v3-ActRelationshipType
type: CodeSystem
node role: treeRoot
id:
  v: v3-ActRelationshipType
text:
  status:
    v: generated
  div: Generated Narrative: CodeSystem v3-ActRelationshipType Properties This code system defines the following properties for its concepts Name Code URI Type Description Not Selectable notSelectable http://hl7.org/fhir/concept-properties#notSelectable boolean Indicates that the code is abstract - only intended to be used as a selector for other concepts Child child http://hl7.org/fhir/concept-properties#child code The concept identified in this property is a child of the concept on which it is a property. The property type will be 'code'. The meaning of parent/child relationships is defined by the hierarchyMeaning attribute status status http://hl7.org/fhir/concept-properties#status code A property that indicates the status of the concept. One of active, experimental, deprecated, retired Concepts This case-sensitive code system http://terminology.hl7.org/CodeSystem/v3-ActRelationshipType defines the following codes in a Is-A hierarchy: Lvl Code Display Definition Not Selectable Child status 1 ART act relationship type Description: A directed association between a source Act and a target Act. Usage Note: This code should never be transmitted in an instance as the value of ActRelationship.typeCode (attribute) 2 _ActClassTemporallyPertains ActClassTemporallyPertains ActClassTemporallyPertains true 2 _ActRelationshipAccounting ActRelationshipAccounting Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element. true 3 _ActRelationshipCostTracking ActRelationshipCostTracking Expresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act. true 4 CHRG has charge A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for …
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
  value: code
    v: external
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
  value: integer
    v: 0
extension:
  extension:
    url:
      v: packageId
    value: id
      v: hl7.fhir.uv.xver-r4.r4b
  extension:
    url:
      v: version
    value: string
      v: 0.0.1-snapshot-2
  url:
    v: http://hl7.org/fhir/StructureDefinition/package-source
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
  value: code
    v: fhir
url:
  v: http://terminology.hl7.org/CodeSystem/v3-ActRelationshipType
version:
  v: 2018-08-12
name:
  v: v3.ActRelationshipType
title:
  v: v3 Code System ActRelationshipType
status:
  v: active
experimental:
  v: false
date:
  v: 2018-08-12T00:00:00+10:00
publisher:
  v: FHIR Infrastructure
contact:
  name:
    v: FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: The source is an excerpt from the target.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
    code:
      v: 001
    display:
      v: World
case sensitive:
  v: true
value set:
  v: http://terminology.hl7.org/ValueSet/v3-ActRelationshipType|3.0.0
  link: 3.0
  link: .0
hierarchy meaning:
  v: is-a
content:
  v: complete
property:
  code:
    v: notSelectable
  uri:
    v: http://hl7.org/fhir/concept-properties#notSelectable
  description:
    v: Indicates that the code is abstract - only intended to be used as a selector for other concepts
  type:
    v: boolean
property:
  code:
    v: child
  uri:
    v: http://hl7.org/fhir/concept-properties#child
  description:
    v: The concept identified in this property is a child of the concept on which it is a property. The property type will be 'code'. The meaning of parent/child relationships is defined by the hierarchyMeaning attribute
  type:
    v: code
property:
  code:
    v: status
  uri:
    v: http://hl7.org/fhir/concept-properties#status
  description:
    v: A property that indicates the status of the concept. One of active, experimental, deprecated, retired
  type:
    v: code
concept:
  code:
    v: ART
  display:
    v: act relationship type
  definition:
    v: Description: A directed association between a source Act and a target Act. Usage Note: This code should never be transmitted in an instance as the value of ActRelationship.typeCode (attribute)
  concept:
    code:
      v: _ActClassTemporallyPertains
    display:
      v: ActClassTemporallyPertains
    definition:
      v: ActClassTemporallyPertains
    property:
      code:
        v: notSelectable
      value: boolean
        v: true
  concept:
    code:
      v: _ActRelationshipAccounting
    display:
      v: ActRelationshipAccounting
    definition:
      v: Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element.
    property:
      code:
        v: notSelectable
      value: boolean
        v: true
    concept:
      code:
        v: _ActRelationshipCostTracking
      display:
        v: ActRelationshipCostTracking
      definition:
        v: Expresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act.
      property:
        value: boolean
    concept:
      code:
        v: _ActRelationshipPosting
      display:
        v: ActRelationshipPosting
      definition:
        v: Expresses values for describing the relationship between a FinancialTransaction and an Account.
      property:
        value: boolean
  concept:
    code:
      v: _ActRelationshipConditional
    display:
      v: ActRelationshipConditional
    definition:
      v: Specifies under what circumstances (target Act) the source-Act may, must, must not or has occurred
    property:
      code:
        v: notSelectable
      value: boolean
        v: true
    concept:
      code:
        v: CIND
      display:
        v: has contra-indication
      definition:
        v: A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service; target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priorityNumber attribute could be used.
    concept:
      code:
        v: PRCN
      display:
        v: has pre-condition
      definition:
        v: A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable.
    concept:
      code:
        v: RSON
      display:
        v: has reason
      definition:
        v: Description: The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action. As well as providing various types of information about the rationale for a service, the RSON act relationship is routinely used between a SBADM act and an OBS act to describe the indication for use of a medication. Child concepts may be used to describe types of indication. Discussion: In prior releases, the code "SUGG" (suggests) was expressed as "an inversion of the reason link." That code has been retired in favor of the inversion indicator that is an attribute of ActRelationship.
    concept:
      code:
        v: TRIG
      display:
        v: has trigger
      definition:
        v: A pre-condition that if true should result in the source Act being executed. The target is in typically in criterion mood. When reported after the fact (i.e. the criterion has been met) it may be in Event mood. A delay between the trigger and the triggered action can be specified. Discussion: This includes the concept of a required act for a service or financial instrument such as an insurance plan or policy. In such cases, the trigger is the occurrence of a specific condition such as coverage limits being exceeded.
  concept:
    code:
      v: _ActRelationshipTemporallyPertains
    display:
      v: ActRelationshipTemporallyPertains
    definition:
      v: Abstract collector for ActRelationhsip types that relate two acts by their timing.

