onsetRange" : { Range },
  "onsetString" : "<string>",
  // abatement[x]: When in resolution/remission. One of these 5:
  ">",
  " },
  " },
  " },
  ">",
  "
  "|
   
  "|
   
  "
    "
    "
    "

  "abatementDateTime" : "<dateTime>",
  "abatementAge" : { Age },
  "abatementPeriod" : { Period },
  "abatementRange" : { Range },
  "abatementString" : "<string>",
  "recordedDate" : "<dateTime>", // Date condition was first recorded
  "participant" : [{ // Who or what participated in the activities related to the condition and how they were involved
    "function" : { CodeableConcept }, // Type of involvement
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Who or what participated in the activities related to the condition
  }],
  "
    "
    "

  "stage" : [{ // Stage/grade, usually assessed formally
    "summary" : { CodeableConcept }, // I Simple summary (disease specific)
    "assessment" : [{ Reference(ClinicalImpression|DiagnosticReport|Observation) }], // I Formal record of assessment
    "type" : { CodeableConcept } // Kind of staging

  }],
  "evidence" : [{ CodeableReference(Any) }], // Supporting evidence for the verification status

  "note" : [{ Annotation }] // Additional information about the Condition
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Condition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Condition.identifier [ Identifier ], ... ; # 0..* External Ids for this condition
  fhir:
  fhir:
  fhir:

  fhir:Condition.clinicalStatus [ CodeableConcept ]; # 1..1 I active | recurrence | relapse | inactive | remission | resolved
  fhir:Condition.verificationStatus [ CodeableConcept ]; # 0..1 unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
  fhir:Condition.category [ CodeableConcept ], ... ; # 0..* I problem-list-item | encounter-diagnosis

  fhir:Condition.severity [ CodeableConcept ]; # 0..1 Subjective severity of condition
  fhir:Condition.code [ CodeableConcept ]; # 0..1 Identification of the condition, problem or diagnosis
  fhir:Condition.bodySite [ CodeableConcept ], ... ; # 0..* Anatomical location, if relevant
  fhir:Condition.subject [ Reference(Group|Patient) ]; # 1..1 Who has the condition?
  fhir:

  fhir:Condition.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Condition was created

  # Condition.onset[x] : 0..1 Estimated or actual date,  date-time, or age. One of these 5
    fhir:Condition.onsetDateTime [ dateTime ]
    fhir:Condition.onsetAge [ Age ]
    fhir:Condition.onsetPeriod [ Period ]
    fhir:Condition.onsetRange [ Range ]
    fhir:Condition.onsetString [ string ]
  # . One of these 5
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
  fhir:
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:

  # Condition.abatement[x] : 0..1 I When in resolution/remission. One of these 5
    fhir:Condition.abatementDateTime [ dateTime ]
    fhir:Condition.abatementAge [ Age ]
    fhir:Condition.abatementPeriod [ Period ]
    fhir:Condition.abatementRange [ Range ]
    fhir:Condition.abatementString [ string ]
  fhir:Condition.recordedDate [ dateTime ]; # 0..1 Date condition was first recorded
  fhir:Condition.participant [ # 0..* Who or what participated in the activities related to the condition and how they were involved
    fhir:Condition.participant.function [ CodeableConcept ]; # 0..1 Type of involvement
    fhir:Condition.participant.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who or what participated in the activities related to the condition

  ], ...;
  fhir:
    fhir:
    fhir:

  fhir:Condition.stage [ # 0..* Stage/grade, usually assessed formally
    fhir:Condition.stage.summary [ CodeableConcept ]; # 0..1 I Simple summary (disease specific)
    fhir:Condition.stage.assessment [ Reference(ClinicalImpression|DiagnosticReport|Observation) ], ... ; # 0..* I Formal record of assessment
    fhir:Condition.stage.type [ CodeableConcept ]; # 0..1 Kind of staging

  ], ...;
  fhir:Condition.evidence [ CodeableReference(Any) ], ... ; # 0..* Supporting evidence for the verification status

  fhir:Condition.note [ Annotation ], ... ; # 0..* Additional information about the Condition
]

