R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

StructureDefinition: ClinicalDocument - XML

Structured Documents Work Group Maturity Level: 0Trial UseUse Context: Any

ClinicalDocument

<?xml version="1.0" encoding="UTF-8"?>

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="clinicaldocument"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="sd"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <url value="http://hl7.org/fhir/StructureDefinition/clinicaldocument"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.5.1178"/> 
  </identifier> 
  <version value="6.0.0-ballot1"/> 
  <name value="ClinicalDocument"/> 
  <title value="Clinical  Document"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <date value="2015-03-17"/> 
  <publisher value="HL7 International / Structured Documents"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/special/committees/structure"/> 
    </telecom> 
  </contact> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/structure"/> 
    </telecom> 
  </contact> 
  <description value="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."/> 
  <fhirVersion value="6.0.0-ballot1"/> 
  <mapping> 
    <identity value="workflow"/> 
    <uri value="http://hl7.org/fhir/workflow"/> 
    <name value="Workflow Pattern"/> 
  </mapping> 
  <mapping> 
    <identity value="rim"/> 
    <uri value="http://hl7.org/v3"/> 
    <name value="RIM Mapping"/> 
  </mapping> 
  <mapping> 
    <identity value="cda"/> 
    <uri value="http://hl7.org/v3/cda"/> 
    <name value="CDA (R2)"/> 
  </mapping> 
  <mapping> 
    <identity value="fhirdocumentreference"/> 
    <uri value="http://hl7.org/fhir/documentreference"/> 
    <name value="FHIR DocumentReference"/> 
  </mapping> 
  <mapping> 
    <identity value="w5"/> 
    <uri value="http://hl7.org/fhir/fivews"/> 
    <name value="FiveWs Pattern Mapping"/> 
  </mapping> 
  <kind value="resource"/> 
  <abstract value="false"/> 
  <type value="Composition"/> 
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Composition"/> 
  <derivation value="constraint"/> 
  <snapshot> 
    <element id="Composition">
      <path value="Composition"/> 
      <short value="A set of resources composed into a single coherent clinical statement with clinical
       attestation"/> 
      <definition value="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.)."/> 
      <comment value="While the focus of this specification is on patient-specific clinical statements,
       this resource can also apply to other healthcare-related statements such as study
       protocol designs, healthcare invoices and other activities that are not necessarily
       patient-specific or clinical."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <constraint> 
        <key value="dom-2"/> 
        <severity value="error"/> 
        <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/> 
        <expression value="contained.contained.empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-3"/> 
        <severity value="error"/> 
        <human value="If the resource is contained in another resource, it SHALL be referred to from
         elsewhere in the resource or SHALL refer to the containing resource"/> 
        <expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofTy
        pe(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url)))
         or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical)
         = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmat
        ched', id).empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-4"/> 
        <severity value="error"/> 
        <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId
         or a meta.lastUpdated"/> 
        <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> 
      </constraint> 
      <constraint> 
        <key value="dom-5"/> 
        <severity value="error"/> 
        <human value="If a resource is contained in another resource, it SHALL NOT have a security label"/> 
        <expression value="contained.meta.security.empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> 
      </constraint> 
      <constraint> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can
           display the resource to a human safely. Including a human readable representation
           in the resource makes for a much more robust eco-system and cheaper handling of
           resources by intermediary systems. Some ecosystems restrict distribution of resources
           to only those systems that do fully understand the resources, and as a consequence
           implementers may believe that the narrative is superfluous. However experience
           shows that such eco-systems often open up to new participants over time."/> 
        </extension> 
        <key value="dom-6"/> 
        <severity value="warning"/> 
        <human value="A resource should have narrative for robust management"/> 
        <expression value="text.`div`.exists()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/DomainResource"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Entity, Role, or Act,Document[classCode=&quot;DOC&quot; and moodCode=&quot;EVN&quot;
         and isNormalAct()]"/> 
      </mapping> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="infrastructure.documents"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="ClinicalDocument"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="when described by DocumentReference"/> 
      </mapping> 
    </element> 
    <element id="Composition.id">
      <path value="Composition.id"/> 
      <short value="Logical id of this artifact"/> 
      <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned,
       this value never changes."/> 
      <comment value="Within the context of the FHIR RESTful interactions, the resource has an id except
       for cases like the create and conditional update. Otherwise, the use of the resouce
       id depends on the given use case."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="id"/> 
        </extension> 
        <code value="http://hl7.org/fhirpath/System.String"/> 
      </type> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.meta">
      <path value="Composition.meta"/> 
      <short value="Metadata about the resource"/> 
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.