v: notSelectable

boolean
v: true

v: CHRG

v: has charge

v: A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.

v: COST

v: has cost

v: A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service. The financial transaction will define the cost of delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.

v: notSelectable

boolean
v: true

v: CREDIT

v: has credit

v: A credit relationship ties a financial transaction (target) to an account (source). A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance.

v: DEBIT

v: has debit

v: A debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance.

v: BLOCK

v: blocks

v: Definition: The source act is performed to block the effects of the target act. This act relationship should be used when describing near miss type incidents where potential harm could have occurred, but the action described in the source act blocked the potential harmful effects of the incident actually occurring.

v: DIAG

v: diagnoses

v: Description: The source act is intended to help establish the presence of a (an adverse) situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.

v: IMM

v: immunization against

v: Description: The source act is intented to provide immunity against the effects of the target act (the target act describes an infectious disease)

code:
  v: ACTIMM
display:
  v: active immunization against
definition:
  v: Description: The source act is intended to provide active immunity against the effects of the target act (the target act describes an infectious disease)

code:
  v: PASSIMM
display:
  v: passive immunization against
definition:
  v: Description: The source act is intended to provide passive immunity against the effects of the target act (the target act describes an infectious disease).

v: MITGT

v: mitigates

v: The source act removes or lessens the occurrence or effect of the target act.

code:
  v: RCVY
display:
  v: recovers
definition:
  v: Definition: The source act is performed to recover from the effects of the target act.

v: PRYLX

v: prophylaxis of

v: Description: The source act is intended to reduce the risk of of an adverse situation to emerge as described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.

v: TREAT

v: treats

v: Description: The source act is intended to improve a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.

code:
  v: ADJUNCT
display:
  v: adjunctive treatment
definition:
  v: Description: The source act is intended to offer an additional treatment for the management or cure of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. It is not a requirement that the non-adjunctive treatment is explicitly specified.

code:
  v: MTREAT
display:
  v: maintenance treatment
definition:
  v: Description: The source act is intended to provide long term maintenance improvement or management of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.

code:
  v: PALLTREAT
display:
  v: palliates
definition:
  v: Description: The source act is intended to provide palliation for the effects of the target act.

code:
  v: SYMP
display:
  v: symptomatic relief
definition:
  v: Description: The source act is intented to provide symptomatic relief for the effects of the target act.