Changes since R4

Condition
Condition.clinicalStatus
  • No Changes Min Cardinality changed from 0 to 1
  • Min Cardinality changed from 0 to 1
Condition.category
  • Remove Binding http://hl7.org/fhir/ValueSet/condition-category (extensible)
  • Remove Binding http://hl7.org/fhir/ValueSet/condition-category (extensible)
Condition.participant
  • Added Element
Condition.participant.function
  • Added Element
Condition.participant.actor
  • Added Mandatory Element
Condition.evidence
  • Type changed from BackboneElement to CodeableReference
  • Type changed from BackboneElement to CodeableReference
Condition.recorder
  • deleted
Condition.asserter
  • deleted
Condition.evidence.code
  • deleted
Condition.evidence.detail
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 See R3 <--> R4 Conversion Maps (status = 12 tests that all execute ok. All tests pass round-trip testing and 1 r3 resources are invalid (0 errors). )

Structure

Person who asserts this
Name Flags Card. Type Description & Constraints doco
. . Condition TU DomainResource Detailed information about conditions, problems or diagnoses
+ Guideline: Condition.clinicalStatus SHOULD be present if verificationStatus is not entered-in-error and Warning: If category is problem-list-item problems list item, the clinicalStatus should not be unknown
+ Rule: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission remission.
+ Rule: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Ids for this condition

. . . clinicalStatus ?! Σ I C 0..1 1..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved
Condition Clinical Status Codes ( Required )
. . . verificationStatus ?! Σ I 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
ConditionVerificationStatus ( Required )
. . . severity 0..1 CodeableConcept Subjective severity of condition
Condition/Diagnosis Severity ( Preferred )
. . . code Σ 0..1 CodeableConcept Identification of the condition, problem or diagnosis
Condition/Problem/Diagnosis Codes ( Example )
. . . bodySite Σ 0..* CodeableConcept Anatomical location, if relevant
SNOMED CT Body Structures ( Example )

. . . subject Σ 1..1 Reference ( Patient | Group ) Who has the condition?
. . . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Condition was created as part of
. . . onset[x] Σ 0..1 Estimated or actual date, date-time, or age
. . . . onsetDateTime dateTime
. . . . onsetAge Age
. . . . onsetPeriod Period
. . . . onsetRange Range
. . . . onsetString string
. . . abatement[x] I C 0..1 When in resolution/remission
. . . . abatementDateTime dateTime
. . . . abatementAge Age
. . . . abatementPeriod Period
. . . . abatementRange Range
. . . . abatementString string
. . . recordedDate Σ 0..1 dateTime Date record condition was first recorded
. . recorder . participant Σ 0..1 0..* Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson BackboneElement ) Who recorded or what participated in the activities related to the condition and how they were involved

. . . asserter . function Σ 0..1 CodeableConcept Type of involvement
ParticipationRoleType ( Extensible )
.... actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam ) Who or what participated in the activities related to the condition
. . . stage I C TU 0..* BackboneElement Stage/grade, usually assessed formally
+ Rule: Stage SHALL have summary or assessment

. . . . summary I C 0..1 CodeableConcept Simple summary (disease specific)
Condition Stage ( Example )
. . . . assessment I C 0..* Reference ( ClinicalImpression | DiagnosticReport | Observation ) Formal record of assessment

. . . . type 0..1 CodeableConcept Kind of staging
Condition Stage Type ( Example ) evidence I 0..* BackboneElement Supporting evidence + Rule: evidence SHALL have code or details
. . code . evidence Σ I TU 0..* CodeableConcept CodeableReference ( Any ) Manifestation/symptom Supporting evidence for the verification status
Manifestation and Symptom Codes SNOMED CT Clinical Findings ( Example )
detail Σ I 0..* Reference ( Any ) Supporting information found elsewhere
. . . note 0..* Annotation Additional information about the Condition


doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

Condition ( DomainResource ) 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 identifier : Identifier [0..*] The clinical status of the condition (this element modifies the meaning of other elements) clinicalStatus : CodeableConcept [0..1] [1..1] « null (Strength=Required) ConditionClinicalStatusCodes ! » « This element has or is affected by some invariants C » The verification status to support the clinical status of the condition. The verification status pertains to the condition, itself, not to any specific condition attribute (this element modifies the meaning of other elements) verificationStatus : CodeableConcept [0..1] « null (Strength=Required) ConditionVerificationStatus ! » A category assigned to the condition category : CodeableConcept [0..*] « null (Strength=Extensible) (Strength=Preferred) ConditionCategoryCodes + ? » « This element has or is affected by some invariants C » A subjective assessment of the severity of the condition as evaluated by the clinician severity : CodeableConcept [0..1] « null (Strength=Preferred) Condition/DiagnosisSeverity ? » Identification of the condition, problem or diagnosis code : CodeableConcept [0..1] « null (Strength=Example) Condition/Problem/DiagnosisCo... ?? » The anatomical location where this condition manifests itself bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » Indicates the patient or group who the condition record is associated with subject : Reference [1..1] « Patient | Group » The Encounter during which this Condition was created or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Estimated or actual date or date-time the condition began, in the opinion of the clinician onset[x] : Element DataType [0..1] « dateTime | Age | Period | Range | string » 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 Some conditions, such as chronic conditions, are never really resolved, but they can abate abatement[x] : Element DataType [0..1] « dateTime | Age | Period | Range | string » « This element has or is affected by some invariants C » The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date recordedDate : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Practitioner | PractitionerRole | Patient | RelatedPerson » Individual who is making Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition statement asserter evidence : Reference CodeableReference [0..1] [0..*] « Practitioner | PractitionerRole | Patient Any | ; RelatedPerson null (Strength=Example) SNOMEDCTClinicalFindings ?? » Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis note : Annotation [0..*] Participant Distinguishes the type of involvement of the actor in the activities related to the condition function : CodeableConcept [0..1] « null (Strength=Extensible) ParticipationRoleType + » Indicates who or what participated in the activities related to the condition actor : Reference [1..1] « Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam » Stage A simple summary of the stage such as "Stage 3". 3" or "Early Onset". The determination of the stage is disease-specific disease-specific, such as cancer, retinopathy of prematurity, kidney diseases, Alzheimer's, or Parkinson disease summary : CodeableConcept [0..1] « null (Strength=Example) ConditionStage ?? » « This element has or is affected by some invariants C » Reference to a formal record of the evidence on which the staging assessment is based assessment : Reference [0..*] « ClinicalImpression | DiagnosticReport | Observation » « This element has or is affected by some invariants C » The kind of staging, such as pathological or clinical staging type : CodeableConcept [0..1] « null (Strength=Example) ConditionStageType ?? » Evidence A manifestation Indicates who or symptom that led what participated in the activities related to the recording of this condition and how they were involved code : CodeableConcept participant [0..*] « null (Strength=Example) ManifestationAndSymptomCodes ?? » Links to other relevant information, including pathology reports detail : Reference [0..*] « Any » Clinical stage or grade A simple summary of a condition. May include formal severity assessments stage [0..*] Supporting evidence / manifestations that are the basis stage such as "Stage 3" or "Early Onset". The determination of the Condition's verification status, stage is disease-specific, such as evidence that confirmed cancer, retinopathy of prematurity, kidney diseases, Alzheimer's, or refuted the condition Parkinson disease evidence stage [0..*]

XML Template 

<Condition xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Ids for this condition --></identifier>
 <</clinicalStatus>
 <</verificationStatus>
 <</category>

 <clinicalStatus><!-- I 1..1 CodeableConcept active | recurrence | relapse | inactive | remission | resolved --></clinicalStatus>
 <verificationStatus><!-- 0..1 CodeableConcept unconfirmed | provisional | differential | confirmed | refuted | entered-in-error --></verificationStatus>
 <category><!-- I 0..* CodeableConcept problem-list-item | encounter-diagnosis --></category>

 <severity><!-- 0..1 CodeableConcept Subjective severity of condition --></severity>
 <code><!-- 0..1 CodeableConcept Identification of the condition, problem or diagnosis --></code>
 <bodySite><!-- 0..* CodeableConcept Anatomical location, if relevant --></bodySite>
 <subject><!-- 1..1 Reference(Group|Patient) Who has the condition? --></subject>
 <</encounter>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Condition was created --></encounter>

