This
page
is
part
of
the
FHIR
Specification
(v4.3.0:
R4B
(v5.0.0:
R5
-
STU
).
The
This
is
the
current
published
version
which
supercedes
in
it's
permanent
home
(it
will
always
be
available
at
this
version
is
5.0.0
.
URL).
For
a
full
list
of
available
versions,
see
the
Directory
of
published
versions
.
Page
versions:
R5
R4B
R5
R4B
R4
R3
R2
Structured
Documents
Work
Group
|
Maturity Level : 0 | Trial Use | Use Context : Any |
The
official
canonical
URL
for
this
profile
is:
http://hl7.org/fhir/StructureDefinition/clinicaldocument
The Clinical Document profile constrains Composition to specify a clinical document (matching CDA). The base Composition is a general resource for compositions or documents about any kind of subject that might be encountered in healthcare including such things as guidelines, medicines, etc. A clinical document is focused on documents related to the provision of care process, where the subject is a patient, a group of patients, or a closely related concept. A clinical document has additional requirements around confidentiality that do not apply in the same way to other kinds of documents.
This
profile
was
published
on
Tue,
Mar
17,
2015
00:00+1100
Thu,
Jan
1,
1970
00:00+1000
as
a
draft
by
Health
Level
Seven,
Inc.
-
Structured
Documents
WG.
HL7.
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work .
This structure is derived from Composition .
Summary
This
structure
is
derived
from
indicates
the
differences
between
this
profile
and
the
base
Composition
.
structure.
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
|
0..* | Composition |
A
set
of
resources
composed
into
a
single
coherent
clinical
statement
with
clinical
attestation
|
|
|
0
..
|
Reference ( Patient | Practitioner | Group | Device | Location ) | Who and/or what the composition is about | |
Documentation
for
this
format
|
||||
This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Composition structure.
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
|
0..* | Composition |
A
set
of
resources
composed
into
a
single
coherent
clinical
statement
with
clinical
attestation
|
|
|
Σ | 0..1 | id | Logical id of this artifact |
|
Σ | 0..1 | Meta | Metadata about the resource |
|
?! Σ | 0..1 | uri | A set of rules under which this content was created |
|
0..1 | code |
Language
of
the
resource
content
Binding: |
|
|
0..1 | Narrative | Text summary of the resource, for human interpretation | |
|
0..* | Resource |
Contained,
inline
Resources
|
|
|
0..* | Extension |
|
|
|
?! Σ |
|
|
|
|
|
|
|
|
|
Σ |
|
Identifier |
Version-independent
identifier
for
the
Composition
|
| Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the Composition |
![]() ![]() |
?! Σ | 1..1 | code |
registered
|
partial
|
preliminary
|
final
|
amended
|
corrected
|
appended
|
cancelled
|
entered-in-error
|
deprecated
|
unknown
Binding: |
|
Σ | 1..1 | CodeableConcept |
Kind
of
composition
(LOINC
if
possible)
Binding: FHIR Document Type Codes ( preferred ): Type of a composition. |
|
Σ | 0..* | CodeableConcept |
Categorization
of
Composition
Binding: |
|
Σ | 0..* | Reference ( Patient | Practitioner | Group | Device | Location ) |
Who
and/or
what
the
composition
is
about
|
|
Σ | 0..1 | Reference ( Encounter ) | Context of the Composition |
|
Σ | 1..1 | dateTime | Composition editing time |
| Σ | 0..* | UsageContext |
The
context
that
the
content
is
intended
to
support
|
|
Σ | 1..* | Reference ( Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization ) |
Who
and/or
what
authored
the
composition
|
|
Σ |
|
string |
|
|
Σ |
|
|
|
|
0..* | Annotation |
For
any
additional
notes
|
|
|
0..* | BackboneElement |
Attests
to
accuracy
of
composition
|
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
1..1 |
|
personal
|
professional
|
legal
|
official
Binding: |
|
|
0..1 | dateTime | When the composition was attested | |
|
0..1 | Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization ) | Who attested the composition | |
|
Σ | 0..1 | Reference ( Organization ) | Organization which maintains the composition |
|
0..* |
|
Relationships
to
other
compositions/documents
|
|
|
Σ | 0..* | BackboneElement |
The
clinical
service(s)
being
documented
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
Σ | 0..1 | Period | The period covered by the documentation |
|
Σ | 0..* |
|
The
event(s)
being
Binding: v3 Code System ActCode
(
example
):
This
list
of
codes
represents
the
main
clinical
acts
being
documented.
