2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). 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

4.3 Resource Condition - Content

This resource maintained by the Patient Care Work Group

Use to record detailed information about conditions, problems or diagnoses recognized by a clinician. There are many uses including: recording a Diagnosis during an Encounter; populating a problem List or a Summary Statement, such as a Discharge Summary.

4.3.1 Scope and Usage

Used to record detailed information pertinent to a clinician's assessment and assertion of a particular aspect of a person's state of health. Examples of condition include problems, diagnoses, concerns, issues. There are many uses of condition which include:
  • recording a problem, diagnosis, health concern or health issue during an encounter
  • the use of such information to populate a problem list of a summary statement such as a discharge summary

This resource is used to record detailed information about a clinician's assessment and assertion of a particular aspect of a patient's state of health. It is intended for use 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 require ongoing monitoring and/or management (health issue/concern), or identification of health issues/situations considered harmful, potentially harmful and required to be investigated and managed (problems).

The condition resource may also be used to record certain health state of a patient which does not normally present negative outcome (until complications are predicted or detected), e.g. pregnancy. Examples of complications of pregnancy include: hyperemesis gravidarum, preeclampsia, eclampsia, which are captured as problems/diagnoses.

The condition resource may be referenced by other resources as “reasons” for an action (e.g. prescription, procedure, DiagnosticOrder, etc)

This resource is not to be used to record information about signs and symptoms that 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.

The condition resource also specifically excludes “AllergyIntolerance” and “Adverse Reactions” as those are handled with their own resources.

This resource is referenced by CarePlan, CarePlan2, ClinicalAssessment, DiagnosticOrder, EpisodeOfCare, Goal, MedicationPrescription, MedicationStatement, Procedure, RiskAssessment and VisionPrescription

4.3.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition DomainResourceDetailed information about conditions, problems or diagnoses
... identifier 0..*IdentifierExternal Ids for this condition
... subject 1..1PatientWho has the condition?
... encounter 0..1EncounterEncounter when condition first asserted
... asserter 0..1Practitioner | PatientPerson who asserts this condition
... dateAsserted 0..1dateWhen first detected/suspected/entered
... code 1..1CodeableConceptIdentification of the condition, problem or diagnosis
ConditionKind (Example)
... category 0..1CodeableConceptE.g. complaint | symptom | finding | diagnosis
ConditionCategory (Incomplete)
... status M1..1codeprovisional | working | confirmed | refuted
ConditionStatus (Required)
... certainty M0..1CodeableConceptDegree of confidence
ConditionCertainty (Example)
... severity 0..1CodeableConceptSubjective severity of condition
ConditionSeverity (Example)
... onset[x] Estimated or actual date, date-time, or age
.... onsetDateTime0..1dateTime
.... onsetAge0..1Age
... abatement[x] If/when in resolution/remission
.... abatementDate0..1date
.... abatementAge0..1Age
.... abatementBoolean0..1boolean
... stage I0..1ElementStage/grade, usually assessed formally
Stage SHALL have summary or assessment
.... summary I0..1CodeableConceptSimple summary (disease specific)
.... assessment I0..*AnyFormal record of assessment
... evidence I0..*ElementSupporting evidence
evidence SHALL have code or details
.... code I0..1CodeableConceptManifestation/symptom
.... detail I0..*AnySupporting information found elsewhere
... location I0..*ElementAnatomical location, if relevant
location SHALL have code or details
.... code I0..1CodeableConceptLocation - may include laterality
.... detail I0..1stringPrecise location details
... dueTo I0..*ElementCauses for this Condition
Relationship SHALL have either a code or a target
.... codeableConcept I0..1CodeableConceptRelationship target by means of a predefined code
ConditionKind (Example)
.... target I0..1Condition | Procedure | MedicationAdministration | Immunization | MedicationStatementRelationship target resource
... occurredFollowing I0..*ElementPrecedent for this Condition
Relationship SHALL have either a code or a target
.... codeableConcept I0..1CodeableConceptRelationship target by means of a predefined code
ConditionKind (Example)
.... target I0..1Condition | Procedure | MedicationAdministration | Immunization | MedicationStatementRelationship target resource
... notes 0..1stringAdditional information about the Condition