code:
  v: notSelectable
value: boolean
  v: true

code:
  v: _ActRelationshipTemporallyPertainsApproximates
display:
  v: ActRelationshipTemporallyPertainsApproximates
definition:
  v: Abstract collector for ActRelationship types that relate two acts by their approximate timing.
property:
  code:
    v: notSelectable
  value: boolean
    v: true
concept:
  code:
    v: ENE
  display:
    v: ends near end
  definition:
    v: A relationship in which the source act's effective time ends near the end of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is ENS
  concept:
    code:
      v: ECW
    display:
      v: ends concurrent with
    definition:
      v: A relationship in which the source act's effective time ends with the end of the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself.
    concept:
      code:
        v: CONCURRENT
      display:
        v: concurrent with
      definition:
        v: A relationship in which the source act's effective time is the same as the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself.
    concept:
      code:
        v: SBSECWE
      display:
        v: starts before start of, ends with
      definition:
        v: The source Act starts before the start of the target Act, and ends with the target Act. UsageNote: Inverse code is SASECWE
concept:
  code:
    v: ENS
  display:
    v: ends near start
  definition:
    v: A relationship in which the source act's effective time ends near the start of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is ENE
  concept:
    code:
      v: ECWS
    display:
      v: ends concurrent with start of
    definition:
      v: The source Act ends when the target act starts (i.e. if we say "ActOne ECWS ActTwo", it means that ActOne ends when ActTwo starts, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SCWE
concept:
  code:
    v: SNE
  display:
    v: starts near end
  definition:
    v: A relationship in which the source act's effective time starts near the end of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is SNS
  concept:
    code:
      v: SCWE
    display:
      v: starts concurrent with end of
    definition:
      v: The source Act starts when the target act ends (i.e. if we say "ActOne SCWE ActTwo", it means that ActOne starts when ActTwo ends, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SBSECWS
concept:
  code:
    v: SNS
  display:
    v: starts near start
  definition:
    v: A relationship in which the source act's effective time starts near the start of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is SNE
  concept:
    code:
      v: SCW
    display:
      v: starts concurrent with
    definition:
      v: A relationship in which the source act's effective time starts with the start of the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself.
    property:
      code:
        v: child
      value: code
        v: CONCURRENT
    concept:
      code:
        v: SCWSEBE
      display:
        v: starts with. ends before end of
      definition:
        v: The source Act starts with.the target Act and ends before the end of the target Act. UsageNote: Inverse code is SCWSEAE
    concept:
      code:
        v: SCWSEAE
      display:
        v: starts with, ends after end of
      definition:
        v: The source Act starts with the target Act, and ends after the end of the target Act.

code:
  v: EAS
display:
  v: ends after start of
definition:
  v: A relationship in which the source act ends after the target act starts. UsageNote: Inverse code is SBE
concept:
  code:
    v: EAE
  display:
    v: ends after end of
  definition:
    v: A relationship in which the source act ends after the target act ends. UsageNote: Inverse code is EBE
  concept:
    code:
      v: SASEAE
    display:
      v: starts after start of, ends after end of
    definition:
      v: The source Act starts after start of the target Act and ends after end of the target Act. UsageNote: Inverse code is SBSEBE
    property:
      code:
        v: child
      value: code
        v: SASSBEEAS
    concept:
      code:
        v: SBEEAE
      display:
        v: contains end of
      definition:
        v: The source Act contains the end of the target Act. UsageNote: Inverse code is EDU
      property:
        value: code
concept:
  code:
    v: SAS
  display:
    v: starts after start of
  definition:
    v: The source Act starts after the start of the target Act (i.e. if we say "ActOne SAS ActTwo", it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SBS
  property:
    code:
      v: child
    value: code
      v: SASEAE
  concept:
    code:
      v: SAE
    display:
      v: starts after end of
    definition:
      v: A relationship in which the source act starts after the target act ends. UsageNote: Inverse code is EBS
  concept:
    code:
      v: DURING
    display:
      v: occurs during
    definition:
      v: A relationship in which the source act's effective time is wholly within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBSEAE
  concept:
    code:
      v: SASECWE
    display:
      v: starts after start of, ends with
    definition:
      v: The source Act starts after start of the target Act, and ends with the target Act. UsageNote: Inverse code is SBSECWE

v: child

code
v: SCWSEAE

v: SASSBEEAS

v: start after start of, contains end of

v: The source Act start after the start of the target Act, and contains the end of the target Act. UsageNote: Inverse code is SBSEASEBE

v: SBSEAE

v: contains time of

v: The source Act contains the time of the target Act. UsageNote: Inverse code is DURING

code:
  v: EASORECWS
display:
  v: ends after or concurrent with start of
definition:
  v: A relationship in which the source act's effective time ends after or concurrent with the start of the target act's effective time. Usage Note: Inverse code is EBSORECWS
property:
  code:
    v: child
  value: code
    v: EAS
property:
  code:
    v: child
  value: code
    v: ECWS
concept:
  code:
    v: EAEORECW
  display:
    v: ends after or concurrent with end of
  definition:
    v: A relationship in which the source act's effective time ends after or concurrent with the end of the target act's effective time. Usage Note: Inverse code is EBEORECW
  property:
    code:
      v: child
    value: code
      v: EAE
  property:
    code:
      v: child
    value: code
      v: ECW

code:
  v: INDEPENDENT
display:
  v: independent of time of
definition:
  v: The source Act is independent of the time of the target Act. UsageNote: This code is reflexive. Therefore its inverse code is itself.

