In the case of a live birth sent in error, a status of 'entered-in-error' must be set.

Jurisdiction live birth report Document

The subject of the composition as a whole is the newborn baby. Different sections in the composition have different focus (e.g.: the mother).

The Encounter for the Composition is the newborn's birth encounter. This Encounter links to the mother's encounter by the Encounter.partOf data element.

The author is the jurisdictional Vital Records Office.

The Composition is broken into sections that, where possible, align with the sections in the Live Birth Certificate. Various administrative and demographic data in the Birth Certificate are contained in other locations in the Composition, such as the Patient and Encounter profiles.

motherPrenatal

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

Entries that are contained in the motherPrenatal Section

Date that mother had her first prenatal care visit

Those visits which are listed in the mother's prenatal care and/or facility records.

Date that the mother's last normal menses began. This item is used to compute the gestational age of the infant.

The pregnancy history of the mother with respect to previous children born alive

The pregnancy history of the mother with respect to previous children born alive

The pregnancy history of the mother with respect to previous children born alive

The pregnancy history of the mother with respect to other pregnancy outcomes (included pregnancy losses of any gestational age, e.g., spontaneous or induced losses or ectopic pregnancies).

The pregnancy history of the mother with respect to other pregnancy outcomes (included pregnancy losses of any gestational age, e.g., spontaneous or induced losses or ectopic pregnancies).

The principal payer for this delivery

The mother's weight at the time of delivery

Mother's height

The mother's prepregnancy weight

Use of the Women, Infant's, and Children (WIC) nutritional program by the mother during the pregnancy.

The number of cigarettes or packs of cigarettes the mother smoked 3 months before and at various intervals during the pregnancy

medicalHealthInformation

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

Entries that are contained in the medicalHealthInformation Section

Selected medical risk factors of the mother during this pregnancy

Number of previous cesarean deliveries

Selected infections that the mother had or was treated for during the course of this pregnancy

Selected medical treatments or invasive/manipulative procedures performed during this pregnancy specifically for management of labor and delivery

Information about the course of labor and delivery

Fetal presentation at birth

Final route and method of delivery

Serious complications experienced by the mother associated with labor and delivery

newbornInformation

Entries that are contained in the newbornInformation Section

The weight of the infant/fetus at birth/delivery

The obstetric estimate of the infant's gestation in completed weeks based on the birth/delivery attendant's final estimate of gestation which should be determined by all perinatal factors and assessments such as ultrasound, but not the neonatal exam

The Apgar Score for the child.

Number of live births this delivery

Disorders or significant morbidity experienced by the newborn infant

Malformations of the newborn diagnosed prenatally or after delivery

Information on the infant's survival

Information on whether the infant is being breastfed at discharge from the hospital

motherInformation

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

Entries that are contained in the motherInformation Section

Was mother married at conception, at the time of birth, or at any time between conception and giving birth?

Was social security number requested for the child

Mother's education

Mother's Present Job

Mother's Input Race and Ethnicity

fatherInformation

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the father.

Entries that are contained in the fatherInformation Section

Whether or not a paternity acknowledgement was signed by the father if the mother was not married at conception, at the time of birth, or at any time between conception and giving birth.

Father's education

Father's Present Job

Father's Input Race and Ethnicity

emergingIssues

Entries that are contained in the emergingIssues Section

Emerging Issues

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.).

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.

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.

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 it's narrative along with other profiles, value sets, etc.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

In the case of a live birth sent in error, a status of 'entered-in-error' must be set.

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 "entered-in-error" 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.

The workflow/clinical status of the composition.

Need to be able to mark interim, amended, or withdrawn compositions or documents.

Jurisdiction live birth report Document

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.

Type of a composition.

Key metadata element describing the composition, used in searching/filtering.

The subject of the composition as a whole is the newborn baby. Different sections in the composition have different focus (e.g.: the mother).

For clinical documents, this is usually the patient.

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

The Encounter for the Composition is the newborn's birth encounter. This Encounter links to the mother's encounter by the Encounter.partOf data element.

Provides context for the composition and supports searching.

This Extension profile is a reference to the maternity encounter.

The composition editing time, when the composition was last logically changed by the author.

The Last Modified Date on the composition may be after the date of the document was attested without being changed.

dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.

The author is the jurisdictional Vital Records Office.

Identifies who is responsible for the content.

Official human-readable label for the composition.

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

The Composition is broken into sections that, where possible, align with the sections in the Live Birth Certificate. Various administrative and demographic data in the Birth Certificate are contained in other locations in the Composition, such as the Patient and Encounter profiles.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

motherPrenatal

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

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.

Entries that are contained in the motherPrenatal Section

If there are no entries in the list, an emptyReason SHOULD be provided.

Date that mother had her first prenatal care visit

If there are no entries in the list, an emptyReason SHOULD be provided.

Those visits which are listed in the mother's prenatal care and/or facility records.

If there are no entries in the list, an emptyReason SHOULD be provided.

Date that the mother's last normal menses began. This item is used to compute the gestational age of the infant.

If there are no entries in the list, an emptyReason SHOULD be provided.

The pregnancy history of the mother with respect to previous children born alive

If there are no entries in the list, an emptyReason SHOULD be provided.

The pregnancy history of the mother with respect to previous children born alive

If there are no entries in the list, an emptyReason SHOULD be provided.

The pregnancy history of the mother with respect to previous children born alive

If there are no entries in the list, an emptyReason SHOULD be provided.