       Changes to the content might not always be associated with version changes to the
       resource."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.meta"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Meta"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.implicitRules">
      <path value="Composition.implicitRules"/> 
      <short value="A set of rules under which this content was created"/> 
      <definition value="A reference to a set of rules that were followed when the resource was constructed,
       and which must be understood when processing the content. Often, this is a reference
       to an implementation guide that defines the special rules along with other profiles
       etc."/> 
      <comment value="Asserting this rule set restricts the content to be only understood by a limited
       set of trading partners. This inherently limits the usefulness of the data in the
       long term. However, the existing health eco-system is highly fractured, and not
       yet ready to define, collect, and exchange data in a generally computable sense.
       Wherever possible, implementers and/or specification writers should avoid using
       this element. Often, when used, the URL is a reference to an implementation guide
       that defines these special rules as part of its narrative along with other profiles,
       value sets, etc."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.implicitRules"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="true"/> 
      <isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional
       knowledge about the resource that modifies its meaning or interpretation"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.language">
      <path value="Composition.language"/> 
      <short value="Language of the resource content"/> 
      <definition value="The base language in which the resource is written."/> 
      <comment value="Language is provided to support indexing and accessibility (typically, services
       such as text to speech use the language tag). The html language tag in the narrative
       applies  to the narrative. The language tag on the resource may be used to specify
       the language of other presentations generated from the data in the resource. Not
       all the content has to be in the base language. The Resource.language should not
       be assumed to apply to the narrative automatically. If a language is specified,
       it should it also be specified on the div element in the html (see rules in HTML5
       for information about the relationship between xml:lang and the html lang attribute)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Resource.language"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language"/> 
        </extension> 
        <strength value="required"/> 
        <description value="IETF language tag for a human language"/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot1"/> 
        <additional> 
          <purpose value="starter"/> 
          <valueSet value="http://hl7.org/fhir/ValueSet/languages"/> 
        </additional> 
      </binding> 
    </element> 
    <element id="Composition.text">
      <path value="Composition.text"/> 
      <short value="Text summary of the resource, for human interpretation"/> 
      <definition value="A human-readable narrative that contains a summary of the resource and can be used
       to represent the content of the resource to a human. The narrative need not encode
       all the structured data, but is required to contain sufficient detail to make it
       &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions
       may define what content should be represented in the narrative to ensure clinical
       safety."/> 
      <comment value="Contained resources do not have a narrative. Resources that are not contained SHOULD
       have a narrative. In some cases, a resource may only have text with little or no
       additional discrete data (as long as all minOccurs=1 elements are satisfied). 
       This may be necessary for data from legacy systems where information is captured
       as a &quot;text blob&quot; or where text is additionally entered raw or narrated
       and encoded information is added later."/> 
      <alias value="narrative"/> 
      <alias value="html"/> 
      <alias value="xhtml"/> 
      <alias value="display"/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="DomainResource.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Narrative"/> 
      </type> 
      <condition value="dom-6"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Act.text?"/> 
      </mapping> 
    </element> 
    <element id="Composition.contained">
      <path value="Composition.contained"/> 
      <short value="Contained, inline Resources"/> 
      <definition value="These resources do not have an independent existence apart from the resource that
       contains them - they cannot be identified independently, nor can they have their
       own independent transaction scope. This is allowed to be a Parameters resource
       if and only if it is referenced by a resource that provides context/meaning."/> 
      <comment value="This should never be done when the content can be identified properly, as once
       identification is lost, it is extremely difficult (and context dependent) to restore
       it again. Contained resources may have profiles and tags in their meta elements,
       but SHALL NOT have security labels."/> 
      <alias value="inline resources"/> 
      <alias value="anonymous resources"/> 
      <alias value="contained resources"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.contained"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Resource"/> 
      </type> 
      <condition value="dom-2"/> 
      <condition value="dom-4"/> 
      <condition value="dom-3"/> 
      <condition value="dom-5"/> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.extension">
      <path value="Composition.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.modifierExtension">
      <path value="Composition.modifierExtension"/> 
      <short value="Extensions that cannot be ignored"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource and that modifies the understanding of the element that contains
       it and/or the understanding of the containing element's descendants. Usually modifier
       elements provide negation or qualification. To make the use of extensions safe
       and managable, there is a strict set of governance applied to the definition and
       use of extensions. Though any implementer is allowed to define an extension, there
       is a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be
       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the
       resource that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.url">
      <path value="Composition.url"/> 
      <short value="Canonical identifier for this Composition, represented as a URI (globally unique)"/> 
      <definition value="An absolute URI that is used to identify this Composition when it is referenced
       in a specification, model, design or an instance; also called its canonical identifier.