UML Diagram

Condition (DomainResource)This records identifiers associated with this condition that are defined by business processed and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier 0..*Indicates the patient who the condition record is associated withsubject : Reference(Patient) 1..1Encounter during which the condition was first assertedencounter : Reference(Encounter) 0..1Person who takes responsibility for asserting the existence of the condition as part of the electronic recordasserter : Reference(Practitioner|Patient) 0..1Estimated or actual date the condition/problem/diagnosis was first detected/suspecteddateAsserted : date 0..1Identification of the condition, problem or diagnosiscode : CodeableConcept 1..1 « (Identification of the Condition or diagnosis.ConditionKind) »A category assigned to the condition. E.g. complaint | symptom | finding | diagnosiscategory : CodeableConcept 0..1 « A category assigned to the condition. E.g. finding | Condition | diagnosis | concern | conditionConditionCategory+ »The clinical status of the condition (this element modifies the meaning of other elements)status : code 1..1 « The clinical status of the Condition or diagnosisConditionStatus »The degree of confidence that this condition is correct (this element modifies the meaning of other elements)certainty : CodeableConcept 0..1 « (The degree of confidence that this condition is correctConditionCertainty) »A subjective assessment of the severity of the condition as evaluated by the clinicianseverity : CodeableConcept 0..1 « (A subjective assessment of the severity of the condition as evaluated by the clinician.ConditionSeverity) »Estimated or actual date or date-time the condition began, in the opinion of the clinicianonset[x] : dateTime|Age 0..1The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abateabatement[x] : date|Age|boolean 0..1Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosisnotes : string 0..1StageA simple summary of the stage such as "Stage 3". The determination of the stage is disease-specificsummary : CodeableConcept 0..1Reference to a formal record of the evidence on which the staging assessment is basedassessment : Reference(Any) 0..*EvidenceA manifestation or symptom that led to the recording of this conditioncode : CodeableConcept 0..1Links to other relevant information, including pathology reportsdetail : Reference(Any) 0..*LocationCode that identifies the structural locationcode : CodeableConcept 0..1Detailed anatomical location informationdetail : string 0..1DueToCode that identifies the target of this relationship. The code takes the place of a detailed instance targetcodeableConcept : CodeableConcept 0..1 « (Identification of the Condition or diagnosis.ConditionKind) »Target of the relationshiptarget : Reference(Condition|Procedure| MedicationAdministration|Immunization| MedicationStatement) 0..1OccurredFollowingCode that identifies the target of this relationship. The code takes the place of a detailed instance targetcodeableConcept : CodeableConcept 0..1 « (Identification of the Condition or diagnosis.ConditionKind) »Target of the relationshiptarget : Reference(Condition|Procedure| MedicationAdministration|Immunization| MedicationStatement) 0..1Clinical stage or grade of a condition. May include formal severity assessmentsstage0..1Supporting Evidence / manifestations that are the basis on which this condition is suspected or confirmedevidence0..*The anatomical location where this condition manifests itselflocation0..*Further conditions, problems, diagnoses, procedures or events or the substance that caused/triggered this ConditiondueTo0..*Further conditions, problems, diagnoses, procedures or events or the substance that preceded this ConditionoccurredFollowing0..*

