A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score.

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 its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

An Extension

DSTU2: ClinicalImpression.trigger[x] (new:CodeableConcept, Reference(Resource))

Element ClinicalImpression.trigger[x] has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.trigger[x] has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.investigations (new:BackboneElement)

Element ClinicalImpression.investigations has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.investigations has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.resolved (new:CodeableConcept)

Element ClinicalImpression.resolved has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.resolved has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.ruledOut (new:BackboneElement)

Element ClinicalImpression.ruledOut has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.ruledOut has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.prognosis (new:string)

Element ClinicalImpression.prognosis has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.prognosis has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.plan (new:Reference(CarePlan,Appointment,CommunicationRequest,DeviceUseRequest,DiagnosticOrder,MedicationOrder,NutritionOrder,Order,ProcedureRequest,ProcessRequest,ReferralRequest,SupplyRequest,VisionPrescription))

Element ClinicalImpression.plan has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.plan has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.action (new:Reference(ReferralRequest,ProcedureRequest,Procedure,MedicationOrder,DiagnosticOrder,NutritionOrder,SupplyRequest,Appointment))

Element ClinicalImpression.action has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.action has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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

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

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.

Identifies the workflow status of the assessment.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid.

The workflow state of a clinical impression.

The patient or group of individuals assessed as part of this record.

Group is typically for veterinary and/or public health purposes.

An Extension

DSTU2: ClinicalImpression.patient additional types from child elements (display, reference)

Element ClinicalImpression.patient is mapped to FHIR R5 element ClinicalImpression.subject as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.patient with unmapped reference targets: Patient.

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.

DSTU2: ClinicalImpression.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element ClinicalImpression.meta is mapped to FHIR R5 element ClinicalImpression.meta as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.meta do not cover the following types: Meta. The mappings for ClinicalImpression.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

DSTU2: ClinicalImpression.text additional types (Narrative) additional types from child elements (div, status)

Element ClinicalImpression.text is mapped to FHIR R5 element ClinicalImpression.text as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.text do not cover the following types: Narrative. The mappings for ClinicalImpression.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

DSTU2: ClinicalImpression.trigger[x] (new:CodeableConcept, Reference(Resource))

Element ClinicalImpression.trigger[x] has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.trigger[x] has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.investigations (new:BackboneElement)

Element ClinicalImpression.investigations has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.investigations has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.resolved (new:CodeableConcept)

Element ClinicalImpression.resolved has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.resolved has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.ruledOut (new:BackboneElement)

Element ClinicalImpression.ruledOut has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.ruledOut has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.prognosis (new:string)

Element ClinicalImpression.prognosis has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.prognosis has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.plan (new:Reference(CarePlan,Appointment,CommunicationRequest,DeviceUseRequest,DiagnosticOrder,MedicationOrder,NutritionOrder,Order,ProcedureRequest,ProcessRequest,ReferralRequest,SupplyRequest,VisionPrescription))

Element ClinicalImpression.plan has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.plan has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.action (new:Reference(ReferralRequest,ProcedureRequest,Procedure,MedicationOrder,DiagnosticOrder,NutritionOrder,SupplyRequest,Appointment))

Element ClinicalImpression.action has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.action has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.patient additional types from child elements (display, reference)

Element ClinicalImpression.patient is mapped to FHIR R5 element ClinicalImpression.subject as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.patient with unmapped reference targets: Patient.

DSTU2: ClinicalImpression.assessor additional types from child elements (display, reference)

Element ClinicalImpression.assessor is mapped to FHIR R5 element ClinicalImpression.performer as RelatedTo. The mappings for ClinicalImpression.assessor do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.assessor with unmapped reference targets: Practitioner.

DSTU2: ClinicalImpression.previous additional types from child elements (display, reference)

Element ClinicalImpression.previous is mapped to FHIR R5 element ClinicalImpression.previous as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.previous do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.previous with unmapped reference targets: ClinicalImpression. It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved).

DSTU2: ClinicalImpression.problem additional types from child elements (display, reference)

Element ClinicalImpression.problem is mapped to FHIR R5 element ClinicalImpression.problem as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.problem do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.problem with unmapped reference targets: AllergyIntolerance, Condition. e.g. The patient is a pregnant, and cardiac congestive failure, ‎Adenocarcinoma, and is allergic to penicillin.

DSTU2: ClinicalImpression.finding.cause (new:string)

Element ClinicalImpression.finding.cause has a context of ClinicalImpression.finding based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.finding.cause has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score.

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

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

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.

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

An Extension

DSTU2: ClinicalImpression.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element ClinicalImpression.meta is mapped to FHIR R5 element ClinicalImpression.meta as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.meta do not cover the following types: Meta. The mappings for ClinicalImpression.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Unless not suitable, these codes SHALL be taken from AllSecurityLabels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|5.0.0)

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

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 its 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).