       This SHOULD be globally unique and SHOULD be a literal address at which an authoritative
       instance of this Composition is (or will be) published. This URL can be the target
       of a canonical reference. It SHALL remain the same when the Composition is stored
       on different servers."/> 
      <comment value="Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple
       instances may share the same URL if they have a distinct version."/> 
      <requirements value="Allows the Composition to be referenced by a single globally unique identifier."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.url"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="uri"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.identifier"/> 
      </mapping> 
    </element> 
    <element id="Composition.identifier">
      <path value="Composition.identifier"/> 
      <short value="Version-independent identifier for the Composition"/> 
      <definition value="A version-independent identifier for the Composition. This identifier stays constant
       as the composition is changed over time."/> 
      <comment value="Similar to ClinicalDocument/setId in CDA. See discussion in resource definition
       for how these relate."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.identifier"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.identifier"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.identifier"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Document.id / Document.setId"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".setId"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.identifier"/> 
      </mapping> 
    </element> 
    <element id="Composition.version">
      <path value="Composition.version"/> 
      <short value="An explicitly assigned identifier of a variation of the content in the Composition"/> 
      <definition value="An explicitly assigned identifier of a variation of the content in the Composition."/> 
      <comment value="While each resource, including the composition itself, has its own version identifier,
       this is a formal identifier for the logical version of the Composition as a whole.
       It would remain constant if the resources were moved to a new server, and all got
       new individual resource versions, for example."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.version"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.version"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".versionNumber"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.version"/> 
      </mapping> 
    </element> 
    <element id="Composition.status">
      <path value="Composition.status"/> 
      <short value="registered | partial | preliminary | final | amended | corrected | appended | cancelled
       | entered-in-error | deprecated | unknown"/> 
      <definition value="The workflow/clinical status of this composition. The status is a marker for the
       clinical standing of the document."/> 
      <comment value="If a composition is marked as withdrawn, the compositions/documents in the series,
       or data from the composition or document series, should never be displayed to a
       user without being clearly marked as untrustworthy. The flag &quot;entered-in-error&quot;
       is why this element is labeled as a modifier of other elements.   

Some reporting work flows require that the original narrative of a final document
       never be altered; instead, only new narrative can be added. The composition resource
       has no explicit status for explicitly noting whether this business rule is in effect.
       This would be handled by an extension if required."/> 
      <requirements value="Need to be able to mark interim, amended, or withdrawn compositions or documents."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.status"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="true"/> 
      <isModifierReason value="This element is labelled as a modifier because it is a status element that contains
       status entered-in-error which means that the resource should not be treated as
       valid"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionStatus"/> 
        </extension> 
        <strength value="required"/> 
        <description value="The workflow/clinical status of the composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot1"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.status"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.status"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interim: .completionCode=&quot;IN&quot; &amp; ./statusCode[isNormalDatatype()]=&quot;active&q
        uot;;  final: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quo
        t;complete&quot; and not(./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelati
        onship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot;
         and domainMember(&quot;ReviseComposition&quot;, code) and isNormalAct()]);  amended:
         .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&qu
        ot; and ./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[
        subsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;Re
        viseComposition&quot;, code) and isNormalAct() and statusCode=&quot;completed&quot;];
          withdrawn : .completionCode=NI &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;obsolete&q
        uot;"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.docStatus"/> 
      </mapping> 
    </element> 
    <element id="Composition.type">
      <path value="Composition.type"/> 
      <short value="Kind of composition (LOINC if possible)"/> 
      <definition value="Specifies the particular kind of composition (e.g. History and Physical, Discharge
       Summary, Progress Note). This usually equates to the purpose of making the composition."/> 
      <comment value="For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation
       guides will require a specific LOINC code, or use LOINC as an extensible binding."/> 
      <requirements value="Key metadata element describing the composition, used in searching/filtering."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.type"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentType"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="Type of a composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/doc-typecodes"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.code"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".code"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.type"/> 
      </mapping> 
    </element> 
    <element id="Composition.category">
      <path value="Composition.category"/> 
      <short value="Categorization of Composition"/> 
      <definition value="A categorization for the type of the composition - helps for indexing and searching.
