Generated Narrative: StructureDefinition TOC-Bundle Name Flags Card. Type Description & Constraints Bundle 0..* Bundle Contains a collection of resources #xD; identifier S 1..1 Identifier Persistent identifier for the bundle #xD; type 1..1 code document | message | transaction | transaction-response | batch | batch-response | history | searchset | collection Required Pattern: document #xD; Slices for entry 2..* BackboneElement Entry in the bundle - will have a resource or information Slice: Unordered, Open by profile:resource #xD; entry:toc-composition S 1..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 TOCComposition A set of resources composed into a single coherent clinical statement with clinical attestation #xD; entry:patient S 1..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCorePatientProfile(8.0.1) Information about an individual or animal receiving health care services #xD; entry:advance-directives S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 ADIDocumentReference A reference to a document #xD; entry:allergies S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreAllergyIntolerance(8.0.1) Allergy or Intolerance (generally: Risk of adverse reaction to a substance) #xD; entry:encounter-diagnosis S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreConditionEncounterDiagnosisProfile(8.0.1) Detailed information about conditions, problems or diagnoses #xD; entry:problems S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreConditionProblemsHealthConcernsProfile(8.0.1) Detailed information about conditions, problems or diagnoses #xD; entry:simple-observation S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreSimpleObservationProfile(8.0.1) assessment observation #xD; entry:immunizations S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreImmunizationProfile(8.0.1) Immunization event information #xD; entry:medical-devices S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 PFEUseOfDevice Record of use of a device #xD; entry:medications S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 A list is a curated collection of resources #xD; resource List(SMPMedicationList) #xD; resource MedicationRequest(USCoreMedicationRequestProfile) #xD; <span title="A record of a medication that is being consumed by a patient. A MedicationStatement may indicate that the patient may be taking the medication now or has taken the medication in the past or will be taking the medication in the future. The source of this information can be the patient, significant other (such as a family member or spouse), or a clinician. A common scenario where this information is captured is during the history taking process during a patient visit or stay. The medication information may come from sources such as the patient's memory, from a prescription bottle, or from a list of medications the patient, clinician or other party maintains. #xA;#xA;The primary difference between a medication statement and a medication administration is that the medication administration has complete administration information and is based on actual administration information from the person who administered the medication. A medication statement is often, if not always, less specific. There is no required date/time when the medication was administered, in fact we only know that a source has reported the patient is taking this medication, where details such as time, quantity, or rate or even medication product may be incomplete or missing or less precise. As stated earlier, the medication statement information may come from the patient's memory, from a prescription bottle or from a list of medications the patient, clinician or other party maintains. Medication administration is more formal and is not missing detailed information.">resource MedicationStatement #xD; resource Medication(USCoreMedicationProfile) #xD; entry:plan-of-care S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreCarePlanProfile(8.0.1) Healthcare plan for patient or group #xD; entry:procedures S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 An action that is being or was performed on a patient #xD; resource Procedure(USCoreProcedureProfile) #xD; resource ServiceRequest(USCoreServiceRequestProfile) #xD; entry:encounter S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreEncounterProfile(8.0.1) An interaction during which services are provided to the patient #xD; entry:vital-signs S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreVitalSignsProfile(8.0.1) US Core Vital Signs Profile #xD; entry:practitioner S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCorePractitionerProfile(8.0.1) A person with a formal responsibility in the provisioning of healthcare or related services #xD; entry:practitioner-role S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCorePractitionerRoleProfile(8.0.1) Roles/organizations the practitioner is associated with #xD; entry:organization S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreOrganizationProfile(8.0.1) A grouping of people or organizations with a common purpose #xD; entry:location S 0..* BackboneElement Entry in the bundle - will have a resource or information #xD; resource 0..1 USCoreLocationProfile(8.0.1) Details and position information for a physical place #xD; Documentation for this format
This is a profile for a Transition of Care Bundle, which includes the necessary resources for documenting a patient's transition from one care setting to another.
A container for a collection of resources.
total.empty() or (type = 'searchset') or (type = 'history')
not(f:total) or (f:type/@value = 'searchset') or (f:type/@value = 'history')
entry.search.empty() or (type = 'searchset')
not(f:entry/f:search) or (f:type/@value = 'searchset')
entry.request mandatory for batch/transaction/history, otherwise prohibited
entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
not(f:entry/f:request) or (f:type/@value = 'batch') or (f:type/@value = 'transaction') or (f:type/@value = 'history')
entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
not(f:entry/f:response) or (f:type/@value = 'batch-response') or (f:type/@value = 'transaction-response') or (f:type/@value = 'history')
FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
(type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
(f:type/@value = 'history') or (count(for $entry in f:entry[f:resource] return $entry[count(parent::f:Bundle/f:entry[f:fullUrl/@value=$entry/f:fullUrl/@value and ((not(f:resource/*/f:meta/f:versionId/@value) and not($entry/f:resource/*/f:meta/f:versionId/@value)) or f:resource/*/f:meta/f:versionId/@value=$entry/f:resource/*/f:meta/f:versionId/@value)])!=1])=0)
A document must have an identifier with a system and a value
type = 'document' implies (identifier.system.exists() and identifier.value.exists())
not(f:type/@value = 'document') or exists(f:identifier/f:system) or exists(f:identifier/f:value)
type = 'document' implies (timestamp.hasValue())
not(f:type/@value = 'document') or exists(f:timestamp/@value)
A document must have a Composition as the first resource
type = 'document' implies entry.first().resource.is(Composition)
not(f:type/@value='document') or f:entry[1]/f:resource/f:Composition
A message must have a MessageHeader as the first resource
type = 'message' implies entry.first().resource.is(MessageHeader)
not(f:type/@value='message') or f:entry[1]/f:resource/f:MessageHeader
ClinicalDocument, if bundle.type = document
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
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 persistent identifier for the bundle that won't change as a bundle is copied from server to server.
