This page is part of the FHIR Specification (v4.4.0: R5 Preview #2). 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
Structured Documents Work Group | Maturity Level: 2 | Trial Use | Security Category: Not Classified | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
A Composition is the basic structure from which FHIR Documents - immutable bundles with attested narrative - are built. A single logical composition may be associated with a series of derived documents, each of which is a frozen copy of the composition.
Note: EN 13606 uses the term "Composition" to refer to a single commit to an EHR system, and offers some common examples: a composition containing a consultation note, a progress note, a report or a letter, an investigation report, a prescription form or a set of bedside nursing observations. Using Composition for an attested EHR commit is a valid use of the Composition resource, but for FHIR purposes, it would be usual to make more granular updates with individual provenance statements.
The Clinical Document profile constrains Composition to specify a clinical document (matching CDA ). See also the comparison with CDA.
Composition is a structure for grouping information for purposes of persistence and attestability. There are several other grouping structures in FHIR with distinct purposes:
The Composition resource organizes clinical and administrative content into sections, each of which contains a narrative, and references other resources for supporting data. The narrative content of the various sections in a Composition are supported by the resources referenced in the section entries. The complete set of content to make up a document includes the Composition resource together with various resources pointed to or indirectly connected to the Composition, all gathered together into a Bundle for transport and persistence. Resources associated with the following list of Composition references SHALL be included in the Bundle:
Other resources referred to by those resources MAY be included in the Bundle at the discretion of the authoring system as documented in the system's operation definition (such as $document operation), or as specified by any applicable profiles.
Every composition has a status element, which describes the status of the content of the composition, taken from this list of codes:
preliminary | This is a preliminary composition or document (also known as initial or interim). The content may be incomplete or unverified. |
final | This version of the composition is complete and verified by an appropriate person and no further work is planned. Any subsequent updates would be on a new version of the composition. |
amended | The composition content or the referenced resources have been modified (edited or added to) subsequent to being released as "final" and the composition is complete and verified by an authorized person. |
entered-in-error | The composition or document was originally created/issued in error, and this is an amendment that marks that the entire series should not be considered as valid. |
Composition status generally only moves down through this list - it moves from preliminary
to final
and then it may progress to amended
.
Note that in many workflows, only final
compositions are made available and the preliminary
status is not used.
A very few compositions are created entirely in error in the workflow - usually the composition concerns the wrong patient or is written by the wrong author,
and the error is only detected after the composition has been used or documents have been derived from it. To support resolution of this case,
the composition is updated to be marked as entered-in-error
and a new derived document can be created. This means that the entire series of derived
documents is now considered to be created in error and systems receiving derived documents based on retracted compositions
SHOULD remove data taken from earlier documents from routine use and/or take other appropriate actions. Systems are not required to
provide this workflow or support documents derived from retracted compositions, but they SHALL NOT ignore a status of entered-in-error
.
Note that systems that handle compositions or derived documents and don't support the error status need to define
some other way of handling compositions that are created in error; while this is not a common occurrence, some clinical systems
have no provision for removing erroneous information from a patient's record, and there is no way for a user to know that it is not fit for use -
this is not safe.
Many users of this specification are familiar with the Clinical Document Architecture (CDA) and related specifications. CDA is a primary design input to the Composition resource (other principal inputs are other HL7 document specifications and EN13606). There are three important structural differences between CDA and the Composition resource:
Composition
(the confidentiality, subject, author, event, event period and encounter) apply to the composition and do not specifically apply to the resources referenced from
the section.entry
. There is no context flow model in FHIR, so each resource referenced from
within a Composition
expresses its own individual context. In this way, clinical content can
safely be extracted from the composition.In addition, note that both the code lists (e.g., Composition.status) and the Composition resource are mapped to HL7 v3 and/or CDA.
This resource is referenced by itself, Contract and Procedure.
This resource implements the Event pattern.