       This may be implied by or derived from the code specified in the Composition Type."/> 
      <requirements value="Helps humans to assess whether the composition is of interest when viewing an index
       of compositions or documents."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.category"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentCategory"/> 
        </extension> 
        <strength value="example"/> 
        <description value="High-level kind of a clinical document at a macro level."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/referenced-item-category"/> 
      </binding> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;
        EVN&quot;].code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumenttReference.category"/> 
      </mapping> 
    </element> 
    <element id="Composition.subject">
      <path value="Composition.subject"/> 
      <short value="Who and/or what the composition is about"/> 
      <definition value="Who or what the composition is about. The composition can be about a person, (patient
       or healthcare practitioner), a device (e.g. a machine) or even a group of subjects
       (such as a document about a herd of livestock, or a set of patients that share
       a common exposure)."/> 
      <comment value="For clinical documents, this is usually the patient."/> 
      <requirements value="Essential metadata for searching for the composition. Identifies who and/or what
       the composition/document is about."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.subject"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.subject"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;SBJ&quot;].role[typeCode=&quot;PAT&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".recordTarget"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.subject"/> 
      </mapping> 
    </element> 
    <element id="Composition.encounter">
      <path value="Composition.encounter"/> 
      <short value="Context of the Composition"/> 
      <definition value="Describes the clinical encounter or type of care this documentation is associated
       with."/> 
      <requirements value="Provides context for the composition and supports searching."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.encounter"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.encounter"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.context"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="unique(highest(./outboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()
        ], priorityNumber)/target[moodCode=&quot;EVN&quot; and classCode=(&quot;ENC&quot;,
         &quot;PCPR&quot;) and isNormalAct])"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".componentOf.encompassingEncounter"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.context"/> 
      </mapping> 
    </element> 
    <element id="Composition.date">
      <path value="Composition.date"/> 
      <short value="Composition editing time"/> 
      <definition value="The composition editing time, when the composition was last logically changed by
       the author."/> 
      <comment value="The Last Modified Date on the composition may be after the date of the document
       was attested without being changed. This means that the date on an amended document
       is the date of the amendment, not the date of original authorship."/> 
      <requirements value="dateTime is used for tracking, organizing versions and searching. Note that this
       is the time of authoring this version of the Composition. When packaged in a document,
       [Bundle.timestamp](bundle-definitions.html#Bundle.timestamp) is the date of packaging."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.date"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.occurrence[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.done[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".effectiveTime[type=&quot;TS&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.content.attachment.date, DocumentReference.date"/> 
      </mapping> 
    </element> 
    <element id="Composition.useContext">
      <path value="Composition.useContext"/> 
      <short value="The context that the content is intended to support"/> 
      <definition value="The content was developed with a focus and intent of supporting the contexts that
       are listed. These contexts may be general categories (gender, age, ...) or may
       be references to specific programs (insurance plans, studies, ...) and may be used
       to assist with indexing and searching for appropriate Composition instances."/> 
      <comment value="When multiple useContexts are specified, there is no expectation that all or any
       of the contexts apply."/> 
      <requirements value="Assist in searching for appropriate content."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.useContext"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="UsageContext"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.author">
      <path value="Composition.author"/> 
      <short value="Who and/or what authored the composition"/> 
      <definition value="Identifies who is responsible for the information in the composition, not necessarily
       who typed it in."/> 
      <requirements value="Identifies who is responsible for the content."/> 
      <min value="1"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.author"/> 
        <min value="1"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.performer"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.author"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".author.assignedAuthor"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.author"/> 
      </mapping> 
    </element> 
    <element id="Composition.name">
      <path value="Composition.name"/> 
      <short value="Name for this Composition (computer friendly)"/> 
      <definition value="A natural language name identifying the {{title}}. This name should be usable as
       an identifier for the module by machine processing applications such as code generation."/> 
      <comment value="The name is not expected to be globally unique. The name should be a simple alphanumeric
       type name to ensure that it is machine-processing friendly."/> 
      <requirements value="Support human navigation and code generation."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.name"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.title">
      <path value="Composition.title"/> 
      <short value="Human Readable name/title"/> 
      <definition value="Official human-readable label for the composition."/> 
      <comment value="For many compositions, the title is the same as the text or a display name of Composition.typ
      e (e.g. a &quot;consultation&quot; or &quot;progress note&quot;). 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. Feedback on this requirement