The pregnancy history of the mother with respect to other pregnancy outcomes (included pregnancy losses of any gestational age, e.g., spontaneous or induced losses or ectopic pregnancies).

If there are no entries in the list, an emptyReason SHOULD be provided.

The pregnancy history of the mother with respect to other pregnancy outcomes (included pregnancy losses of any gestational age, e.g., spontaneous or induced losses or ectopic pregnancies).

If there are no entries in the list, an emptyReason SHOULD be provided.

The principal payer for this delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

The mother's weight at the time of delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Mother's height

If there are no entries in the list, an emptyReason SHOULD be provided.

The mother's prepregnancy weight

If there are no entries in the list, an emptyReason SHOULD be provided.

Use of the Women, Infant's, and Children (WIC) nutritional program by the mother during the pregnancy.

If there are no entries in the list, an emptyReason SHOULD be provided.

The number of cigarettes or packs of cigarettes the mother smoked 3 months before and at various intervals during the pregnancy

If there are no entries in the list, an emptyReason SHOULD be provided.

medicalHealthInformation

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

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.

Entries that are contained in the medicalHealthInformation Section

If there are no entries in the list, an emptyReason SHOULD be provided.

Selected medical risk factors of the mother during this pregnancy

If there are no entries in the list, an emptyReason SHOULD be provided.

Number of previous cesarean deliveries

If there are no entries in the list, an emptyReason SHOULD be provided.

Selected infections that the mother had or was treated for during the course of this pregnancy

If there are no entries in the list, an emptyReason SHOULD be provided.

Selected medical treatments or invasive/manipulative procedures performed during this pregnancy specifically for management of labor and delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Information about the course of labor and delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Fetal presentation at birth

If there are no entries in the list, an emptyReason SHOULD be provided.

Final route and method of delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Serious complications experienced by the mother associated with labor and delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

newbornInformation

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

Entries that are contained in the newbornInformation Section

If there are no entries in the list, an emptyReason SHOULD be provided.

The weight of the infant/fetus at birth/delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

The obstetric estimate of the infant's gestation in completed weeks based on the birth/delivery attendant's final estimate of gestation which should be determined by all perinatal factors and assessments such as ultrasound, but not the neonatal exam

If there are no entries in the list, an emptyReason SHOULD be provided.

The Apgar Score for the child.

If there are no entries in the list, an emptyReason SHOULD be provided.

Number of live births this delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Disorders or significant morbidity experienced by the newborn infant

If there are no entries in the list, an emptyReason SHOULD be provided.

Malformations of the newborn diagnosed prenatally or after delivery

If there are no entries in the list, an emptyReason SHOULD be provided.

Information on the infant's survival

If there are no entries in the list, an emptyReason SHOULD be provided.

Information on whether the infant is being breastfed at discharge from the hospital

If there are no entries in the list, an emptyReason SHOULD be provided.

motherInformation

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the mother.

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.

Entries that are contained in the motherInformation Section

If there are no entries in the list, an emptyReason SHOULD be provided.

Was mother married at conception, at the time of birth, or at any time between conception and giving birth?

If there are no entries in the list, an emptyReason SHOULD be provided.

Was social security number requested for the child

If there are no entries in the list, an emptyReason SHOULD be provided.

Mother's education

If there are no entries in the list, an emptyReason SHOULD be provided.

Mother's Present Job

If there are no entries in the list, an emptyReason SHOULD be provided.

Mother's Input Race and Ethnicity

If there are no entries in the list, an emptyReason SHOULD be provided.

fatherInformation

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

The subject of the composition as a whole is the fetus baby. The focus of this section in the composition is the father.

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.

Entries that are contained in the fatherInformation Section

If there are no entries in the list, an emptyReason SHOULD be provided.

Whether or not a paternity acknowledgement was signed by the father if the mother was not married at conception, at the time of birth, or at any time between conception and giving birth.

If there are no entries in the list, an emptyReason SHOULD be provided.

Father's education

If there are no entries in the list, an emptyReason SHOULD be provided.

Father's Present Job

If there are no entries in the list, an emptyReason SHOULD be provided.

Father's Input Race and Ethnicity

If there are no entries in the list, an emptyReason SHOULD be provided.

emergingIssues

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A code identifying the kind of content contained within the section. This must be consistent with the section title.

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.

Classification of a section of a composition/document.

Provides computable standardized labels to topics within the document.

Entries that are contained in the emergingIssues Section

If there are no entries in the list, an emptyReason SHOULD be provided.

Emerging Issues

If there are no entries in the list, an emptyReason SHOULD be provided.

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.).

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.

The logical id of the resource, as used in the URL for the resource. 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.

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.

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.

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 it's narrative along with other profiles, value sets, etc.

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 language.

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 "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. 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 "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

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.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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.

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.

A version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.

Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.

In the case of a live birth sent in error, a status of 'entered-in-error' must be set.

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 "entered-in-error" 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.

The workflow/clinical status of the composition.

Need to be able to mark interim, amended, or withdrawn compositions or documents.

Jurisdiction live birth report Document

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.

Type of a composition.

Key metadata element describing the composition, used in searching/filtering.

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.

This is a metadata field from XDS/MHD.

High-level kind of a clinical document at a macro level.

Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

The subject of the composition as a whole is the newborn baby. Different sections in the composition have different focus (e.g.: the mother).

For clinical documents, this is usually the patient.

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

The Encounter for the Composition is the newborn's birth encounter. This Encounter links to the mother's encounter by the Encounter.partOf data element.

Provides context for the composition and supports searching.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

This Extension profile is a reference to the maternity encounter.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).