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Composition | TU | DomainResource | A set of resources composed into a single coherent clinical statement with clinical attestation Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | Σ | 0..1 | Identifier | Version-independent identifier for the Composition |
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error CompositionStatus (Required) |
type | Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) FHIR Document Type Codes (Preferred) |
category | Σ | 0..* | CodeableConcept | Categorization of Composition Document Class Value Set (Example) |
subject | Σ | 0..1 | Reference(Any) | Who and/or what the composition is about |
encounter | Σ | 0..1 | Reference(Encounter) | Context of the Composition |
date | Σ | 1..1 | dateTime | Composition editing time |
author | Σ | 1..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the composition |
title | Σ | 1..1 | string | Human Readable name/title |
confidentiality | Σ | 0..1 | code | As defined by affinity domain V3 Value SetConfidentialityClassification (Required) |
attester | 0..* | BackboneElement | Attests to accuracy of composition | |
mode | 1..1 | code | personal | professional | legal | official CompositionAttestationMode (Required) | |
time | 0..1 | dateTime | When the composition was attested | |
party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition | |
custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the composition |
relatesTo | 0..* | BackboneElement | Relationships to other compositions/documents | |
code | 1..1 | code | replaces | transforms | signs | appends DocumentRelationshipType (Required) | |
target[x] | 1..1 | Target of the relationship | ||
targetIdentifier | Identifier | |||
targetReference | Reference(Composition) | |||
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented |
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented v3 Code System ActCode (Example) |
period | Σ | 0..1 | Period | The period covered by the documentation |
detail | Σ | 0..* | Reference(Any) | The event(s) being documented |
section | I | 0..* | BackboneElement | Composition is broken into sections + Rule: A section must contain at least one of text, entries, or sub-sections + Rule: A section can only have an emptyReason if it is empty |
title | 0..1 | string | Label for section (e.g. for ToC) | |
code | 0..1 | CodeableConcept | Classification of section (recommended) Document Section Codes (Example) | |
author | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section | |
focus | 0..1 | Reference(Any) | Who/what the section is about, when it is not about the subject of composition | |
text | I | 0..1 | Narrative | Text summary of the section, for human interpretation |
mode | 0..1 | code | working | snapshot | changes ListMode (Required) | |
orderedBy | 0..1 | CodeableConcept | Order of section entries List Order Codes (Preferred) | |
entry | I | 0..* | Reference(Any) | A reference to data that supports this section |
emptyReason | I | 0..1 | CodeableConcept | Why the section is empty List Empty Reasons (Preferred) |
section | I | 0..* | see section | Nested Section |
Documentation for this format |
UML Diagram (Legend)
XML Template
<Composition xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..1 Identifier Version-independent identifier for the Composition --></identifier> <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error --> <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type> <category><!-- 0..* CodeableConcept Categorization of Composition --></category> <subject><!-- 0..1 Reference(Any) Who and/or what the composition is about --></subject> <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter> <date value="[dateTime]"/><!-- 1..1 Composition editing time --> <author><!-- 1..* Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Who and/or what authored the composition --></author> <title value="[string]"/><!-- 1..1 Human Readable name/title --> <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain --> <attester> <!-- 0..* Attests to accuracy of composition --> <mode value="[code]"/><!-- 1..1 personal | professional | legal | official --> <time value="[dateTime]"/><!-- 0..1 When the composition was attested --> <party><!-- 0..1 Reference(Organization|Patient|Practitioner|PractitionerRole| RelatedPerson) Who attested the composition --></party> </attester> <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian> <relatesTo> <!-- 0..* Relationships to other compositions/documents --> <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends --> <target[x]><!-- 1..1 Identifier|Reference(Composition) Target of the relationship --></target[x]> </relatesTo> <event> <!-- 0..* The clinical service(s) being documented --> <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code> <period><!-- 0..1 Period The period covered by the documentation --></period> <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail> </event> <section> <!-- 0..* Composition is broken into sections --> <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) --> <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code> <author><!-- 0..* Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Who and/or what authored the section --></author> <focus><!-- 0..1 Reference(Any) Who/what the section is about, when it is not about the subject of composition --></focus> <text><!-- 0..1 Narrative Text summary of the section, for human interpretation --></text> <mode value="[code]"/><!-- 0..1 working | snapshot | changes --> <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy> <entry><!-- 0..* Reference(Any) A reference to data that supports this section --></entry> <emptyReason><!-- 0..1 CodeableConcept Why the section is empty --></emptyReason> <section><!-- 0..* Content as for Composition.section Nested Section --></section> </section> </Composition>