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>
 <subject><!-- 1..1 Reference(Patient) Who has the condition? --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter when condition first asserted --></encounter>
 <asserter><!-- 0..1 Reference(Practitioner|Patient) Person who asserts this condition --></asserter>
 <dateAsserted value="[date]"/><!-- 0..1 When first detected/suspected/entered -->
 <code><!-- 1..1 CodeableConcept Identification of the condition, problem or diagnosis --></code>
 <category><!-- 0..1 CodeableConcept E.g. complaint | symptom | finding | diagnosis --></category>
 <status value="[code]"/><!-- 1..1 provisional | working | confirmed | refuted -->
 <certainty><!-- 0..1 CodeableConcept Degree of confidence --></certainty>
 <severity><!-- 0..1 CodeableConcept Subjective severity of condition --></severity>
 <onset[x]><!-- 0..1 dateTime|Age Estimated or actual date,  date-time, or age --></onset[x]>
 <abatement[x]><!-- 0..1 date|Age|boolean If/when in resolution/remission --></abatement[x]>
 <stage>  <!-- 0..1 Stage/grade, usually assessed formally -->
  <summary><!-- ?? 0..1 CodeableConcept Simple summary (disease specific) --></summary>
  <assessment><!-- ?? 0..* Reference(Any) Formal record of assessment --></assessment>
 </stage>
 <evidence>  <!-- 0..* Supporting evidence -->
  <code><!-- ?? 0..1 CodeableConcept Manifestation/symptom --></code>
  <detail><!-- ?? 0..* Reference(Any) Supporting information found elsewhere --></detail>
 </evidence>
 <location>  <!-- 0..* Anatomical location, if relevant -->
  <code><!-- ?? 0..1 CodeableConcept Location - may include laterality --></code>
  <detail value="[string]"/><!-- ?? 0..1 Precise location details -->
 </location>
 <dueTo>  <!-- 0..* Causes for this Condition -->
  <codeableConcept><!-- ?? 0..1 CodeableConcept Relationship target by means of a predefined code --></codeableConcept>
  <target><!-- ?? 0..1 Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) Relationship target resource --></target>
 </dueTo>
 <occurredFollowing>  <!-- 0..* Precedent for this Condition -->
  <codeableConcept><!-- ?? 0..1 CodeableConcept Relationship target by means of a predefined code --></codeableConcept>
  <target><!-- ?? 0..1 Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) Relationship target resource --></target>
 </occurredFollowing>
 <notes value="[string]"/><!-- 0..1 Additional information about the Condition -->
</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
  "subject" : { Reference(Patient) }, // R! Who has the condition?
  "encounter" : { Reference(Encounter) }, // Encounter when condition first asserted
  "asserter" : { Reference(Practitioner|Patient) }, // Person who asserts this condition
  "dateAsserted" : "<date>", // When first detected/suspected/entered
  "code" : { CodeableConcept }, // R! Identification of the condition, problem or diagnosis
  "category" : { CodeableConcept }, // E.g. complaint | symptom | finding | diagnosis
  "status" : "<code>", // R! provisional | working | confirmed | refuted
  "certainty" : { CodeableConcept }, // Degree of confidence
  "severity" : { CodeableConcept }, // Subjective severity of condition
  // onset[x]: Estimated or actual date,  date-time, or age. One of these 2:
  "onsetDateTime" : "<dateTime>",
  "onsetAge" : { Age },
  // abatement[x]: If/when in resolution/remission. One of these 3:
  "abatementDate" : "<date>",
  "abatementAge" : { Age },
  "abatementBoolean" : <boolean>,
  "stage" : { // Stage/grade, usually assessed formally
    "summary" : { CodeableConcept }, // C? Simple summary (disease specific)
    "assessment" : [{ Reference(Any) }] // C? Formal record of assessment
  },
  "evidence" : [{ // Supporting evidence
    "code" : { CodeableConcept }, // C? Manifestation/symptom
    "detail" : [{ Reference(Any) }] // C? Supporting information found elsewhere
  }],
  "location" : [{ // Anatomical location, if relevant
    "code" : { CodeableConcept }, // C? Location - may include laterality
    "detail" : "<string>" // C? Precise location details
  }],
  "dueTo" : [{ // Causes for this Condition
    "codeableConcept" : { CodeableConcept }, // C? Relationship target by means of a predefined code
    "target" : { Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) } // C? Relationship target resource
  }],
  "occurredFollowing" : [{ // Precedent for this Condition
    "codeableConcept" : { CodeableConcept }, // C? Relationship target by means of a predefined code
    "target" : { Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) } // C? Relationship target resource
  }],
  "notes" : "<string>" // Additional information about the Condition
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Condition DomainResourceDetailed information about conditions, problems or diagnoses
... identifier 0..*IdentifierExternal Ids for this condition
... subject 1..1PatientWho has the condition?
... encounter 0..1EncounterEncounter when condition first asserted
... asserter 0..1Practitioner | PatientPerson who asserts this condition
... dateAsserted 0..1dateWhen first detected/suspected/entered
... code 1..1CodeableConceptIdentification of the condition, problem or diagnosis
ConditionKind (Example)
... category 0..1CodeableConceptE.g. complaint | symptom | finding | diagnosis
ConditionCategory (Incomplete)
... status M1..1codeprovisional | working | confirmed | refuted
ConditionStatus (Required)
... certainty M0..1CodeableConceptDegree of confidence
ConditionCertainty (Example)
... severity 0..1CodeableConceptSubjective severity of condition
ConditionSeverity (Example)
... onset[x] Estimated or actual date, date-time, or age
.... onsetDateTime0..1dateTime
.... onsetAge0..1Age
... abatement[x] If/when in resolution/remission
.... abatementDate0..1date
.... abatementAge0..1Age
.... abatementBoolean0..1boolean
... stage I0..1ElementStage/grade, usually assessed formally
Stage SHALL have summary or assessment
.... summary I0..1CodeableConceptSimple summary (disease specific)
.... assessment I0..*AnyFormal record of assessment
... evidence I0..*ElementSupporting evidence
evidence SHALL have code or details
.... code I0..1CodeableConceptManifestation/symptom
.... detail I0..*AnySupporting information found elsewhere
... location I0..*ElementAnatomical location, if relevant
location SHALL have code or details
.... code I0..1CodeableConceptLocation - may include laterality
.... detail I0..1stringPrecise location details
... dueTo I0..*ElementCauses for this Condition
Relationship SHALL have either a code or a target
.... codeableConcept I0..1CodeableConceptRelationship target by means of a predefined code
ConditionKind (Example)
.... target I0..1Condition | Procedure | MedicationAdministration | Immunization | MedicationStatementRelationship target resource
... occurredFollowing I0..*ElementPrecedent for this Condition
Relationship SHALL have either a code or a target
.... codeableConcept I0..1CodeableConceptRelationship target by means of a predefined code
ConditionKind (Example)
.... target I0..1Condition | Procedure | MedicationAdministration | Immunization | MedicationStatementRelationship target resource
... notes 0..1stringAdditional information about the Condition