|
|
|
0..* | BackboneElement |
Composition
is
broken
into
sections
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
0..1 | string | Label for section (e.g. for ToC) | |
|
0..1 | CodeableConcept |
Classification
of
section
(recommended)
Binding: Document Section Codes ( example ): Classification of a section of a composition/document. |
|
|
0..* | Reference ( Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization ) |
Who
and/or
what
authored
the
section
|
|
|
0..1 | Reference ( Resource ) | Who/what the section is about, when it is not about the subject of composition | |
|
|
0..1 | Narrative | Text summary of the section, for human interpretation |
|
0..1 | CodeableConcept |
Order
of
section
entries
Binding: List Order Codes ( preferred ): What order applies to the items in the entry. |
|
|
|
0..* | Reference ( Resource ) |
A
reference
to
data
that
supports
this
section
|
|
|
0..1 | CodeableConcept |
Why
the
section
is
empty
Binding: List Empty Reasons ( preferred ): If a section is empty, why it is empty. |
|
0..* | See section (Composition) |
Nested
Section
|
|
Documentation
for
this
format
|
||||
<!-- Clinical Document --><!-- ClinicalDocument --><Composition xmlns="http://hl7.org/fhir" > <!-- from Element: extension --> <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
<</meta> < < <<meta><!-- I 0..1 Meta Metadata about the resource --></meta> <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created --> <language value="[code]"/><!-- I 0..1 Language of the resource content --> <text><!-- I 0..1 Narrative Text summary of the resource, for human interpretation --></text><</contained> <<a href="clinicaldocument-definitions.html#Composition.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<contained><!-- 0..* Resource Contained, inline Resources --></contained> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored --></modifierExtension> <url value="[uri]"/><!-- I 0..1 Canonical identifier for this Composition, represented as a URI (globally unique) --> <identifier><!-- I 0..* Identifier Version-independent identifier for the Composition --></identifier>< <</type> <</category> <<version value="[string]"/><!-- I 0..1 An explicitly assigned identifer of a variation of the content in the Composition --> <status value="[code]"/><!-- I 1..1 registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown --> <type><!-- I 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type> <category><!-- I 0..* CodeableConcept Categorization of Composition --></category> <subject><!-- I 0..* Reference(Patient) Who and/or what the composition is about --></subject><</encounter> < <<encounter><!-- I 0..1 Reference(Encounter) Context of the Composition --></encounter> <date value="[dateTime]"/><!-- I 1..1 Composition editing time --> <useContext><!-- I 0..* UsageContext The context that the content is intended to support --></useContext> <author><!-- I 1..* Reference(Practitioner) Who and/or what authored the composition --></author>< < < <<a href="clinicaldocument-definitions.html#Composition.attester.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<name value="[string]"/><!-- I 0..1 Name for this Composition (computer friendly) --> <title value="[string]"/><!-- I 1..1 Human Readable name/title --> <note><!-- I 0..* Annotation For any additional notes --></note> <attester> I 0..* BackboneElement <!-- I 0..* Attests to accuracy of composition --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < < < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <mode><!-- I 1..1 CodeableConcept personal | professional | legal | official --></mode> <time value="[dateTime]"/><!-- I 0..1 When the composition was attested --> <party><!-- I 0..1 Reference(Patient) Who attested the composition --></party> </attester><<custodian><!-- I 0..1 Reference(Organization) Organization which maintains the composition --></custodian>< <<a href="clinicaldocument-definitions.html#Composition.relatesTo.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < < Target of the relationship</target[x]> </relatesTo> < <<a href="clinicaldocument-definitions.html#Composition.event.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<relatesTo><!-- I 0..* RelatedArtifact Relationships to other compositions/documents --></relatesTo> <event> I 0..* BackboneElement <!-- I 0..* The clinical service(s) being documented --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> <</code> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <period><!-- I 0..1 Period The period covered by the documentation --></period>< The event(s) being documented</detail><detail><!-- I 0..* CodeableReference The event(s) being documented, as code(s), reference(s), or both--></detail> </event>