JSON Template
{ "resourceType" : "Composition", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : { Identifier }, // Version-independent identifier for the Composition "status" : "<code>", // R! preliminary | final | amended | entered-in-error "type" : { CodeableConcept }, // R! Kind of composition (LOINC if possible) "category" : [{ CodeableConcept }], // Categorization of Composition "subject" : { Reference(Any) }, // Who and/or what the composition is about "encounter" : { Reference(Encounter) }, // Context of the Composition "date" : "<dateTime>", // R! Composition editing time "author" : [{ Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }], // R! Who and/or what authored the composition "title" : "<string>", // R! Human Readable name/title "confidentiality" : "<code>", // As defined by affinity domain "attester" : [{ // Attests to accuracy of composition "mode" : "<code>", // R! personal | professional | legal | official "time" : "<dateTime>", // When the composition was attested "party" : { Reference(Organization|Patient|Practitioner|PractitionerRole| RelatedPerson) } // Who attested the composition }], "custodian" : { Reference(Organization) }, // Organization which maintains the composition "relatesTo" : [{ // Relationships to other compositions/documents "code" : "<code>", // R! replaces | transforms | signs | appends // target[x]: Target of the relationship. One of these 2: "targetIdentifier" : { Identifier } "targetReference" : { Reference(Composition) } }], "event" : [{ // The clinical service(s) being documented "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented "period" : { Period }, // The period covered by the documentation "detail" : [{ Reference(Any) }] // The event(s) being documented }], "section" : [{ // Composition is broken into sections "title" : "<string>", // Label for section (e.g. for ToC) "code" : { CodeableConcept }, // Classification of section (recommended) "author" : [{ Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }], // Who and/or what authored the section "focus" : { Reference(Any) }, // Who/what the section is about, when it is not about the subject of composition "text" : { Narrative }, // C? Text summary of the section, for human interpretation "mode" : "<code>", // working | snapshot | changes "orderedBy" : { CodeableConcept }, // Order of section entries "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section "emptyReason" : { CodeableConcept }, // C? Why the section is empty "section" : [{ Content as for Composition.section }] // C? Nested Section }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:Composition; 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:Composition.identifier [ Identifier ]; # 0..1 Version-independent identifier for the Composition fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible) fhir:Composition.category [ CodeableConcept ], ... ; # 0..* Categorization of Composition fhir:Composition.subject [ Reference(Any) ]; # 0..1 Who and/or what the composition is about fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time fhir:Composition.author [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 1..* Who and/or what authored the composition fhir:Composition.title [ string ]; # 1..1 Human Readable name/title fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain fhir:Composition.attester [ # 0..* Attests to accuracy of composition fhir:Composition.attester.mode [ code ]; # 1..1 personal | professional | legal | official fhir:Composition.attester.time [ dateTime ]; # 0..1 When the composition was attested fhir:Composition.attester.party [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who attested the composition ], ...; fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition fhir:Composition.relatesTo [ # 0..* Relationships to other compositions/documents fhir:Composition.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends # Composition.relatesTo.target[x] : 1..1 Target of the relationship. One of these 2 fhir:Composition.relatesTo.targetIdentifier [ Identifier ] fhir:Composition.relatesTo.targetReference [ Reference(Composition) ] ], ...; fhir:Composition.event [ # 0..* The clinical service(s) being documented fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented ], ...; fhir:Composition.section [ # 0..* Composition is broken into sections fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC) fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended) fhir:Composition.section.author [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who and/or what authored the section fhir:Composition.section.focus [ Reference(Any) ]; # 0..1 Who/what the section is about, when it is not about the subject of composition fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section ], ...; ]
Changes since R3
Composition | |
Composition.status |
|
Composition.confidentiality |
|
Composition.attester.mode |
|
Composition.relatesTo.code |
|
