Generated Narrative: StructureDefinition profile-Condition Name Flags Card. Type Description & Constraints Condition 0..* Condition Detailed information about conditions, problems or diagnoses #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:recorder 0..1 Reference(Cross-version Profile for R4.Practitioner for use in FHIR STU3(0.1.0) | Practitioner | Cross-version Profile for R4.PractitionerRole for use in FHIR STU3(0.1.0) | PractitionerRole | Cross-version Profile for R4.Patient for use in FHIR STU3(0.1.0) | Patient | Cross-version Profile for R4.RelatedPerson for use in FHIR STU3(0.1.0) | RelatedPerson) R4: Who recorded the condition (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Condition.recorder #xD; clinicalStatus #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:clinicalStatus 0..1 CodeableConcept R4: active | recurrence | relapse | inactive | remission | resolved additional types URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Condition.clinicalStatus Binding: R4ConditionClinicalForR3 (0.1.0) (required): The clinical status of the condition or diagnosis. #xD; verificationStatus #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:verificationStatus 0..1 CodeableConcept R4: unconfirmed | provisional | differential | confirmed | refuted | entered-in-error additional types URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Condition.verificationStatus Binding: R4ConditionVerStatusForR3 (0.1.0) (required): The verification status to support or decline the clinical status of the condition or diagnosis. #xD; asserter #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:asserter 0..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/alternate-reference]] R4: asserter URL: http://hl7.org/fhir/StructureDefinition/alternate-reference #xD; stage #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url #xD; extension:type 0..1 CodeableConcept R4: Kind of staging (new) URL: http://hl7.org/fhir/4.0/StructureDefinition/extension-Condition.stage.type #xD; Documentation for this format
Cross-version Profile for R4.Condition for use in FHIR STU3
This cross-version profile allows R4 Condition content to be represented via FHIR STU3 Condition resources.
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.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL NOT contain any narrative
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty()
not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))
If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
abatement.empty() or (abatement as boolean).not() or clinicalStatus='resolved' or clinicalStatus='remission' or clinicalStatus='inactive'
not(exists(*[starts-with(local-name(.), 'abatement')])) or f:clinicalStatus/@value=('resolved', 'remission', 'inactive')
Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error
verificationStatus='entered-in-error' or clinicalStatus.exists()
f:verificationStatus/@value='entered-in-error' or exists(f:clinicalStatus)
< 243796009 |Situation with explicit context|: 246090004 |Associated finding| = ((< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 272379006 |Event|)
Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
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 may not always be associated with version changes to the resource.
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.
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. This element is labelled 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).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. 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 in formation is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
R4: `Condition.recorder` (new:Reference(Practitioner,PractitionerRole,Patient,RelatedPerson))
Element `Condition.recorder` has a context of Condition based on following the parent source element upwards and mapping to `Condition`. Element `Condition.recorder` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).
All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
This records identifiers associated with this condition that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).
Need to allow connection to a wider workflow.
active | recurrence | inactive | remission | resolved
This element is labeled as a modifier because the status contains codes that mark the condition as not currently valid or of concern.
The clinical status of the condition or diagnosis.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
unique id for the element within a resource (for internal references)
R4: active | recurrence | relapse | inactive | remission | resolved additional types
R4: `Condition.clinicalStatus` additional types (CodeableConcept) additional types from child elements (coding)
Element `Condition.clinicalStatus` is mapped to FHIR STU3 element `Condition.clinicalStatus` as `SourceIsBroaderThanTarget`. The mappings for `Condition.clinicalStatus` do not cover the following types: CodeableConcept. The mappings for `Condition.clinicalStatus` do not cover the following types based on type expansion: coding. The target context `Condition.clinicalStatus` is a modifier element, so this extension does not need to be defined as a modifier. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
provisional | differential | confirmed | refuted | entered-in-error | unknown
The verification status to support the clinical status of the condition.
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
The verification status to support or decline the clinical status of the condition or diagnosis.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
R4: unconfirmed | provisional | differential | confirmed | refuted | entered-in-error additional types
R4: `Condition.verificationStatus` additional types (CodeableConcept) additional types from child elements (coding)
Element `Condition.verificationStatus` is mapped to FHIR STU3 element `Condition.verificationStatus` as `SourceIsBroaderThanTarget`. The mappings for `Condition.verificationStatus` do not cover the following types: CodeableConcept. The mappings for `Condition.verificationStatus` do not cover the following types based on type expansion: coding. The target context `Condition.verificationStatus` is a modifier element, so this extension does not need to be defined as a modifier. verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.
'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
A subjective assessment of the severity of the condition as evaluated by the clinician.
Coding of the severity with a terminology is preferred, where possible.
Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
Identification of the condition, problem or diagnosis
Identification of the condition, problem or diagnosis.
0..1 to account for primarily narrative only resources.
Identification of the condition or diagnosis.
code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
The anatomical location where this condition manifests itself.
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [body-site-instance](http://hl7.org/fhir/STU3/extension-body-site-instance.html). May be a summary code, or a reference to a very precise definition of the location, or both.
Codes describing anatomical locations. May include laterality.
< 442083009 |Anatomical or acquired body structure|
Indicates the patient or group who the condition record is associated with.
Group is typically used for veterinary or public health use cases.
Encounter or episode when condition first asserted
Encounter during which the condition was first asserted.
This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Estimated or actual date, date-time, or age
Estimated or actual date or date-time the condition began, in the opinion of the clinician.
Age is generally used when the patient reports an age at which the Condition began to occur.
.effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
.effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
The date on which the existance of the Condition was first asserted or acknowledged.
The assertedDate represents the date when this particular Condition record was created in the EHR, not the date of the most recent update in terms of when severity, abatement, etc. were specified. The date of the last record modification can be retrieved from the resource metadata.
Individual who is making the condition statement.
unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Element `Condition.asserter` is mapped to FHIR STU3 element `Condition.asserter` as `SourceIsBroaderThanTarget`. The standard extension `alternate-reference` has been mapped as the representation of FHIR R4 element `Condition.asserter` with unmapped reference targets: PractitionerRole.
Literal reference, Relative, internal or absolute URL
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.
Logical reference, when literal reference is not known
An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity 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.
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.
Clinical stage or grade of a condition. May include formal severity assessments.
exists(f:summary) or exists(f:assessment)
./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
R4: `Condition.stage.type` (new:CodeableConcept)
Element `Condition.stage.type` has a context of Condition.stage based on following the parent source element upwards and mapping to `Condition`. Element `Condition.stage.type` has no mapping targets in FHIR STU3. 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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
Codes describing condition stages (e.g. Cancer stages).
Reference to a formal record of the evidence on which the staging assessment is based.
Supporting Evidence / manifestations that are the basis on which this condition is suspected or confirmed.
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
.outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
Additional Content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
A manifestation or symptom that led to the recording of this condition.
Codes that describe the manifestation or symptoms of a condition.
Links to other relevant information, including pathology reports.
Additional information about the Condition
Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value