UML Diagram

Condition (DomainResource)This records identifiers associated with this condition that are defined by business processed and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)identifier : Identifier 0..*Indicates the patient who the condition record is associated withsubject : Reference(Patient) 1..1Encounter during which the condition was first assertedencounter : Reference(Encounter) 0..1Person who takes responsibility for asserting the existence of the condition as part of the electronic recordasserter : Reference(Practitioner|Patient) 0..1Estimated or actual date the condition/problem/diagnosis was first detected/suspecteddateAsserted : date 0..1Identification of the condition, problem or diagnosiscode : CodeableConcept 1..1 « (Identification of the Condition or diagnosis.ConditionKind) »A category assigned to the condition. E.g. complaint | symptom | finding | diagnosiscategory : CodeableConcept 0..1 « A category assigned to the condition. E.g. finding | Condition | diagnosis | concern | conditionConditionCategory+ »The clinical status of the condition (this element modifies the meaning of other elements)status : code 1..1 « The clinical status of the Condition or diagnosisConditionStatus »The degree of confidence that this condition is correct (this element modifies the meaning of other elements)certainty : CodeableConcept 0..1 « (The degree of confidence that this condition is correctConditionCertainty) »A subjective assessment of the severity of the condition as evaluated by the clinicianseverity : CodeableConcept 0..1 « (A subjective assessment of the severity of the condition as evaluated by the clinician.ConditionSeverity) »Estimated or actual date or date-time the condition began, in the opinion of the clinicianonset[x] : dateTime|Age 0..1The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abateabatement[x] : date|Age|boolean 0..1Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosisnotes : string 0..1StageA simple summary of the stage such as "Stage 3". The determination of the stage is disease-specificsummary : CodeableConcept 0..1Reference to a formal record of the evidence on which the staging assessment is basedassessment : Reference(Any) 0..*EvidenceA manifestation or symptom that led to the recording of this conditioncode : CodeableConcept 0..1Links to other relevant information, including pathology reportsdetail : Reference(Any) 0..*LocationCode that identifies the structural locationcode : CodeableConcept 0..1Detailed anatomical location informationdetail : string 0..1DueToCode that identifies the target of this relationship. The code takes the place of a detailed instance targetcodeableConcept : CodeableConcept 0..1 « (Identification of the Condition or diagnosis.ConditionKind) »Target of the relationshiptarget : Reference(Condition|Procedure| MedicationAdministration|Immunization| MedicationStatement) 0..1OccurredFollowingCode that identifies the target of this relationship. The code takes the place of a detailed instance targetcodeableConcept : CodeableConcept 0..1 « (Identification of the Condition or diagnosis.ConditionKind) »Target of the relationshiptarget : Reference(Condition|Procedure| MedicationAdministration|Immunization| MedicationStatement) 0..1Clinical stage or grade of a condition. May include formal severity assessmentsstage0..1Supporting Evidence / manifestations that are the basis on which this condition is suspected or confirmedevidence0..*The anatomical location where this condition manifests itselflocation0..*Further conditions, problems, diagnoses, procedures or events or the substance that caused/triggered this ConditiondueTo0..*Further conditions, problems, diagnoses, procedures or events or the substance that preceded this ConditionoccurredFollowing0..*