Composition.section.mode |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
Composition | TU | DomainResource | A set of resources composed into a single coherent clinical statement with clinical attestation Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
identifier | Σ | 0..1 | Identifier | Version-independent identifier for the Composition |
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error CompositionStatus (Required) |
type | Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) FHIR Document Type Codes (Preferred) |
category | Σ | 0..* | CodeableConcept | Categorization of Composition Document Class Value Set (Example) |
subject | Σ | 0..1 | Reference(Any) | Who and/or what the composition is about |
encounter | Σ | 0..1 | Reference(Encounter) | Context of the Composition |
date | Σ | 1..1 | dateTime | Composition editing time |
author | Σ | 1..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the composition |
title | Σ | 1..1 | string | Human Readable name/title |
confidentiality | Σ | 0..1 | code | As defined by affinity domain V3 Value SetConfidentialityClassification (Required) |
attester | 0..* | BackboneElement | Attests to accuracy of composition | |
mode | 1..1 | code | personal | professional | legal | official CompositionAttestationMode (Required) | |
time | 0..1 | dateTime | When the composition was attested | |
party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition | |
custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the composition |
relatesTo | 0..* | BackboneElement | Relationships to other compositions/documents | |
code | 1..1 | code | replaces | transforms | signs | appends DocumentRelationshipType (Required) | |
target[x] | 1..1 | Target of the relationship | ||
targetIdentifier | Identifier | |||
targetReference | Reference(Composition) | |||
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented |
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented v3 Code System ActCode (Example) |
period | Σ | 0..1 | Period | The period covered by the documentation |
detail | Σ | 0..* | Reference(Any) | The event(s) being documented |
section | I | 0..* | BackboneElement | Composition is broken into sections + Rule: A section must contain at least one of text, entries, or sub-sections + Rule: A section can only have an emptyReason if it is empty |
title | 0..1 | string | Label for section (e.g. for ToC) | |
code | 0..1 | CodeableConcept | Classification of section (recommended) Document Section Codes (Example) | |
author | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section | |
focus | 0..1 | Reference(Any) | Who/what the section is about, when it is not about the subject of composition | |
text | I | 0..1 | Narrative | Text summary of the section, for human interpretation |
mode | 0..1 | code | working | snapshot | changes ListMode (Required) | |
orderedBy | 0..1 | CodeableConcept | Order of section entries List Order Codes (Preferred) | |
entry | I | 0..* | Reference(Any) | A reference to data that supports this section |
emptyReason | I | 0..1 | CodeableConcept | Why the section is empty List Empty Reasons (Preferred) |
section | I | 0..* | see section | Nested Section |
Documentation for this format |
XML Template
<Composition xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..1 Identifier Version-independent identifier for the Composition --></identifier> <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error --> <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type> <category><!-- 0..* CodeableConcept Categorization of Composition --></category> <subject><!-- 0..1 Reference(Any) Who and/or what the composition is about --></subject> <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter> <date value="[dateTime]"/><!-- 1..1 Composition editing time --> <author><!-- 1..* Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Who and/or what authored the composition --></author> <title value="[string]"/><!-- 1..1 Human Readable name/title --> <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain --> <attester> <!-- 0..* Attests to accuracy of composition --> <mode value="[code]"/><!-- 1..1 personal | professional | legal | official --> <time value="[dateTime]"/><!-- 0..1 When the composition was attested --> <party><!-- 0..1 Reference(Organization|Patient|Practitioner|PractitionerRole| RelatedPerson) Who attested the composition --></party> </attester> <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian> <relatesTo> <!-- 0..* Relationships to other compositions/documents --> <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends --> <target[x]><!-- 1..1 Identifier|Reference(Composition) Target of the relationship --></target[x]> </relatesTo> <event> <!-- 0..* The clinical service(s) being documented --> <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code> <period><!-- 0..1 Period The period covered by the documentation --></period> <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail> </event> <section> <!-- 0..* Composition is broken into sections --> <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) --> <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code> <author><!-- 0..* Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Who and/or what authored the section --></author> <focus><!-- 0..1 Reference(Any) Who/what the section is about, when it is not about the subject of composition --></focus> <text><!-- 0..1 Narrative Text summary of the section, for human interpretation --></text> <mode value="[code]"/><!-- 0..1 working | snapshot | changes --> <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy> <entry><!-- 0..* Reference(Any) A reference to data that supports this section --></entry> <emptyReason><!-- 0..1 CodeableConcept Why the section is empty --></emptyReason> <section><!-- 0..* Content as for Composition.section Nested Section --></section> </section> </Composition>