 <onset[x]><!-- 0..1 dateTime|Age|Period|Range|string Estimated or actual date,  date-time, or age --></onset[x]>
 <</abatement[x]>
 <
 <|
   </recorder>
 <|
   </asserter>
 <
  <</summary>
  <</assessment>

 <abatement[x]><!-- I 0..1 dateTime|Age|Period|Range|string When in resolution/remission --></abatement[x]>
 <recordedDate value="[dateTime]"/><!-- 0..1 Date condition was first recorded -->
 <participant>  <!-- 0..* Who or what participated in the activities related to the condition and how they were involved -->
  <function><!-- 0..1 CodeableConcept Type of involvement --></function>
  <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) Who or what participated in the activities related to the condition --></actor>

 </participant>
 <stage>  <!-- 0..* Stage/grade, usually assessed formally -->
  <summary><!-- I 0..1 CodeableConcept Simple summary (disease specific) --></summary>
  <assessment><!-- I 0..* Reference(ClinicalImpression|DiagnosticReport|Observation) Formal record of assessment --></assessment>

  <type><!-- 0..1 CodeableConcept Kind of staging --></type>
 </stage>
 <
  <</code>
  <</detail>
 </evidence>

 <evidence><!-- 0..* CodeableReference(Any) Supporting evidence for the verification status --></evidence>

 <note><!-- 0..* Annotation Additional information about the Condition --></note>
</Condition>

JSON Template 

{doco
  "resourceType" : "Condition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Ids for this condition
  "
  "
  "

  "clinicalStatus" : { CodeableConcept }, // I R!  active | recurrence | relapse | inactive | remission | resolved
  "verificationStatus" : { CodeableConcept }, // unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
  "category" : [{ CodeableConcept }], // I problem-list-item | encounter-diagnosis

  "severity" : { CodeableConcept }, // Subjective severity of condition
  "code" : { CodeableConcept }, // Identification of the condition, problem or diagnosis
  "bodySite" : [{ CodeableConcept }], // Anatomical location, if relevant
  "subject" : { Reference(Group|Patient) }, // R!  Who has the condition?
  "

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Condition was created

  // onset[x]: Estimated or actual date,  date-time, or age. One of these 5:
  "onsetDateTime" : "<dateTime>",
  "onsetAge" : { Age },
  "onsetPeriod" : { Period },
  "onsetRange" : { Range },
  "onsetString" : "<string>",
  // abatement[x]: When in resolution/remission. One of these 5:
  ">",
  " },
  " },
  " },
  ">",
  "
  "|
   
  "|
   
  "
    "
    "
    "

  "abatementDateTime" : "<dateTime>",
  "abatementAge" : { Age },
  "abatementPeriod" : { Period },
  "abatementRange" : { Range },
  "abatementString" : "<string>",
  "recordedDate" : "<dateTime>", // Date condition was first recorded
  "participant" : [{ // Who or what participated in the activities related to the condition and how they were involved
    "function" : { CodeableConcept }, // Type of involvement
    "actor" : { Reference(CareTeam|Device|Organization|Patient|Practitioner|
    PractitionerRole|RelatedPerson) } // R!  Who or what participated in the activities related to the condition
  }],
  "
    "
    "

  "stage" : [{ // Stage/grade, usually assessed formally
    "summary" : { CodeableConcept }, // I Simple summary (disease specific)
    "assessment" : [{ Reference(ClinicalImpression|DiagnosticReport|Observation) }], // I Formal record of assessment
    "type" : { CodeableConcept } // Kind of staging

  }],
  "evidence" : [{ CodeableReference(Any) }], // Supporting evidence for the verification status

  "note" : [{ Annotation }] // Additional information about the Condition
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Condition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Condition.identifier [ Identifier ], ... ; # 0..* External Ids for this condition
  fhir:
  fhir:
  fhir:

  fhir:Condition.clinicalStatus [ CodeableConcept ]; # 1..1 I active | recurrence | relapse | inactive | remission | resolved
  fhir:Condition.verificationStatus [ CodeableConcept ]; # 0..1 unconfirmed | provisional | differential | confirmed | refuted | entered-in-error
  fhir:Condition.category [ CodeableConcept ], ... ; # 0..* I problem-list-item | encounter-diagnosis

  fhir:Condition.severity [ CodeableConcept ]; # 0..1 Subjective severity of condition
  fhir:Condition.code [ CodeableConcept ]; # 0..1 Identification of the condition, problem or diagnosis
  fhir:Condition.bodySite [ CodeableConcept ], ... ; # 0..* Anatomical location, if relevant
  fhir:Condition.subject [ Reference(Group|Patient) ]; # 1..1 Who has the condition?
  fhir:

  fhir:Condition.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Condition was created