       is welcome during the trial use period."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.title"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./title"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".title"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.description, DocumentReference.content.attachment.title"/> 
      </mapping> 
    </element> 
    <element id="Composition.note">
      <path value="Composition.note"/> 
      <short value="For any additional notes"/> 
      <definition value="For any additional notes."/> 
      <comment value="A comment, general note or annotation not coded elsewhere."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.note"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Annotation"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
    </element> 
    <element id="Composition.attester">
      <path value="Composition.attester"/> 
      <short value="Attests to accuracy of composition"/> 
      <definition value="A participant who has attested to the accuracy of the composition/document."/> 
      <comment value="Only list each attester once."/> 
      <requirements value="Identifies responsibility for the accuracy of the composition content."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.attester"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUTHEN&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator/.legalAuthenticator"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.attester"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.id">
      <path value="Composition.attester.id"/> 
      <representation value="xmlAttr"/> 
      <short value="Unique id for inter-element referencing"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may
       be any string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/> 
        </extension> 
        <code value="http://hl7.org/fhirpath/System.String"/> 
      </type> 
      <condition value="ele-1"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.extension">
      <path value="Composition.attester.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.modifierExtension">
      <path value="Composition.attester.modifierExtension"/> 
      <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be
       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <alias value="modifiers"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="BackboneElement.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the
       element that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.mode">
      <path value="Composition.attester.mode"/> 
      <short value="personal | professional | legal | official"/> 
      <definition value="The type of attestation the authenticator offers."/> 
      <requirements value="Indicates the level of authority of the attestation."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.mode"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionAttestationMode"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="The way in which a person authenticated a composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/composition-attestation-mode"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="unique(./modeCode)"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="implied by .authenticator/.legalAuthenticator"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.attester.mode"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.time">
      <path value="Composition.attester.time"/> 
      <short value="When the composition was attested"/> 
      <definition value="When the composition was attested by the party."/> 
      <requirements value="Identifies when the information in the composition was deemed accurate.  (Things
       may have changed since then.)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.time"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./time[type=&quot;TS&quot; and isNormalDatatype()]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator.time"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.attester.time"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.party">
      <path value="Composition.attester.party"/> 
      <short value="Who attested the composition"/> 
      <definition value="Who attested the composition in the specified way."/> 
      <requirements value="Identifies who has taken on the responsibility for accuracy of the composition
       content."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.party"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.witness"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./role[classCode=&quot;ASSIGNED&quot; and isNormalRole]/player[determinerCode=&quot;INST&quot
        ; and classCode=(&quot;DEV&quot;, &quot;PSN&quot;) and isNormalEntity()] or ./role[classCode=&
        quot;ASSIGNED&quot; and isNormalRole and not(player)]/scoper[determinerCode=&quot;INST&quot;
         and classCode=&quot;ORG&quot; and isNormalEntity()]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator.assignedEnttty"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.attester.party"/> 
      </mapping> 
    </element> 
    <element id="Composition.custodian">
      <path value="Composition.custodian"/> 
      <short value="Organization which maintains the composition"/> 
      <definition value="Identifies the organization or group who is responsible for ongoing maintenance
       of and access to the composition/document information."/> 
      <comment value="This is useful when documents are derived from a composition - provides guidance
       for how to get the latest version of the document. This is optional because this
       is sometimes not known by the authoring system, and can be inferred by context.
       However, it is important that this information be known when working with a derived
       document, so providing a custodian is encouraged."/> 
      <requirements value="Identifies where to go to find the current version, where to report issues, etc."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.custodian"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;RCV&quot;].role[classCode=&quot;CUST&quot;].scoper[classCode=&q
        uot;ORG&quot; and determinerCode=&quot;INST&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".custodian.assignedCustodian"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.custodian"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo">
      <path value="Composition.relatesTo"/> 
      <short value="Relationships to other compositions/documents"/> 
      <definition value="Relationships that this composition has with other compositions or documents that
       already exist."/> 
      <comment value="To reference (using relatesTo) a Bundle of type &quot;document&quot; or another
       Composition where you only have the identifier, use a resourceReference with an
       identifier.\
When a Composition is an alternate representation of another type of document e.g.