IETF language tag for 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 a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

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

An Extension

DSTU2: ClinicalImpression.text additional types (Narrative) additional types from child elements (div, status)

Element ClinicalImpression.text is mapped to FHIR R5 element ClinicalImpression.text as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.text do not cover the following types: Narrative. The mappings for ClinicalImpression.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

The status of a resource narrative.

The actual narrative content, a stripped down version of XHTML.

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

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.

An Extension

DSTU2: ClinicalImpression.trigger[x] (new:CodeableConcept, Reference(Resource))

Element ClinicalImpression.trigger[x] has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.trigger[x] has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.investigations (new:BackboneElement)

Element ClinicalImpression.investigations has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.investigations has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.resolved (new:CodeableConcept)

Element ClinicalImpression.resolved has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.resolved has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.ruledOut (new:BackboneElement)

Element ClinicalImpression.ruledOut has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.ruledOut has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.prognosis (new:string)

Element ClinicalImpression.prognosis has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.prognosis has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.plan (new:Reference(CarePlan,Appointment,CommunicationRequest,DeviceUseRequest,DiagnosticOrder,MedicationOrder,NutritionOrder,Order,ProcedureRequest,ProcessRequest,ReferralRequest,SupplyRequest,VisionPrescription))

Element ClinicalImpression.plan has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.plan has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ClinicalImpression.action (new:Reference(ReferralRequest,ProcedureRequest,Procedure,MedicationOrder,DiagnosticOrder,NutritionOrder,SupplyRequest,Appointment))

Element ClinicalImpression.action has a context of ClinicalImpression based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.action has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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

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

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.

Business identifiers assigned to this clinical impression by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Allows identification of the clinical impression as it is known by various participating systems and in a way that remains consistent across servers.

Identifies the workflow status of the assessment.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid.

The workflow state of a clinical impression.

Captures the reason for the current state of the ClinicalImpression.

This is generally only used for "exception" statuses such as "not-done", "on-hold" or "stopped".

Codes identifying the reason for the current state of a clinical impression.

A summary of the context and/or cause of the assessment - why / where it was performed, and what patient events/status prompted it.

The patient or group of individuals assessed as part of this record.

Group is typically for veterinary and/or public health purposes.

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

An Extension

DSTU2: ClinicalImpression.patient additional types from child elements (display, reference)

Element ClinicalImpression.patient is mapped to FHIR R5 element ClinicalImpression.subject as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.patient with unmapped reference targets: Patient.

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The Encounter during which this ClinicalImpression was created or to which the creation of this record is tightly associated.

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

The point in time or period over which the subject was assessed.

This SHOULD be accurate to at least the minute, though some assessments only have a known date.

Indicates when the documentation of the assessment was complete.

The clinician performing the assessment.

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

An Extension

DSTU2: ClinicalImpression.assessor additional types from child elements (display, reference)

Element ClinicalImpression.assessor is mapped to FHIR R5 element ClinicalImpression.performer as RelatedTo. The mappings for ClinicalImpression.assessor do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.assessor with unmapped reference targets: Practitioner.

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

A reference to the last assessment that was conducted on this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changes.

It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved).

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

An Extension

DSTU2: ClinicalImpression.previous additional types from child elements (display, reference)

Element ClinicalImpression.previous is mapped to FHIR R5 element ClinicalImpression.previous as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.previous do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.previous with unmapped reference targets: ClinicalImpression. It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved).

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

A list of the relevant problems/conditions for a patient.

e.g. The patient is a pregnant, has congestive heart failure, has an ‎Adenocarcinoma, and is allergic to penicillin.

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

An Extension

DSTU2: ClinicalImpression.problem additional types from child elements (display, reference)

Element ClinicalImpression.problem is mapped to FHIR R5 element ClinicalImpression.problem as SourceIsBroaderThanTarget. The mappings for ClinicalImpression.problem do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ClinicalImpression.problem with unmapped reference targets: AllergyIntolerance, Condition. e.g. The patient is a pregnant, and cardiac congestive failure, ‎Adenocarcinoma, and is allergic to penicillin.

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 known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

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).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Change in the status/pattern of a subject's condition since previously assessed, such as worsening, improving, or no change. It is a subjective assessment of the direction of the change.

Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosis.

A text summary of the investigations and the diagnosis.

Specific findings or diagnoses that were considered likely or relevant to ongoing treatment.

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

An Extension

DSTU2: ClinicalImpression.finding.cause (new:string)

Element ClinicalImpression.finding.cause has a context of ClinicalImpression.finding based on following the parent source element upwards and mapping to ClinicalImpression. Element ClinicalImpression.finding.cause has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

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

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

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.

Specific text, code or reference for finding or diagnosis, which may include ruled-out or resolved conditions.

Identification of the Condition or diagnosis.

Which investigations support finding or diagnosis.

Estimate of likely outcome.

Prognosis or outlook findings.

RiskAssessment expressing likely outcome.

Information supporting the clinical impression, which can contain investigation results.

Commentary about the impression, typically recorded after the impression itself was made, though supplemental notes by the original author could also appear.

Don't use this element for content that should more properly appear as one of the specific elements of the impression.