< <<a href="clinicaldocument-definitions.html#Composition.section.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<section> I 0..* BackboneElement <!-- I 0..* Composition is broken into sections --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < <</code> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <title value="[string]"/><!-- I 0..1 Label for section (e.g. for ToC) --> <code><!-- I 0..1 CodeableConcept Classification of section (recommended) --></code> <author><!-- I 0..* Reference(Practitioner) Who and/or what authored the section --></author><<focus><!-- I 0..1 Reference(Resource) Who/what the section is about, when it is not about the subject of composition --></focus><<text><!-- I 0..1 Narrative Text summary of the section, for human interpretation --></text>< <</orderedBy> <<orderedBy><!-- I 0..1 CodeableConcept Order of section entries --></orderedBy> <entry><!-- I 0..* Reference(Resource) A reference to data that supports this section --></entry><</emptyReason><emptyReason><!-- I 0..1 CodeableConcept Why the section is empty --></emptyReason> <section><!-- See http://hl7.org/fhir/StructureDefinition/Composition#Composition.section Nested Section --></section> </section> </Composition>
{ //{ // ClinicalDocument // from Element: extension" " " " " " { // // from Element: } ], "<a href="clinicaldocument-definitions.html#Composition.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."meta" : { Meta }, // IMetadata about the resource "implicitRules" : "<uri>", // IA set of rules under which this content was created "language" : "<code>", // ILanguage of the resource content "text" : { Narrative }, // IText summary of the resource, for human interpretation "contained" : [{ Resource }], //Contained, inline Resources "Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"> " " " " " " " " " " " " " " " Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored "url" : "<uri>", // ICanonical identifier for this Composition, represented as a URI (globally unique) "identifier" : [{ Identifier }], // IVersion-independent identifier for the Composition "version" : "<string>", // IAn explicitly assigned identifer of a variation of the content in the Composition "status" : "<code>", // I R! registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown "type" : { CodeableConcept }, // I R! Kind of composition (LOINC if possible) "category" : [{ CodeableConcept }], // ICategorization of Composition "subject" : [{ Reference(Patient) }], // IWho and/or what the composition is about "encounter" : { Reference(Encounter) }, // IContext of the Composition "date" : "<dateTime>", // I R! Composition editing time "useContext" : [{ UsageContext }], // IThe context that the content is intended to support "author" : [{ Reference(Practitioner) }], // I R! Who and/or what authored the composition "name" : "<string>", // IName for this Composition (computer friendly) "title" : "<string>", // I R! Human Readable name/title "note" : [{ Annotation }], // IFor any additional notes "attester" : [{ BackboneElement }], // IAttests to accuracy of composition "custodian" : { Reference(Organization) }, // IOrganization which maintains the composition "relatesTo" : [{ RelatedArtifact }], // IRelationships to other compositions/documents "event" : [{ BackboneElement }], // IThe clinical service(s) being documented "section" : [{ BackboneElement }] // IComposition is broken into sections }
This structure is derived from Composition .
Differential View
This
structure
is
derived
from
indicates
the
differences
between
this
profile
and
the
base
Composition
.
structure.