  # Condition.onset[x] : 0..1 Estimated or actual date,  date-time, or age. One of these 5
    fhir:Condition.onsetDateTime [ dateTime ]
    fhir:Condition.onsetAge [ Age ]
    fhir:Condition.onsetPeriod [ Period ]
    fhir:Condition.onsetRange [ Range ]
    fhir:Condition.onsetString [ string ]
  # . One of these 5
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
  fhir:
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:

  # Condition.abatement[x] : 0..1 I When in resolution/remission. One of these 5
    fhir:Condition.abatementDateTime [ dateTime ]
    fhir:Condition.abatementAge [ Age ]
    fhir:Condition.abatementPeriod [ Period ]
    fhir:Condition.abatementRange [ Range ]
    fhir:Condition.abatementString [ string ]
  fhir:Condition.recordedDate [ dateTime ]; # 0..1 Date condition was first recorded
  fhir:Condition.participant [ # 0..* Who or what participated in the activities related to the condition and how they were involved
    fhir:Condition.participant.function [ CodeableConcept ]; # 0..1 Type of involvement
    fhir:Condition.participant.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who or what participated in the activities related to the condition

  ], ...;
  fhir:
    fhir:
    fhir:

  fhir:Condition.stage [ # 0..* Stage/grade, usually assessed formally
    fhir:Condition.stage.summary [ CodeableConcept ]; # 0..1 I Simple summary (disease specific)
    fhir:Condition.stage.assessment [ Reference(ClinicalImpression|DiagnosticReport|Observation) ], ... ; # 0..* I Formal record of assessment
    fhir:Condition.stage.type [ CodeableConcept ]; # 0..1 Kind of staging

  ], ...;
  fhir:Condition.evidence [ CodeableReference(Any) ], ... ; # 0..* Supporting evidence for the verification status

  fhir:Condition.note [ Annotation ], ... ; # 0..* Additional information about the Condition
]

Changes since Release 4

Condition
Condition.clinicalStatus
  • No Changes Min Cardinality changed from 0 to 1
  • Min Cardinality changed from 0 to 1
Condition.category
  • Remove Binding http://hl7.org/fhir/ValueSet/condition-category (extensible)
  • Remove Binding http://hl7.org/fhir/ValueSet/condition-category (extensible)
Condition.participant
  • Added Element
Condition.participant.function
  • Added Element
Condition.participant.actor
  • Added Mandatory Element
Condition.evidence
  • Type changed from BackboneElement to CodeableReference
  • Type changed from BackboneElement to CodeableReference
Condition.recorder
  • deleted
Condition.asserter
  • deleted
Condition.evidence.code
  • deleted
Condition.evidence.detail
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 See R3 <--> R4 Conversion Maps (status = 12 tests that all execute ok. All tests pass round-trip testing and 1 r3 resources are invalid (0 errors). )

 

See the Profiles & Extensions and the alternate Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

9.2.4.1 Terminology Bindings

Condition.evidence.code
Path Definition Type Reference
Condition.clinicalStatus

Preferred value set for Condition Clinical Status.

Required ConditionClinicalStatusCodes
Condition.verificationStatus

The verification status to support or decline the clinical status of the condition or diagnosis.

Required ConditionVerificationStatus
Condition.category

Preferred value set for Condition Categories.

Extensible Preferred ConditionCategoryCodes
Condition.severity

Preferred value set for Condition/Diagnosis severity grading.

Preferred Condition/DiagnosisSeverity
Condition.code

Example value set for Condition/Problem/Diagnosis codes.

Example Condition/Problem/DiagnosisCodes
Condition.bodySite

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).