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>
 <subject><!-- 1..1 Reference(Patient) Who has the condition? --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter when condition first asserted --></encounter>
 <asserter><!-- 0..1 Reference(Practitioner|Patient) Person who asserts this condition --></asserter>
 <dateAsserted value="[date]"/><!-- 0..1 When first detected/suspected/entered -->
 <code><!-- 1..1 CodeableConcept Identification of the condition, problem or diagnosis --></code>
 <category><!-- 0..1 CodeableConcept E.g. complaint | symptom | finding | diagnosis --></category>
 <status value="[code]"/><!-- 1..1 provisional | working | confirmed | refuted -->
 <certainty><!-- 0..1 CodeableConcept Degree of confidence --></certainty>
 <severity><!-- 0..1 CodeableConcept Subjective severity of condition --></severity>
 <onset[x]><!-- 0..1 dateTime|Age Estimated or actual date,  date-time, or age --></onset[x]>
 <abatement[x]><!-- 0..1 date|Age|boolean If/when in resolution/remission --></abatement[x]>
 <stage>  <!-- 0..1 Stage/grade, usually assessed formally -->
  <summary><!-- ?? 0..1 CodeableConcept Simple summary (disease specific) --></summary>
  <assessment><!-- ?? 0..* Reference(Any) Formal record of assessment --></assessment>
 </stage>
 <evidence>  <!-- 0..* Supporting evidence -->
  <code><!-- ?? 0..1 CodeableConcept Manifestation/symptom --></code>
  <detail><!-- ?? 0..* Reference(Any) Supporting information found elsewhere --></detail>
 </evidence>
 <location>  <!-- 0..* Anatomical location, if relevant -->
  <code><!-- ?? 0..1 CodeableConcept Location - may include laterality --></code>
  <detail value="[string]"/><!-- ?? 0..1 Precise location details -->
 </location>
 <dueTo>  <!-- 0..* Causes for this Condition -->
  <codeableConcept><!-- ?? 0..1 CodeableConcept Relationship target by means of a predefined code --></codeableConcept>
  <target><!-- ?? 0..1 Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) Relationship target resource --></target>
 </dueTo>
 <occurredFollowing>  <!-- 0..* Precedent for this Condition -->
  <codeableConcept><!-- ?? 0..1 CodeableConcept Relationship target by means of a predefined code --></codeableConcept>
  <target><!-- ?? 0..1 Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) Relationship target resource --></target>
 </occurredFollowing>
 <notes value="[string]"/><!-- 0..1 Additional information about the Condition -->
</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
  "subject" : { Reference(Patient) }, // R! Who has the condition?
  "encounter" : { Reference(Encounter) }, // Encounter when condition first asserted
  "asserter" : { Reference(Practitioner|Patient) }, // Person who asserts this condition
  "dateAsserted" : "<date>", // When first detected/suspected/entered
  "code" : { CodeableConcept }, // R! Identification of the condition, problem or diagnosis
  "category" : { CodeableConcept }, // E.g. complaint | symptom | finding | diagnosis
  "status" : "<code>", // R! provisional | working | confirmed | refuted
  "certainty" : { CodeableConcept }, // Degree of confidence
  "severity" : { CodeableConcept }, // Subjective severity of condition
  // onset[x]: Estimated or actual date,  date-time, or age. One of these 2:
  "onsetDateTime" : "<dateTime>",
  "onsetAge" : { Age },
  // abatement[x]: If/when in resolution/remission. One of these 3:
  "abatementDate" : "<date>",
  "abatementAge" : { Age },
  "abatementBoolean" : <boolean>,
  "stage" : { // Stage/grade, usually assessed formally
    "summary" : { CodeableConcept }, // C? Simple summary (disease specific)
    "assessment" : [{ Reference(Any) }] // C? Formal record of assessment
  },
  "evidence" : [{ // Supporting evidence
    "code" : { CodeableConcept }, // C? Manifestation/symptom
    "detail" : [{ Reference(Any) }] // C? Supporting information found elsewhere
  }],
  "location" : [{ // Anatomical location, if relevant
    "code" : { CodeableConcept }, // C? Location - may include laterality
    "detail" : "<string>" // C? Precise location details
  }],
  "dueTo" : [{ // Causes for this Condition
    "codeableConcept" : { CodeableConcept }, // C? Relationship target by means of a predefined code
    "target" : { Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) } // C? Relationship target resource
  }],
  "occurredFollowing" : [{ // Precedent for this Condition
    "codeableConcept" : { CodeableConcept }, // C? Relationship target by means of a predefined code
    "target" : { Reference(Condition|Procedure|MedicationAdministration|
    Immunization|MedicationStatement) } // C? Relationship target resource
  }],
  "notes" : "<string>" // Additional information about the Condition
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.3.2.1 Terminology Bindings