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
|
0..* | Composition |
A
set
of
resources
composed
into
a
single
coherent
clinical
statement
with
clinical
attestation
|
|
|
0
..
|
Reference ( Patient | Practitioner | Group | Device | Location ) | Who and/or what the composition is about | |
Documentation
for
this
format
|
||||
Snapshot View
This provides the consolidated view (aka snapshot) of the profile after applying the changes in this profile to the base Composition structure.
| Name | Flags | Card. | Type |
Description
&
Constraints
|
|---|---|---|---|---|
|
0..* | Composition |
A
set
of
resources
composed
into
a
single
coherent
clinical
statement
with
clinical
attestation
|
|
|
Σ | 0..1 | id | Logical id of this artifact |
|
Σ | 0..1 | Meta | Metadata about the resource |
|
?! Σ | 0..1 | uri | A set of rules under which this content was created |
|
0..1 | code |
Language
of
the
resource
content
Binding: |
|
|
0..1 | Narrative | Text summary of the resource, for human interpretation | |
|
0..* | Resource |
Contained,
inline
Resources
|
|
|
0..* | Extension |
|
|
|
?! Σ |
|
|
|
|
|
|
|
|
|
Σ |
|
Identifier |
Version-independent
identifier
for
the
Composition
|
| Σ | 0..1 | string | An explicitly assigned identifer of a variation of the content in the Composition |
![]() ![]() |
?! Σ | 1..1 | code |
registered
|
partial
|
preliminary
|
final
|
amended
|
corrected
|
appended
|
cancelled
|
entered-in-error
|
deprecated
|
unknown
Binding: |
|
Σ | 1..1 | CodeableConcept |
Kind
of
composition
(LOINC
if
possible)
Binding: FHIR Document Type Codes ( preferred ): Type of a composition. |
|
Σ | 0..* | CodeableConcept |
Categorization
of
Composition
Binding: |
|
Σ | 0..* | Reference ( Patient | Practitioner | Group | Device | Location ) |
Who
and/or
what
the
composition
is
about
|
|
Σ | 0..1 | Reference ( Encounter ) | Context of the Composition |
|
Σ | 1..1 | dateTime | Composition editing time |
| Σ | 0..* | UsageContext |
The
context
that
the
content
is
intended
to
support
|
|
Σ | 1..* | Reference ( Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization ) |
Who
and/or
what
authored
the
composition
|
|
Σ |
|
string |
|
|
Σ |
|
|
|
|
0..* | Annotation |
For
any
additional
notes
|
|
|
0..* | BackboneElement |
Attests
to
accuracy
of
composition
|
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
1..1 |
|
personal
|
professional
|
legal
|
official
Binding: |
|
|
0..1 | dateTime | When the composition was attested | |
|
0..1 | Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization ) | Who attested the composition | |
|
Σ | 0..1 | Reference ( Organization ) | Organization which maintains the composition |
|
0..* |
|
Relationships
to
other
compositions/documents
|
|
|
Σ | 0..* | BackboneElement |
The
clinical
service(s)
being
documented
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
Σ | 0..1 | Period | The period covered by the documentation |
|
Σ | 0..* |
|
The
event(s)
being
Binding: v3 Code System ActCode
(
example
):
This
list
of
codes
represents
the
main
clinical
acts
being
documented.