code:
  v: SAEORSCWE
display:
  v: starts after or concurrent with end of
definition:
  v: A relationship in which the source act's effective time starts after or concurrent with the end of the target act's effective time. Usage Note: Inverse code is SBEORSCWE
property:
  code:
    v: child
  value: code
    v: SCWE
property:
  code:
    v: child
  value: code
    v: SAE

code:
  v: SASORSCW
display:
  v: starts after or concurrent with start of
definition:
  v: A relationship in which the source act's effective time starts after or concurrent with the start of the target act's effective time. Usage Note: Inverse code is SBSORSCW
property:
  code:
    v: child
  value: code
    v: SAS
property:
  code:
    v: child
  value: code
    v: SCW

code:
  v: SBEORSCWE
display:
  v: starts before or concurrent with end of
definition:
  v: A relationship in which the source act's effective time starts before or concurrent with the end of the target act's effective time. Usage Note: Inverse code is SAEORSCWE
concept:
  code:
    v: OVERLAP
  display:
    v: overlaps with
  definition:
    v: A relationship in which the source act's effective time overlaps the target act's effective time in any way. UsageNote: This code is reflexive. Therefore its inverse code is itself.
  property:
    code:
      v: child
    value: code
      v: ECW
  property:
    code:
      v: child
    value: code
      v: SBEEAE
  property:
    code:
      v: child
    value: code
      v: SCW
  property:
    code:
      v: child
    value: code
      v: SCWE
  concept:
    code:
      v: EDU
    display:
      v: ends during
    definition:
      v: A relationship in which the source act ends within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBEEAE
    property:
      code:
        v: child
      value: code
        v: SCWSEBE
    concept:
      code:
        v: SBSEASEBE
      display:
        v: contains start of, ends before end of
      definition:
        v: The source Act contains the start of the target Act, and ends before the end of the target Act. UsageNote: Inverse code is SASSBEEAS
  concept:
    code:
      v: SBSEAS
    display:
      v: contains start of
    definition:
      v: The source Act contains the start of the target Act. UsageNote: Inverse code is SDU
    property:
      code:
        v: child
      value: code
        v: SBSECWE
    property:
      code:
        v: child
      value: code
        v: SBSEASEBE
    property:
      code:
        v: child
      value: code
        v: SBSEAE
  concept:
    code:
      v: SDU
    display:
      v: starts during
    definition:
      v: A relationship in which the source act starts within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBSEAS
    property:
      code:
        v: child
      value: code
        v: SASSBEEAS
concept:
  code:
    v: SBE
  display:
    v: starts before end of
  definition:
    v: The source Act starts before the end of the target Act (i.e. if we say "ActOne SBE ActTwo", it means that ActOne starts before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is EAS
  property:
    code:
      v: child
    value: code
      v: SBSEASEBE
  property:
    code:
      v: child
    value: code
      v: SCWSEBE
  concept:
    code:
      v: EBE
    display:
      v: ends before end of
    definition:
      v: The source Act ends before the end of the target Act (i.e. if we say "ActOne EBE ActTwo", it means that ActOne ends before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is EAE
    concept:
      code:
        v: SBSEBE
      display:
        v: starts before start of, ends before end of
      definition:
        v: The source Act starts before the start of the target Act, and ends before the end of the target Act. UsageNote: Inverse code is SASEAE
      property:
        value: code
  concept:
    code:
      v: EBEORECW
    display:
      v: ends before or concurrent with end of
    definition:
      v: A relationship in which the source act's effective time ends before or concurrent with the end of the target act's effective time. Usage Note: Inverse code is EAEORECW
    property:
      code:
        v: child
      value: code
        v: ECW
    property:
      code:
        v: child
      value: code
        v: EBE
  concept:
    code:
      v: SBSORSCW
    display:
      v: starts before or concurrent with start of
    definition:
      v: A relationship in which the source act's effective time starts before or concurrent with the start of the target act's effective time. Usage Note: Inverse code is SASORSCW
    property:
      code:
        v: child
      value: code
        v: SCW
    concept:
      code:
        v: SBS
      display:
        v: starts before start of
      definition:
        v: A relationship in which the source act begins before the target act begins. UsageNote: Inverse code is SAS
      property:
        value: code
      property:
        value: code