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
document | message | transaction | transaction-response | batch | batch-response | history | searchset | collection
Indicates the purpose of this bundle - how it is intended to be used.
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
Indicates the purpose of a bundle - how it is intended to be used.
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated. Usage: * document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time * message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message * history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates * searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query * transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
A series of links that provide context to this bundle.
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. [HATEOAS](http://en.wikipedia.org/wiki/HATEOAS)). Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was [read](http://hl7.org/fhir/R4/http.html#read) directly. This specification defines some specific uses of Bundle.link for [searching](http://hl7.org/fhir/R4/search.html#conformance) and [paging](http://hl7.org/fhir/R4/http.html#paging), but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Additional content defined by implementations
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 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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Extensions that cannot be ignored even if unrecognized
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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
See http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1
A name which details the functional use for this link - see [http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1](http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1).
Slice based on the entry.resource profile
Entry in the bundle - will have a resource or information
An entry in a bundle resource - will either contain a resource or information about a resource (transactions and history only).
For bundles of type 'document' and 'message', the first resource is special (must be Composition or MessageHeader respectively). For all bundles, the meaning of the order of entries depends on the bundle type
must be a resource unless there's a request or response
resource.exists() or request.exists() or response.exists()
exists(f:resource) or exists(f:request) or exists(f:response)
fullUrl cannot be a version specific reference
not(exists(f:fullUrl[contains(string(@value), '/_history/')]))
A series of links that provide context to this entry.
URI for resource (Absolute URL server address or URI for UUID/OID)
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that: * fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle) * Results from operations might involve resources that are not identified.
fullUrl might not be [unique in the context of a resource](http://hl7.org/fhir/R4/bundle.html#bundle-unique). Note that since [FHIR resources do not need to be served through the FHIR API](http://hl7.org/fhir/R4/references.html), the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the [regex](http://hl7.org/fhir/R4/references.html#regex), then the 'id' portion of the fullUrl SHALL end with the Resource.id. Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
The Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Information about the search process that lead to the creation of this entry.
match | include | outcome - why this is in the result set
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
When searching, the server's search ranking score for the entry.
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order. See [Patient Match](http://hl7.org/fhir/R4/patient-operation-match.html) for the EMPI search which relates to this element.
Additional execution information (transaction/batch/history)
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
GET | HEAD | POST | PUT | DELETE | PATCH
In a transaction or batch, this is the HTTP action to be executed for this entry. In a history bundle, this indicates the HTTP action that occurred.
HTTP verbs (in the HTTP command line). See [HTTP rfc](https://tools.ietf.org/html/rfc7231) for details.
The URL for this entry, relative to the root (the address to which the request is posted).
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
If the ETag values match, return a 304 Not Modified status. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4/http.html#cread).
Only perform the operation if the last updated date matches. See the API documentation for ["Conditional Read"](http://hl7.org/fhir/R4/http.html#cread).
Only perform the operation if the Etag value matches. For more information, see the API section ["Managing Resource Contention"](http://hl7.org/fhir/R4/http.html#concurrency).
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for ["Conditional Create"](http://hl7.org/fhir/R4/http.html#ccreate). This is just the query portion of the URL - what follows the "?" (not including the "?").
Results of execution (transaction/batch/history)
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
The location (if the operation returns a location)
The location header created by processing this operation, populated if the operation returns a location.
The Etag for the resource, if the operation for the entry produced a versioned resource (see [Resource Metadata and Versioning](http://hl7.org/fhir/R4/http.html#versioning) and [Managing Resource Contention](http://hl7.org/fhir/R4/http.html#concurrency)).
Etags match the Resource.meta.versionId. The ETag has to match the version id in the header if a resource is included.
The date/time that the resource was modified on the server.
This has to match the same time in the meta header (meta.lastUpdated) if a resource is included.
OperationOutcome with hints and warnings (for batch/transaction)
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned. This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
A set of resources composed into a single coherent clinical statement with clinical attestation
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.
Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
Information about an individual or animal receiving health care services
Demographics and other administrative information about an individual or animal receiving care or other health-related services.
This is a basic constraint on DocumentRefernce for use in the US Core IG.
Usually, this is used for documents other than those defined by FHIR.
Document[classCode="DOC" and moodCode="EVN"]
Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.
Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.
Observation[classCode=OBS, moodCode=EVN]
Detailed information about conditions, problems or diagnoses
A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.
< 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
Measurements and simple assertions made about a patient, device or other subject.
Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.
Describes the event of a patient being administered a vaccine or a record of an immunization as reported by a patient, a clinician or another party.
A record of a device being used by a patient where the record is the result of a report from the patient or another clinician.
A list is a curated collection of resources
Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
An action that is being or was performed on a patient
An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
An interaction during which services are provided to the patient
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
The FHIR Vitals Signs profile sets minimum expectations for the Observation Resource to record, search and fetch the vital signs associated with a patient.
A person with a formal responsibility in the provisioning of healthcare or related services
A person who is directly or indirectly involved in the provisioning of healthcare.
Roles/organizations the practitioner is associated with
A specific set of Roles/Locations/specialties/services that a practitioner may perform at an organization for a period of time.
A grouping of people or organizations with a common purpose
A formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc.
Organization(classCode=ORG, determinerCode=INST)
Details and position information for a physical place
Details and position information for a physical place where services are provided and resources and participants may be stored, found, contained, or accommodated.
Digital Signature - base64 encoded. XML-DSig or a JWT.
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.