|
|
|
0..* | BackboneElement |
Composition
is
broken
into
sections
|
|
0..1 | string | Unique id for inter-element referencing | |
|
0..* | Extension |
Additional
content
defined
by
implementations
|
|
|
?! Σ | 0..* | Extension |
Extensions
that
cannot
be
ignored
even
if
unrecognized
|
|
0..1 | string | Label for section (e.g. for ToC) | |
|
0..1 | CodeableConcept |
Classification
of
section
(recommended)
Binding: Document Section Codes ( example ): Classification of a section of a composition/document. |
|
|
0..* | Reference ( Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization ) |
Who
and/or
what
authored
the
section
|
|
|
0..1 | Reference ( Resource ) | Who/what the section is about, when it is not about the subject of composition | |
|
|
0..1 | Narrative | Text summary of the section, for human interpretation |
|
0..1 | CodeableConcept |
Order
of
section
entries
Binding: List Order Codes ( preferred ): What order applies to the items in the entry. |
|
|
|
0..* | Reference ( Resource ) |
A
reference
to
data
that
supports
this
section
|
|
|
0..1 | CodeableConcept |
Why
the
section
is
empty
Binding: List Empty Reasons ( preferred ): If a section is empty, why it is empty. |
|
0..* | See section (Composition) |
Nested
Section
|
|
Documentation
for
this
format
|
||||
XML Template
<!-- Clinical Document --><!-- ClinicalDocument --><Composition xmlns="http://hl7.org/fhir" > <!-- from Element: extension --> <id value="[id]"/><!-- 0..1 Logical id of this artifact -->
<</meta> < < <<meta><!-- I 0..1 Meta Metadata about the resource --></meta> <implicitRules value="[uri]"/><!-- I 0..1 A set of rules under which this content was created --> <language value="[code]"/><!-- I 0..1 Language of the resource content --> <text><!-- I 0..1 Narrative Text summary of the resource, for human interpretation --></text><</contained> <<a href="clinicaldocument-definitions.html#Composition.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<contained><!-- 0..* Resource Contained, inline Resources --></contained> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored --></modifierExtension> <url value="[uri]"/><!-- I 0..1 Canonical identifier for this Composition, represented as a URI (globally unique) --> <identifier><!-- I 0..* Identifier Version-independent identifier for the Composition --></identifier>< <</type> <</category> <<version value="[string]"/><!-- I 0..1 An explicitly assigned identifer of a variation of the content in the Composition --> <status value="[code]"/><!-- I 1..1 registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown --> <type><!-- I 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type> <category><!-- I 0..* CodeableConcept Categorization of Composition --></category> <subject><!-- I 0..* Reference(Patient) Who and/or what the composition is about --></subject><</encounter> < <<encounter><!-- I 0..1 Reference(Encounter) Context of the Composition --></encounter> <date value="[dateTime]"/><!-- I 1..1 Composition editing time --> <useContext><!-- I 0..* UsageContext The context that the content is intended to support --></useContext> <author><!-- I 1..* Reference(Practitioner) Who and/or what authored the composition --></author>< < < <<a href="clinicaldocument-definitions.html#Composition.attester.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<name value="[string]"/><!-- I 0..1 Name for this Composition (computer friendly) --> <title value="[string]"/><!-- I 1..1 Human Readable name/title --> <note><!-- I 0..* Annotation For any additional notes --></note> <attester> I 0..* BackboneElement <!-- I 0..* Attests to accuracy of composition --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < < < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <mode><!-- I 1..1 CodeableConcept personal | professional | legal | official --></mode> <time value="[dateTime]"/><!-- I 0..1 When the composition was attested --> <party><!-- I 0..1 Reference(Patient) Who attested the composition --></party> </attester><<custodian><!-- I 0..1 Reference(Organization) Organization which maintains the composition --></custodian>< <<a href="clinicaldocument-definitions.html#Composition.relatesTo.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < < Target of the relationship</target[x]> </relatesTo> < <<a href="clinicaldocument-definitions.html#Composition.event.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<relatesTo><!-- I 0..* RelatedArtifact Relationships to other compositions/documents --></relatesTo> <event> I 0..* BackboneElement <!-- I 0..* The clinical service(s) being documented --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> <</code> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <period><!-- I 0..1 Period The period covered by the documentation --></period>< The event(s) being documented</detail><detail><!-- I 0..* CodeableReference The event(s) being documented, as code(s), reference(s), or both--></detail> </event>