Example SNOMEDCTBodyStructures
Condition.participant.function

This FHIR value set is comprised of Actor participation Type codes, which can be used to value FHIR agents, actors, and other role elements. The codes are intended to express how the agent participated in some activity. Sometimes refered to the agent functional-role relative to the activity.

Extensible ParticipationRoleType
Condition.stage.summary

Example value set for stages of cancer and other conditions.

Example ConditionStage
Condition.stage.type

Example value set for the type of stages of cancer and other conditions

Example ConditionStageType
Condition.evidence

This value set includes all the "Clinical finding" SNOMED CT icon codes - concepts where concept is-a 404684003 (Clinical finding (finding)).

Example ManifestationAndSymptomCodes SNOMEDCTClinicalFindings

9.2.4.2 Constraints

con-5 Rule (base) 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()
id UniqueKey Level Location Description Expression
con-1 img  con-1 Rule Condition.stage Stage SHALL have summary or assessment summary.exists() or assessment.exists()
con-2 Rule Condition.evidence evidence SHALL have code or details code.exists() or detail.exists() con-3 img  con-2 Guideline Warning (base) Condition.clinicalStatus SHOULD be present if verificationStatus is not entered-in-error and If category is problem-list-item problems list item, the clinicalStatus should not be unknown verificationStatus.empty().not() and verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').exists().not() and category.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-category' and code='problem-list-item').exists() implies clinicalStatus.empty().not() clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and code='unknown').exists().not() This is (only) a best practice guideline because: Most systems will expect a clinicalStatus to be valued for problem-list-items that are managed over time, but might not need a clinicalStatus for point in time encounter-diagnosis.
con-4 img  con-3 Rule (base) If condition is abated, then clinicalStatus must be either inactive, resolved, or remission remission. abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' abatement.exists() implies (clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' (code='inactive' or code='remission' code='resolved' or code='inactive')).exists() code='remission')).exists())

9.2.4.3 Use of Condition.code

Many of the code systems used for coding conditions will provide codes that define not only the condition itself, but may also specify a particular stage, location, or causality as part of the code. This is particularly true if SNOMED CT is used for the condition, and especially if expressions are allowed.

The Condition.code may also include such concepts as "history as "history of X" and "good and "good health", where it is useful or appropriate to make such assertions. It can also be used to capture "risk of" and "fear of", in addition to physical conditions, as well as "no known problems" or "negated" conditions (e.g., "no X" or "no history of X" - see the following section for "No Known Problems" and Negated Conditions).

When the Condition.code specifies additional properties of the condition, the other properties are not given a value - instead, the value must be understood from the Condition.code.

9.2.4.4 "No Known Problems" and Negated Conditions

Conditions/Problems Not Reviewed, Not Asked

When a sending system does not have any information about conditions/problems being reviewed or the statement is about conditions/problems not yet being asked, then the List resource should be used to indicate the List.emptyReason.code="notasked".

Conditions/Problems Reviewed, None Identified

Systems may use the List.emptyReason when a statement is about the full scope of the list (i.e. the patient has no conditions/problems of any type). However, it may be preferred to use a code for "no known problems" (e.g., SNOMED CT: 160245001 |No current problems or disability (situation)|), so that all condition/problem data will be available and queryable from Condition resource instances.

Also note that care should be used when adding new Condition resources to a list to ensure that any negation statements that are voided by the addition of a new record are removed from the list. E.g. If the list contains a "no known problems" record and you add a "diabetes" condition record, then be sure that you remove the "no known problems" record.

Trial-Use Note: Note to Implementers: There are two primary ways of reporting "no known problems" in the current specification: using the CodeableConcept, as described above, or using the List resource with emptyReason. During the STU period, feedback icon is sought regarding the preferred approach.

Provide feedback here icon .

Patient Denies Condition

When the patient denies a condition, that can be annotated in the Condition.note element.

