PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot
PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot
This page is part of the PACIO Advance Directive Information Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions 
| Defining URL: | http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-Header |
| Version: | 0.1.0 |
| Name: | PADIHeader |
| Title: | PACIO ADI Header |
| Status: | Active as of 12/6/21 8:50 PM |
| Definition: | This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents. |
| Publisher: | HL7 Patient Empowerment Working Group |
| Source Resource: | XML / JSON / Turtle |
The official URL for this profile is:
http://hl7.org/fhir/us/pacio-adi/StructureDefinition/PADI-Header
This profile, largely based on the CCDA on FHIR US Realm Header profile, defines requirements that address specific exchange requirements for a composition containing a person’s advance care plan (PACP) information.
In the cases where the patient is not able to “write” the PACP contents due to literacy constraints or physical disability, e.g. hemiplegia, the patient/subject is still considered author of the content, and a data enterer will fill the role of physically creating the document by entering the author’s requested information into the system used to create the document.
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from Clinical Document
Summary
Mandatory: 5 elements (5 nested mandatory elements)
Must-Support: 29 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
This structure is derived from Clinical Document
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  Composition | 0..* | Clinical Document | This is an abstract profile A set of resources composed into a single coherent clinical statement with clinical attestation | |
  id | Σ | 0..1 | string | Logical id of this artifact |
 meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
 Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
 composition-clinicaldocument-versionNumber | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber | |
| padi-versionNumber-extension | S | 0..1 | integer | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-versionNumber-extension |
| padi-effective-date-extension | S | 0..1 | Period | Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-effective-date-extension |
| padi-jurisdiction-extension | 0..* | CodeableConcept | Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible) | |
| padi-dataEnterer-extension | S | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-dataEnterer-extension |
| padi-informant-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-informant-extension |
| padi-informationRecipient-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson | US Core Organization Profile) | Information Recipient URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-informationRecipient-extension |
| padi-participant-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-participant-extension |
| padi-performer-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-performer-extension |
| padi-authorization-extension | S | 0..* | Reference(Consent) | Authorization URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-authorization-extension |
| padi-clause-extension | S | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-clause-extension |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣ | 1..1 | Identifier | Version-independent identifier for the Composition |
| status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. |
| type | SΣ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Directive Categories (extensible) |
| category | SΣ | 1..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
 subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about |
| encounter | SΣ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition |
| date | SΣ | 1..1 | dateTime | Composition editing time |
| author | SΣ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition |
| title | SΣ | 1..1 | string | Human Readable name/title |
  Slices for attester | 0..* | BackboneElement | Attests to accuracy of composition Slice: Unordered, Open by value:mode | |
   attester:All Slices | Content/Rules for all slices | |||
  id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| padi-attestationInformation-extension | I | 1..1 | (Complex) | Attestation Information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-attestationInformation-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. | |
| time | 0..1 | dateTime | When the composition was attested | |
 party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition | |
| attester:legal_attester | S | 0..1 | BackboneElement | Attests to accuracy of composition |
 id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: legal |
| time | 0..1 | dateTime | When the composition was attested | |
 party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson | US Core Organization Profile) | Who attested the composition |
| attester:notary_attester | S | 0..* | BackboneElement | Attests to accuracy of composition |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: professional |
| time | 0..1 | dateTime | When the composition was attested | |
| party | S | 1..1 | Reference(RelatedPerson) | Who attested the composition |
 attester:witness_attester | S | 0..* | BackboneElement | Attests to accuracy of composition |
 id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: personal |
| time | 0..1 | dateTime | When the composition was attested | |
| party | S | 1..1 | Reference(US Core Patient Profile | RelatedPerson) | Who attested the composition |
| custodian | SΣ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition |
| relatesTo | 0..* | BackboneElement | Relationships to other compositions/documents | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. | |
  target[x] | 1..1 | Target of the relationship | ||
| targetIdentifier | Identifier | |||
 targetReference | Reference(Composition) | |||
| event | Σ | 0..* | BackboneElement | The clinical service(s) being documented |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. |
| period | Σ | 0..1 | Period | The period covered by the documentation |
| detail | Σ | 0..* | Reference(Resource) | The event(s) being documented |
| section | I | 0..* | BackboneElement | Composition is broken into sections cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| padi-clause-extension | S | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-clause-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| title | 0..1 | string | Label for section (e.g. for ToC) | |
| code | 0..1 | CodeableConcept | Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. | |
| author | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section | |
| focus | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition | |
| text | I | 0..1 | Narrative | Text summary of the section, for human interpretation |
| mode | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section. | |
| orderedBy | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry. | |
| entry | I | 0..* | Reference(Resource) | A reference to data that supports this section |
| emptyReason | I | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty. |
| section | I | 0..* | See section (Composition) | Nested Section |
| Documentation for this format | ||||
This structure is derived from Clinical Document
Summary
Mandatory: 5 elements (5 nested mandatory elements)
Must-Support: 29 elements
Prohibited: 1 element
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from Clinical Document