JSON Template
{ "resourceType" : "Composition", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : { Identifier }, // Version-independent identifier for the Composition "status" : "<code>", // R! preliminary | final | amended | entered-in-error "type" : { CodeableConcept }, // R! Kind of composition (LOINC if possible) "category" : [{ CodeableConcept }], // Categorization of Composition "subject" : { Reference(Any) }, // Who and/or what the composition is about "encounter" : { Reference(Encounter) }, // Context of the Composition "date" : "<dateTime>", // R! Composition editing time "author" : [{ Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }], // R! Who and/or what authored the composition "title" : "<string>", // R! Human Readable name/title "confidentiality" : "<code>", // As defined by affinity domain "attester" : [{ // Attests to accuracy of composition "mode" : "<code>", // R! personal | professional | legal | official "time" : "<dateTime>", // When the composition was attested "party" : { Reference(Organization|Patient|Practitioner|PractitionerRole| RelatedPerson) } // Who attested the composition }], "custodian" : { Reference(Organization) }, // Organization which maintains the composition "relatesTo" : [{ // Relationships to other compositions/documents "code" : "<code>", // R! replaces | transforms | signs | appends // target[x]: Target of the relationship. One of these 2: "targetIdentifier" : { Identifier } "targetReference" : { Reference(Composition) } }], "event" : [{ // The clinical service(s) being documented "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented "period" : { Period }, // The period covered by the documentation "detail" : [{ Reference(Any) }] // The event(s) being documented }], "section" : [{ // Composition is broken into sections "title" : "<string>", // Label for section (e.g. for ToC) "code" : { CodeableConcept }, // Classification of section (recommended) "author" : [{ Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }], // Who and/or what authored the section "focus" : { Reference(Any) }, // Who/what the section is about, when it is not about the subject of composition "text" : { Narrative }, // C? Text summary of the section, for human interpretation "mode" : "<code>", // working | snapshot | changes "orderedBy" : { CodeableConcept }, // Order of section entries "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section "emptyReason" : { CodeableConcept }, // C? Why the section is empty "section" : [{ Content as for Composition.section }] // C? Nested Section }] }
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> . [ a fhir:Composition; 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:Composition.identifier [ Identifier ]; # 0..1 Version-independent identifier for the Composition fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible) fhir:Composition.category [ CodeableConcept ], ... ; # 0..* Categorization of Composition fhir:Composition.subject [ Reference(Any) ]; # 0..1 Who and/or what the composition is about fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time fhir:Composition.author [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 1..* Who and/or what authored the composition fhir:Composition.title [ string ]; # 1..1 Human Readable name/title fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain fhir:Composition.attester [ # 0..* Attests to accuracy of composition fhir:Composition.attester.mode [ code ]; # 1..1 personal | professional | legal | official fhir:Composition.attester.time [ dateTime ]; # 0..1 When the composition was attested fhir:Composition.attester.party [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who attested the composition ], ...; fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition fhir:Composition.relatesTo [ # 0..* Relationships to other compositions/documents fhir:Composition.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends # Composition.relatesTo.target[x] : 1..1 Target of the relationship. One of these 2 fhir:Composition.relatesTo.targetIdentifier [ Identifier ] fhir:Composition.relatesTo.targetReference [ Reference(Composition) ] ], ...; fhir:Composition.event [ # 0..* The clinical service(s) being documented fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented ], ...; fhir:Composition.section [ # 0..* Composition is broken into sections fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC) fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended) fhir:Composition.section.author [ Reference(Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ], ... ; # 0..* Who and/or what authored the section fhir:Composition.section.focus [ Reference(Any) ]; # 0..1 Who/what the section is about, when it is not about the subject of composition fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section ], ...; ]
Changes since Release 3
Composition | |
Composition.status |
|
Composition.confidentiality |
|
Composition.attester.mode |
|
Composition.relatesTo.code |