       CDA, the other document could be referenced in a DocumentReference resource.  
Here is an example of using relatesTo to reference another Bundle of type &quot;document&quot
      ; or Composition where you only have the identifier:
```
&quot;relatesTo&quot;: [{
  &quot;type&quot;: &quot;replaces&quot;,
  &quot;resourceReference&quot;: {
    &quot;identifier&quot;: { 
      &quot;system&quot;: &quot;...&quot;, 
      &quot;value&quot;: &quot;...&quot;
    }
  } 
}]
```"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.relatesTo"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="RelatedArtifact"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".relatedDocument"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.relatesTo"/> 
      </mapping> 
    </element> 
    <element id="Composition.event">
      <path value="Composition.event"/> 
      <short value="The clinical service(s) being documented"/> 
      <definition value="The clinical service, such as a colonoscopy or an appendectomy, being documented."/> 
      <comment value="The event needs to be consistent with the type element, though can provide further
       information if desired."/> 
      <requirements value="Provides context for the composition and creates a linkage between a resource describing
       an event and the composition created describing the event."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.event"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outboundRelationship[typeCode=&quot;SUBJ&quot;].target[classCode&lt;'ACT']"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".documentationOf.serviceEvent"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.id">
      <path value="Composition.event.id"/> 
      <representation value="xmlAttr"/> 
      <short value="Unique id for inter-element referencing"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may
       be any string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/> 
        </extension> 
        <code value="http://hl7.org/fhirpath/System.String"/> 
      </type> 
      <condition value="ele-1"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.extension">
      <path value="Composition.event.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.modifierExtension">
      <path value="Composition.event.modifierExtension"/> 
      <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be
       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <alias value="modifiers"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="BackboneElement.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the
       element that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.period">
      <path value="Composition.event.period"/> 
      <short value="The period covered by the documentation"/> 
      <definition value="The period of time covered by the documentation. There is no assertion that the
       documentation is a complete representation for this period, only that it documents
       events during this time."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.event.period"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Period"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.period"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.detail">
      <path value="Composition.event.detail"/> 
      <short value="The event(s) being documented, as code(s), reference(s), or both"/> 
      <definition value="Represents the main clinical acts, such as a colonoscopy or an appendectomy, being
       documented. In some cases, the event is inherent in the typeCode, such as a &quot;History
       and Physical Report&quot; in which case the procedure being documented is necessarily
       a &quot;History and Physical&quot; act. The events may be included as a code or
       as a reference to an other resource."/> 
      <comment value="An event can further specialize the act inherent in the typeCode, such as where
       it is simply &quot;Procedure Report&quot; and the procedure was a &quot;colonoscopy&quot;.
       If one or more events are included, they SHALL NOT conflict with the values inherent
       in the classCode, practiceSettingCode or typeCode, as such a conflict would create
       an ambiguous situation. This short list of codes is provided to be used as key
       words for certain types of queries."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.event.detail"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableReference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentEventType"/> 
        </extension> 
        <strength value="example"/> 
        <description value="This list of codes represents the main clinical acts being documented."/> 
        <valueSet value="http://terminology.hl7.org/ValueSet/v3-ActCode"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;SUBJ&quot;].target"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.event"/> 
      </mapping> 
    </element> 
    <element id="Composition.section">
      <path value="Composition.section"/> 
      <short value="Composition is broken into sections"/> 
      <definition value="The root of the sections that make up the composition."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </type> 
      <constraint> 
        <key value="cmp-1"/> 
        <severity value="error"/> 
        <human value="A section must contain at least one of text, entries, or sub-sections"/> 
        <expression value="text.exists() or entry.exists() or section.exists()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Composition"/> 
      </constraint> 
      <constraint> 
        <key value="cmp-2"/> 
        <severity value="error"/> 
        <human value="A section can only have an emptyReason if it is empty"/> 
        <expression value="emptyReason.empty() or entry.empty()"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Composition"/> 
      </constraint> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./outboundRelationship[typeCode=&quot;COMP&quot; and isNormalActRelationship()]/target[moodCo
        de=&quot;EVN&quot; and classCode=&quot;DOCSECT&quot; and isNormalAct]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".component.structuredBody.component.section"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.id">
      <path value="Composition.section.id"/> 
      <representation value="xmlAttr"/> 
      <short value="Unique id for inter-element referencing"/> 
      <definition value="Unique id for the element within a resource (for internal references). This may
       be any string value that does not contain spaces."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Element.id"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
          <valueUrl value="string"/> 
        </extension> 
        <code value="http://hl7.org/fhirpath/System.String"/> 
      </type> 
      <condition value="ele-1"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.extension">
      <path value="Composition.section.extension"/> 
      <short value="Additional content defined by implementations"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. To make the use of extensions safe and managable, there is a strict
       set of governance applied to the definition and use of extensions. Though any implementer
       can define an extension, there is a set of requirements that SHALL be met as part
       of the definition of the extension."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Element.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.modifierExtension">
      <path value="Composition.section.modifierExtension"/> 
      <short value="Extensions that cannot be ignored even if unrecognized"/> 
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element and that modifies the understanding of the element in which it is
       contained and/or the understanding of the containing element's descendants. Usually
       modifier elements provide negation or qualification. To make the use of extensions
       safe and managable, there is a strict set of governance applied to the definition
       and use of extensions. Though any implementer can define an extension, there is
       a set of requirements that SHALL be met as part of the definition of the extension.
       Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or
       DomainResource (including cannot change the meaning of modifierExtension itself)."/> 
      <comment value="There can be no stigma associated with the use of extensions by any application,
       project, or standard - regardless of the institution or jurisdiction that uses
       or defines the extensions.  The use of extensions is what allows the FHIR specification
       to retain a core level of simplicity for everyone."/> 
      <requirements value="Modifier extensions allow for extensions that *cannot* be safely ignored to be
       clearly distinguished from the vast majority of extensions which can be safely
       ignored.  This promotes interoperability by eliminating the need for implementers
       to prohibit the presence of extensions. For further information, see the [definition
       of modifier extensions](extensibility.html#modifierExtension)."/> 
      <alias value="extensions"/> 
      <alias value="user content"/> 
      <alias value="modifiers"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="BackboneElement.modifierExtension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <isModifier value="true"/> 
      <isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the
       element that contains them"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="N/A"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.title">
      <path value="Composition.section.title"/> 
      <short value="Label for section (e.g. for ToC)"/> 
      <definition value="The label for this particular section.  This will be part of the rendered content
       for the document, and is often used to build a table of contents."/> 
      <comment value="The title identifies the section for a human reader. The title must be consistent
       with the narrative of the resource that is the target of the section.content reference.
       Generally, sections SHOULD have titles, but in some documents, it is unnecessary
       or inappropriate. Typically, this is where a section has subsections that have
       their own adequately distinguishing title,  or documents that only have a single
       section. Most Implementation Guides will make section title to be a required element."/> 
      <requirements value="Section headings are often standardized for different types of documents.  They
       give guidance to humans on how the document is organized."/> 
      <alias value="header"/> 
      <alias value="label"/> 
      <alias value="caption"/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.title"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./title"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".title"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.code">
      <path value="Composition.section.code"/> 
      <short value="Classification of section (recommended)"/> 
      <definition value="A code identifying the kind of content contained within the section. This must
       be consistent with the section title."/> 
      <comment value="The code identifies the section for an automated processor of the document. This
       is particularly relevant when using profiles to control the structure of the document.
         

If the section has content (instead of sub-sections), the section.code does not
       change the meaning or interpretation of the resource that is the content of the
       section in the comments for the section.code."/> 
      <requirements value="Provides computable standardized labels to topics within the document."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.code"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionSectionType"/> 
        </extension> 
        <strength value="example"/> 
        <description value="Classification of a section of a composition/document."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/doc-section-codes"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".code"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.author">
      <path value="Composition.section.author"/> 
      <short value="Who and/or what authored the section"/> 
      <definition value="Identifies who is responsible for the information in this section, not necessarily
       who typed it in."/> 
      <requirements value="Identifies who is responsible for the content."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.author"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.author"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".author.assignedAuthor"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.focus">
      <path value="Composition.section.focus"/> 
      <short value="Who/what the section is about, when it is not about the subject of composition"/> 
      <definition value="The actual focus of the section when it is not the subject of the composition,
       but instead represents something or someone associated with the subject such as
       (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified,
       the focus is assumed to be focus of the parent section, or, for a section in the
       Composition itself, the subject of the composition. Sections with a focus SHALL
       only include resources where the logical subject (patient, subject, focus, etc.)
       matches the section focus, or the resources have no logical subject (few resources)."/> 
      <comment value="Typically, sections in a doument are about the subject of the document, whether
       that is a  patient, or group of patients, location, or device, or whatever. For
       some kind of documents, some sections actually contain data about related entities.