v: child

code
v: SBSEASEBE

v: EBSORECWS

v: ends before or concurrent with start of

v: A relationship in which the source act's effective time ends before or concurrent with the start of the target act's effective time. Usage Note: Inverse code is EASORECWS

code:
  v: child
value: code
  v: ECWS

code:
  v: EBS
display:
  v: ends before start of
definition:
  v: A relationship in which the source act ends before the target act starts. UsageNote: Inverse code is SAE

v: child

code
v: SBSEBE

v: child

code
v: SBSEAS

code:
  v: AUTH
display:
  v: authorized by
definition:
  v: A relationship in which the target act authorizes or certifies the source act.

code:
  v: CAUS
display:
  v: is etiology for
definition:
  v: Description: An assertion that an act was the cause of another act.This is stronger and more specific than the support link. The source (cause) is typically an observation, but may be any act, while the target may be any act. Examples: a growth of Staphylococcus aureus may be considered the cause of an abscess contamination of the infusion bag was deemed to be the cause of the infection that the patient experienced lack of staff on the shift was deemed to be a supporting factor (proximal factor) causing the patient safety incident where the patient fell out of bed because the bed-sides had not been put up which caused the night patient to fall out of bed

code:
  v: COMP
display:
  v: has component
definition:
  v: The target act is a component of the source act, with no semantics regarding composition or aggregation implied.
concept:
  code:
    v: CTRLV
  display:
    v: has control variable
  definition:
    v: A relationship from an Act to a Control Variable. For example, if a Device makes an Observation, this relates the Observation to its Control Variables documenting the device's settings that influenced the observation.
concept:
  code:
    v: MBR
  display:
    v: has member
  definition:
    v: The target Acts are aggregated by the source Act. Target Acts may have independent existence, participate in multiple ActRelationships, and do not contribute to the meaning of the source. UsageNotes: This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts). It is expected that this will be primarily used with _ActClassRecordOrganizer, BATTERY, and LIST
  concept:
    code:
      v: STEP
    display:
      v: has step
    definition:
      v: A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently. UsageNotes: Sequence of steps may be indicated by use of _ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode. OpenIssue: Need Additional guidelines on when each approach should be used.
    concept:
      code:
        v: ARR
      display:
        v: arrival
      definition:
        v: The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act entered into the source Act by means of the target Transportation act.
    concept:
      code:
        v: DEP
      display:
        v: departure
      definition:
        v: The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act departed from the source Act by means of the target Transportation act.
concept:
  code:
    v: PART
  display:
    v: has part
  definition:
    v: The source Act is a composite of the target Acts. The target Acts do not have an existence independent of the source Act. UsageNote: In UML 1.1, this is a "composition" defined as: "A form of aggregation with strong ownership and coincident lifetime as part of the whole. Parts with non-fixed multiplicity may be created after the composite itself, but once created they live and die with it (i.e., they share lifetimes). Such parts can also be explicitly removed before the death of the composite. Composition may be recursive."

code:
  v: COVBY
display:
  v: covered by
definition:
  v: A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy.

code:
  v: DRIV
display:
  v: is derived from
definition:
  v: Associates a derived Act with its input parameters. E.G., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,), chloride-, and bicarbonate-observations. The narrative content (Act.text) of a source act is wholly machine-derived from the collection of target acts.

code:
  v: ELNK
display:
  v: episodeLink
definition:
  v: Expresses an association that links two instances of the same act over time, indicating that the instance are part of the same episode, e.g. linking two condition nodes for episode of illness; linking two encounters for episode of encounter.

code:
  v: EVID
display:
  v: provides evidence for
definition:
  v: Indicates that the target Act provides evidence in support of the action represented by the source Act. The target is not a 'reason' for the source act, but rather gives supporting information on why the source act is an appropriate course of action. Possible targets might be clinical trial results, journal articles, similar successful therapies, etc. Rationale: Provides a mechanism for conveying clinical justification for non-approved or otherwise non-traditional therapies.