< <<a href="clinicaldocument-definitions.html#Composition.section.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.<section> I 0..* BackboneElement <!-- I 0..* Composition is broken into sections --> <Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < <</code> < Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension><!-- I 0..* Extension Extensions that cannot be ignored even if unrecognized --></modifierExtension> <title value="[string]"/><!-- I 0..1 Label for section (e.g. for ToC) --> <code><!-- I 0..1 CodeableConcept Classification of section (recommended) --></code> <author><!-- I 0..* Reference(Practitioner) Who and/or what authored the section --></author><<focus><!-- I 0..1 Reference(Resource) Who/what the section is about, when it is not about the subject of composition --></focus><<text><!-- I 0..1 Narrative Text summary of the section, for human interpretation --></text>< <</orderedBy> <<orderedBy><!-- I 0..1 CodeableConcept Order of section entries --></orderedBy> <entry><!-- I 0..* Reference(Resource) A reference to data that supports this section --></entry><</emptyReason><emptyReason><!-- I 0..1 CodeableConcept Why the section is empty --></emptyReason> <section><!-- See http://hl7.org/fhir/StructureDefinition/Composition#Composition.section Nested Section --></section> </section> </Composition>
JSON Template
{ //{ // ClinicalDocument // from Element: extension" " " " " " { // // from Element: } ], "<a href="clinicaldocument-definitions.html#Composition.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions."meta" : { Meta }, // IMetadata about the resource "implicitRules" : "<uri>", // IA set of rules under which this content was created "language" : "<code>", // ILanguage of the resource content "text" : { Narrative }, // IText summary of the resource, for human interpretation "contained" : [{ Resource }], //Contained, inline Resources "Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"> " " " " " " " " " " " " " " " Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict">modifierExtension" : [{ Extension }], // IExtensions that cannot be ignored "url" : "<uri>", // ICanonical identifier for this Composition, represented as a URI (globally unique) "identifier" : [{ Identifier }], // IVersion-independent identifier for the Composition "version" : "<string>", // IAn explicitly assigned identifer of a variation of the content in the Composition "status" : "<code>", // I R! registered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown "type" : { CodeableConcept }, // I R! Kind of composition (LOINC if possible) "category" : [{ CodeableConcept }], // ICategorization of Composition "subject" : [{ Reference(Patient) }], // IWho and/or what the composition is about "encounter" : { Reference(Encounter) }, // IContext of the Composition "date" : "<dateTime>", // I R! Composition editing time "useContext" : [{ UsageContext }], // IThe context that the content is intended to support "author" : [{ Reference(Practitioner) }], // I R! Who and/or what authored the composition "name" : "<string>", // IName for this Composition (computer friendly) "title" : "<string>", // I R! Human Readable name/title "note" : [{ Annotation }], // IFor any additional notes "attester" : [{ BackboneElement }], // IAttests to accuracy of composition "custodian" : { Reference(Organization) }, // IOrganization which maintains the composition "relatesTo" : [{ RelatedArtifact }], // IRelationships to other compositions/documents "event" : [{ BackboneElement }], // IThe clinical service(s) being documented "section" : [{ BackboneElement }] // IComposition is broken into sections }
Alternate definitions: Master Definition ( XML , JSON ), Schematron
| Path | Name | Conformance | ValueSet |
| Composition.language |
|
|
|
| Composition.status |
|
required |
|
| Composition.type | FHIR Document Type Codes | preferred | FHIR Document Type Codes |
| Composition.category |
|
example |
|
| Composition.attester.mode |
|
|
|
|
|
v3 Code System ActCode | example |
v3
Code
System
ActCode
|
| Composition.section.code | Document Section Codes | example | Document Section Codes |
|
|
List Order Codes | preferred | List Order Codes |
| Composition.section.emptyReason | List Empty Reasons | preferred | List Empty Reasons |