       Typical examples are  a section in a newborn discharge summary concerning the mother,
       or family history documents, with a section about each family member, though there
       are many other examples."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.focus"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".subject? (CDA did not differentiate between subject and focus)"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.text">
      <path value="Composition.section.text"/> 
      <short value="Text summary of the section, for human interpretation"/> 
      <definition value="A human-readable narrative that contains the attested content of the section, used
       to represent the content of the resource to a human. The narrative need not encode
       all the structured data, but is required to contain sufficient detail to make it
       &quot;clinically safe&quot; for a human to just read the narrative."/> 
      <comment value="Document profiles may define what content should be represented in the narrative
       to ensure clinical safety."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Narrative"/> 
      </type> 
      <condition value="cmp-1"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".text"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".text"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.orderedBy">
      <path value="Composition.section.orderedBy"/> 
      <short value="Order of section entries"/> 
      <definition value="Specifies the order applied to the items in the section entries."/> 
      <comment value="Applications SHOULD render ordered lists in the order provided, but MAY allow users
       to re-order based on their own preferences as well. If there is no order specified,
       the order is unknown, though there may still be some order."/> 
      <requirements value="Important for presentation and rendering.  Lists may be sorted to place more important
       information first or to group related entries."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.orderedBy"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="SectionEntryOrder"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="What order applies to the items in the entry."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/list-order"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=COMP].sequenceNumber &gt; 1"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.entry">
      <path value="Composition.section.entry"/> 
      <short value="A reference to data that supports this section"/> 
      <definition value="A reference to the actual resource from which the narrative in the section is derived."/> 
      <comment value="If there are no entries in the list, an emptyReason SHOULD be provided."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.entry"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <condition value="cmp-1"/> 
      <condition value="cmp-2"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=COMP] or  .participation[typeCode=SBJ]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".entry"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.emptyReason">
      <path value="Composition.section.emptyReason"/> 
      <short value="Why the section is empty"/> 
      <definition value="If the section is empty, why the list is empty. An empty section typically has
       some text explaining the empty reason."/> 
      <comment value="The various reasons for an empty section make a significant interpretation to its
       interpretation. Note that this code is for use when the entire section content
       has been suppressed, and not for when individual items are omitted - implementers
       may consider using a text note or a flag on an entry in these cases."/> 
      <requirements value="Allows capturing things like &quot;none exist&quot; or &quot;not asked&quot; which
       can be important for most lists."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.emptyReason"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <condition value="cmp-2"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="SectionEmptyReason"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="If a section is empty, why it is empty."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/list-empty-reason"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".inboundRelationship[typeCode=SUBJ,code&lt;ListEmptyReason].value[type=CD]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.section">
      <path value="Composition.section.section"/> 
      <short value="Nested Section"/> 
      <definition value="A nested sub-section within this section."/> 
      <comment value="Nested sections are primarily used to help human readers navigate to particular
       portions of the document."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.section"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <contentReference value="http://hl7.org/fhir/StructureDefinition/Composition#Composition.section"/> 
      <constraint> 
        <key value="ele-1"/> 
        <severity value="error"/> 
        <human value="All FHIR elements must have a @value or children"/> 
        <expression value="hasValue() or (children().count() &gt; id.count())"/> 
        <source value="http://hl7.org/fhir/StructureDefinition/Element"/> 
      </constraint> 
      <mustSupport value="false"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./outboundRelationship[typeCode=&quot;COMP&quot; and isNormalActRelationship()]/target[moodCo
        de=&quot;EVN&quot; and classCode=&quot;DOCSECT&quot; and isNormalAct]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".component.section"/> 
      </mapping> 
    </element> 
  </snapshot> 
  <differential> 
    <element id="Composition">
      <path value="Composition"/> 
      <min value="0"/> 
      <max value="*"/> 
    </element> 
    <element id="Composition.subject">
      <path value="Composition.subject"/> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> 
      </type> 
    </element> 
  </differential> 
</StructureDefinition>