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| Composition | 0..* | Clinical Document | This is an abstract profile A set of resources composed into a single coherent clinical statement with clinical attestation | |
| id | Σ | 0..1 | string | Logical id of this artifact |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language. |
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |
| contained | 0..* | Resource | Contained, inline Resources | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| composition-clinicaldocument-versionNumber | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber | |
| padi-versionNumber-extension | S | 0..1 | integer | Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-versionNumber-extension |
| padi-effective-date-extension | S | 0..1 | Period | Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-effective-date-extension |
| padi-jurisdiction-extension | 0..* | CodeableConcept | Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible) | |
| padi-dataEnterer-extension | S | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-dataEnterer-extension |
| padi-informant-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-informant-extension |
| padi-informationRecipient-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson | US Core Organization Profile) | Information Recipient URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-informationRecipient-extension |
| padi-participant-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-participant-extension |
| padi-performer-extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-performer-extension |
| padi-authorization-extension | S | 0..* | Reference(Consent) | Authorization URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-authorization-extension |
| padi-clause-extension | S | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-clause-extension |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣ | 1..1 | Identifier | Version-independent identifier for the Composition |
| status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. |
| type | SΣ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Directive Categories (extensible) |
| category | SΣ | 1..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. |
| subject | SΣ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about |
| encounter | SΣ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition |
| date | SΣ | 1..1 | dateTime | Composition editing time |
| author | SΣ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition |
| title | SΣ | 1..1 | string | Human Readable name/title |
| Slices for attester | 0..* | BackboneElement | Attests to accuracy of composition Slice: Unordered, Open by value:mode | |
| attester:All Slices | Content/Rules for all slices | |||
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |
| padi-attestationInformation-extension | I | 1..1 | (Complex) | Attestation Information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-attestationInformation-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. | |
| time | 0..1 | dateTime | When the composition was attested | |
| party | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition | |
| attester:legal_attester | S | 0..1 | BackboneElement | Attests to accuracy of composition |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: legal |
| time | 0..1 | dateTime | When the composition was attested | |
| party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson | US Core Organization Profile) | Who attested the composition |
| attester:notary_attester | S | 0..* | BackboneElement | Attests to accuracy of composition |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: professional |
| time | 0..1 | dateTime | When the composition was attested | |
| party | S | 1..1 | Reference(RelatedPerson) | Who attested the composition |
| attester:witness_attester | S | 0..* | BackboneElement | Attests to accuracy of composition |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| mode | S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: personal |
| time | 0..1 | dateTime | When the composition was attested | |
| party | S | 1..1 | Reference(US Core Patient Profile | RelatedPerson) | Who attested the composition |
| custodian | SΣ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition |
| relatesTo | 0..* | BackboneElement | Relationships to other compositions/documents | |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents. | |
| target[x] | 1..1 | Target of the relationship | ||
| targetIdentifier | Identifier | |||
| targetReference | Reference(Composition) | |||
| event | Σ | 0..* | BackboneElement | The clinical service(s) being documented |
| id | 0..1 | string | Unique id for inter-element referencing | |
| extension | 0..* | Extension | Additional content defined by implementations | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. |
| period | Σ | 0..1 | Period | The period covered by the documentation |
| detail | Σ | 0..* | Reference(Resource) | The event(s) being documented |
| section | I | 0..* | BackboneElement | Composition is broken into sections cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty |
| id | 0..1 | string | Unique id for inter-element referencing | |
| Slices for extension | 0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| padi-clause-extension | S | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-clause-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| title | 0..1 | string | Label for section (e.g. for ToC) | |
| code | 0..1 | CodeableConcept | Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. | |
| author | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section | |
| focus | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition | |
| text | I | 0..1 | Narrative | Text summary of the section, for human interpretation |
| mode | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section. | |
| orderedBy | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry. | |
| entry | I | 0..* | Reference(Resource) | A reference to data that supports this section |
| emptyReason | I | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty. |
| section | I | 0..* | See section (Composition) | Nested Section |
| Documentation for this format | ||||
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet / Code |
| Composition.language | preferred | CommonLanguages Max Binding: AllLanguages |
| Composition.status | required | CompositionStatus |
| Composition.type | extensible | PADIAdvanceDirectiveCategoriesVS |
| Composition.category | example | DocumentClassValueSet |
| Composition.attester.mode | required | CompositionAttestationMode |
| Composition.attester:legal_attester.mode | required | Pattern: legal |
| Composition.attester:notary_attester.mode | required | Pattern: professional |
| Composition.attester:witness_attester.mode | required | Pattern: personal |
| Composition.relatesTo.code | required | DocumentRelationshipType |
| Composition.event.code | example | ActCode |
| Composition.section.code | example | DocumentSectionCodes |
| Composition.section.mode | required | ListMode |
| Composition.section.orderedBy | preferred | ListOrderCodes |
| Composition.section.emptyReason | preferred | ListEmptyReasons |
| Id | Path | Details | Requirements |
| cmp-1 | Composition.section | A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists() | |
| cmp-2 | Composition.section | A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty() |
IG © 2021+ HL7 Patient Empowerment Working Group. Package hl7.fhir.us.pacio-adi#0.1.0 based on FHIR 4.0.1. Generated 2021-12-06
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