9.2.4.5 Assertions of Condition Absence

Generally, electronic records do not contain assertions of conditions that a patient does not have. There are however two exceptions:

  • It is appropriate to capture a "refuted" Condition record if the patient or anyone else had reason to believe that a patient did have a condition for a period of time Condition was considered present and subsequent evidence has demonstrated refuted it. Specifically, Condition.verificationStatus can convey refuted. The corresponding evidence of that belief was mistaken. In this case, a concrete statement acknowledging the belief as well as the refutation of it can be conveyed in Condition.evidence. When the condition is useful. refuted, other elements may be retained for legal reasons, but those other elements are no longer clinically relevant.
  • It is common as part of checklists prior to admission, surgery, enrollment in trials, etc. to ask questions such as "are you pregnant", "do you have a history of hypertension", etc. This information should NOT be captured using the Condition resource but should instead be captured using QuestionnaireResponse or Observation. In this case, the combination of the question and answer would convey that a particular condition was not present.

9.2.4.6 Use of Condition.evidence

The Condition.evidence provides the basis for whatever is present in Condition.code.

9.2.4.7 Use of Condition.abatementRange

A range is used to communicate age period of subject at time of abatement.

9.2.4.8 Use of Condition.asserter

If the data enterer is different from the asserter and needs to be known, this could be captured using a Provenance instance pointing to the Condition. For example, it is possible that a nurse records the condition on behalf of a physician. The physician is taking responsibility, despite the nurse entering it into the medical record.

9.2.4.9 Use of Condition.clinicalStatus

The Condition.stage and Condition.clinicalStatus may have interdependencies. For example, some "stages" of cancer, etc. will be different for a remission than for the initial occurrence.

9.2.4.10 Diagnosis Role and Rank within an Encounter

To represent the role of the diagnosis within an encounter, such as admission diagnosis or discharge diagnosis, use Encounter.diagnosis.role .

To represent the numeric ranking of the diagnosis within an encounter, such as primary, secondary, or tertiary, use Encounter.diagnosis.rank .

9.2.4.11 Known Issue

A known issue exists with circular references between Condition and ClinicalImpression, which is due to the low maturity level of ClinicalImpression. The Patient Care work group intends to address this issue when ClinicalImpression is considered substantially complete and ready for implementation.

9.2.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
abatement-age quantity Abatement as age or age range Condition.abatement.as(Age) Condition.abatement.ofType(Age) | Condition.abatement.as(Range) Condition.abatement.ofType(Range)
abatement-date date Date-related abatements (dateTime and period) Condition.abatement.as(dateTime) Condition.abatement.ofType(dateTime) | Condition.abatement.as(Period) Condition.abatement.ofType(Period)
abatement-string string Abatement as a string Condition.abatement.as(string) asserter reference Person who asserts this condition Condition.asserter ( Practitioner , Patient , PractitionerRole , RelatedPerson ) Condition.abatement.ofType(string)
body-site token Anatomical location, if relevant Condition.bodySite
category token The category of the condition Condition.category
clinical-status token The clinical status of the condition Condition.clinicalStatus
code token Code for the condition Condition.code
encounter reference The Encounter during which this Condition was created as part of Condition.encounter
( Encounter )
evidence token Manifestation/symptom Condition.evidence.code Condition.evidence.concept
evidence-detail reference Supporting information found elsewhere Condition.evidence.detail (Any) Condition.evidence.reference
identifier token A unique identifier of the condition record Condition.identifier
onset-age quantity Onsets as age or age range Condition.onset.as(Age) Condition.onset.ofType(Age) | Condition.onset.as(Range) Condition.onset.ofType(Range)
onset-date date Date related onsets (dateTime and Period) Condition.onset.as(dateTime) Condition.onset.ofType(dateTime) | Condition.onset.as(Period) Condition.onset.ofType(Period)
onset-info string Onsets as a string Condition.onset.as(string) Condition.onset.ofType(string)
participant-actor reference Who or what participated in the activities related to the condition Condition.participant.actor
( Practitioner , Organization , CareTeam , Device , Patient , PractitionerRole , RelatedPerson )
participant-function token Type of involvement of the actor in the activities related to the condition Condition.participant.function
patient reference Who has the condition? Condition.subject.where(resolve() is Patient)
( Patient )
recorded-date N date Date record was first recorded Condition.recordedDate
severity token The severity of the condition Condition.severity
stage token Simple summary (disease specific) Condition.stage.summary
subject reference Who has the condition? Condition.subject
( Group , Patient )
verification-status token unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Condition.verificationStatus