Describes the intended objective(s) of patient care, for example, weight loss, restoring an activity of daily living, etc.

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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 as much as possible.

The base language in which the resource is written.

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).

A human-readable narrative that contains a summary of the resource, and may 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 "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

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.

An Extension

• unordered
• Open
• discriminators: url

The type of goal, expressed as a code, for example, Goal: weight loss, [SNOMED CT: 289169006].

The element describing the target for the goal, allowing the progress of the goal to be monitored against an observation.

unique id for the element within a resource (for internal references).

An Extension

• unordered
• Open
• discriminators: url

The parameter whose value is being tracked, e.g., body weight, blood pressure, or hemoglobin A1c level.

The target value range of the focus to be achieved to signify the fulfillment of the goal, e.g., 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition should be version specific. This will ideally be the URI for the Resource Profile defining the extension, with the code for the extension after a #.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

The effective time period for the goal, from the time the goal was created to the time goal was removed or revoked as an active goal.

The reason the goal was not accepted. Applies only if the status of the goal is rejected.

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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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.

This records identifiers associated with this care plan that are defined by business processed and/ or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

Need to allow connection to a wider workflow.

Identifies the patient/subject whose intended care is described by the plan.

Goals are associated with a patient.

Human-readable description of a specific desired objective of care.

Without a description of what's trying to be achieved, element has no purpose.

Indicates whether the goal has been reached and is still considered relevant.

Allows measuring outcome and whether goal needs to be further tracked.

Any comments related to the goal.

There's a need to capture information about the goal that doesn't actually describe the goal.

May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.

The identified conditions that this goal relates to - the condition that caused it to be created, or that it is intended to address.

Allows specific goals to explicitly linked to conditions - makes the goal more understandable.