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Composition.section.mode |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a
Path | Definition | Type | Reference |
---|---|---|---|
Composition.status | The workflow/clinical status of the composition. | Required | CompositionStatus |
Composition.type | Type of a composition. | Preferred | FHIRDocumentTypeCodes |
Composition.category | High-level kind of a clinical document at a macro level. | Example | DocumentClassValueSet |
Composition.confidentiality | Codes specifying the level of confidentiality of the composition. | Required | v3.ConfidentialityClassification |
Composition.attester.mode | The way in which a person authenticated a composition. | Required | CompositionAttestationMode |
Composition.relatesTo.code | The type of relationship between documents. | Required | DocumentRelationshipType |
Composition.event.code | This list of codes represents the main clinical acts being documented. | Example | v3.ActCode |
Composition.section.code | Classification of a section of a composition/document. | Example | DocumentSectionCodes |
Composition.section.mode | The processing mode that applies to this section. | Required | ListMode |
Composition.section.orderedBy | What order applies to the items in the entry. | Preferred | ListOrderCodes |
Composition.section.emptyReason | If a section is empty, why it is empty. | Preferred | ListEmptyReasons |
id | Level | Location | Description | Expression |
cmp-1 | Rule | Composition.section | A section must contain at least one of text, entries, or sub-sections | text.exists() or entry.exists() or section.exists() |
cmp-2 | Rule | Composition.section | A section can only have an emptyReason if it is empty | emptyReason.empty() or entry.empty() |
Composition.section.text
) and no entries (Composition.section.entry
)Typically, a composition is made about the subject - e.g. a patient, or group of patients, location, or device - and the distinction between the subject and the composition describes the subject. Some kinds of documents contain data about other parties or entities that are relevant to the subject of the document. Some examples:
In all these cases, the subject of the document is a single patient, but some of the details are actually
related to other persons or entities. When this happens, these other entities are detailed in the Composition.section.focus
element.
In the absence of a focus
, it is assumed that the subject
of the composition is the focus.
If a focus
is specified, then the resources referred to from the section SHALL
either:
subject
(however named e.g. patient
) or focus
element (if present) is the focus indicatedsubject
element
A few compositions genuinely cover multiple subjects - different sections are about different subjects. In such
case, Composition.subject
is omitted, and the extension section-subject
is used on each section to indicate the subject.
Trial-Use Note: Feedback is welcome on two issues related to Composition:
- For many compositions, the title is the same as the text or a display name of Composition.type (e.g., a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here during the trial use period.
- A client can ask a server to generate a fully bundled document from a Composition resource using the $snapshot operation. This operation definition does not resolve the question how document signatures are created. This is an open issue during the period of trial use, and feedback is requested regarding this question.
Feedback here .
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 |
attester | reference | Who attested the composition | Composition.attester.party (Practitioner, Organization, Patient, PractitionerRole, RelatedPerson) | |
author | reference | Who and/or what authored the composition | Composition.author (Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson) | |
category | token | Categorization of Composition | Composition.category | |
confidentiality N | token | As defined by affinity domain | Composition.confidentiality | |
context | token | Code(s) that apply to the event being documented | Composition.event.code | |
date N | date | Composition editing time | Composition.date | 17 Resources |
encounter | reference | Context of the Composition | Composition.encounter (Encounter) | 12 Resources |
entry | reference | A reference to data that supports this section | Composition.section.entry (Any) | |
identifier | token | Version-independent identifier for the Composition | Composition.identifier | 30 Resources |
patient | reference | Who and/or what the composition is about | Composition.subject.where(resolve() is Patient) (Patient) | 33 Resources |
period | date | The period covered by the documentation | Composition.event.period | |
related-id | token | Target of the relationship | (Composition.relatesTo.target as Identifier) | |
related-ref | reference | Target of the relationship | (Composition.relatesTo.target as Reference) (Composition) | |
section | token | Classification of section (recommended) | Composition.section.code | |
status N | token | preliminary | final | amended | entered-in-error | Composition.status | |
subject | reference | Who and/or what the composition is about | Composition.subject (Any) | |
title N | string | Human Readable name/title | Composition.title | |
type | token | Kind of composition (LOINC if possible) | Composition.type | 5 Resources |