PathDefinitionTypeReference
Condition.code
Condition.dueTo.codeableConcept
Condition.occurredFollowing.codeableConcept 		Identification of the Condition or diagnosis.Examplehttp://hl7.org/fhir/vs/condition-code
Condition.category A category assigned to the condition. E.g. finding | Condition | diagnosis | concern | conditionIncompletehttp://hl7.org/fhir/vs/condition-category
Condition.status The clinical status of the Condition or diagnosisFixedhttp://hl7.org/fhir/condition-status
Condition.certainty The degree of confidence that this condition is correctExamplehttp://hl7.org/fhir/vs/condition-certainty
Condition.severity A subjective assessment of the severity of the condition as evaluated by the clinician.Examplehttp://hl7.org/fhir/vs/condition-severity

4.3.2.2 Constraints

  • con-1: On Condition.stage: Stage SHALL have summary or assessment (xpath on f:Condition/f:stage: exists(f:summary) or exists(f:assessment))
  • con-2: On Condition.evidence: evidence SHALL have code or details (xpath on f:Condition/f:evidence: exists(f:code) or exists(f:detail))
  • con-3: On Condition.location: location SHALL have code or details (xpath on f:Condition/f:location: exists(f:code) or exists(f:detail))
  • con-4: On Condition.dueTo: Relationship SHALL have either a code or a target (xpath on f:Condition/f:dueTo: exists(f:code) != exists(f:target))
  • con-5: On Condition.occurredFollowing: Relationship SHALL have either a code or a target (xpath on f:Condition/f:occurredFollowing: exists(f:code) != exists(f:target))

4.3.2.3 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.

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.

4.3.3 Search Parameters

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

NameTypeDescriptionPaths
asserterreferencePerson who asserts this conditionCondition.asserter
(Patient, Practitioner)
categorytokenThe category of the conditionCondition.category
codetokenCode for the conditionCondition.code
date-asserteddateWhen first detected/suspected/enteredCondition.dateAsserted
dueto-codetokenRelationship target by means of a predefined codeCondition.dueTo.codeableConcept
dueto-itemreferenceRelationship target resourceCondition.dueTo.target
(Condition, MedicationAdministration, Procedure, MedicationStatement, Immunization)
encounterreferenceEncounter when condition first assertedCondition.encounter
(Encounter)
evidencetokenManifestation/symptomCondition.evidence.code
following-codetokenRelationship target by means of a predefined codeCondition.occurredFollowing.codeableConcept
following-itemreferenceRelationship target resourceCondition.occurredFollowing.target
(Condition, MedicationAdministration, Procedure, MedicationStatement, Immunization)
locationtokenLocation - may include lateralityCondition.location.code
onsetdateWhen the Condition started (if started on a date)Condition.onset[x]
patientreferenceWho has the condition?Condition.subject
(Patient)
severitytokenThe severity of the conditionCondition.severity
stagetokenSimple summary (disease specific)Condition.stage.summary
statustokenThe status of the conditionCondition.status
subjectreferenceWho has the condition?Condition.subject
(Patient)