code:
  v: EXACBY
display:
  v: exacerbated by
definition:
  v: Description:The source act is aggravated by the target act. (Example "chest pain" EXACBY "exercise")

code:
  v: EXPL
display:
  v: has explanation
definition:
  v: This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition.

code:
  v: INTF
display:
  v: interfered by
definition:
  v: the target act documents a set of circumstances (events, risks) which prevent successful completion, or degradation of quality of, the source Act. UsageNote: This provides the semantics to document barriers to care

code:
  v: ITEMSLOC
display:
  v: items located
definition:
  v: Items located

code:
  v: LIMIT
display:
  v: limited by
definition:
  v: A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood.

code:
  v: META
display:
  v: has metadata
definition:
  v: Definition: Indicates that the attributes and associations of the target act provide metadata (for example, identifiers, authorship, etc.) for the source act. Constraint: Source act must have either a mood code that is not "EVN" (event) or its "isCriterion" attribute must set to "true". Target act must be an Act with a mood code of EVN and with isCriterionInd attribute set to "true".

code:
  v: MFST
display:
  v: is manifestation of
definition:
  v: An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.

code:
  v: NAME
display:
  v: assigns name
definition:
  v: Used to assign a "name" to a condition thread. Source is a condition node, target can be any service.

code:
  v: OUTC
display:
  v: has outcome
definition:
  v: An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-conditional".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute (AND, OR, XOR) can be used. An outcome link is often inverted to describe an outcome assessment.
concept:
  code:
    v: _ActRelationsipObjective
  display:
    v: Act Relationsip Objective
  definition:
    v: The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood.
  property:
    code:
      v: notSelectable
    value: boolean
      v: true
  concept:
    code:
      v: OBJC
    display:
      v: has continuing objective
    definition:
      v: A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.
  concept:
    code:
      v: OBJF
    display:
      v: has final objective
    definition:
      v: A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood.
concept:
  code:
    v: GOAL
  display:
    v: has goal
  definition:
    v: A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.
concept:
  code:
    v: RISK
  display:
    v: has risk
  definition:
    v: A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.

code:
  v: PERT
display:
  v: has pertinent information
definition:
  v: This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays.

code:
  v: PREV
display:
  v: has previous instance
definition:
  v: A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services.

code:
  v: REFR
display:
  v: refers to
definition:
  v: A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.
concept:
  code:
    v: USE
  display:
    v: uses
  definition:
    v: Indicates that the source act makes use of (or will make use of) the information content of the target act. UsageNotes: A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate. Rationale: There is a need when defining a clinical trial protocol to indicate that the protocol makes use of other protocol or treatment specifications. This is stronger than the assertion of "references". References may exist without usage, and in a clinical trial protocol is common to assert both: what other specifications does this trial use and what other specifications does it merely reference.

code:
  v: REFV
display:
  v: has reference values
definition:
  v: Reference ranges are essentially descriptors of a class of result values assumed to be "normal", "abnormal", or "critical." Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results.

code:
  v: RELVBY
display:
  v: relieved by
definition:
  v: Description:The source act is wholly or partially alleviated by the target act. (Example "chest pain" RELVBY "sublingual nitroglycerin administration")

code:
  v: SEQL
display:
  v: is sequel
definition:
  v: An act relationship indicating that the source act follows the target act. The source act should in principle represent the same kind of act as the target. Source and target need not have the same mood code (mood will often differ). The target of a sequel is called antecedent. Examples for sequel relationships are: revision, transformation, derivation from a prototype (as a specialization is a derivation of a generalization), followup, realization, instantiation.
concept:
  code:
    v: APND
  display:
    v: is appendage
  definition:
    v: An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.
concept:
  code:
    v: BSLN
  display:
    v: has baseline
  definition:
    v: Indicates that the target observation(s) provide an initial reference for the source observation or observation group. UsageConstraints: Both source and target must be Observations or specializations thereof.
concept:
  code:
    v: COMPLY
  display:
    v: complies with
  definition:
    v: Description:The source act complies with, adheres to, conforms to, or is permissible under (in whole or in part) the policy, contract, agreement, law, conformance criteria, certification guidelines or requirement conveyed by the target act. Examples for compliance relationships are: audits of adherence with a security policy, certificate of conformance to system certification requirements, or consent directive in compliance with or permissible under a privacy policy.
concept:
  code:
    v: DOC
  display:
    v: documents
  definition:
    v: The source act documents the target act.
concept:
  code:
    v: FLFS
  display:
    v: fulfills
  definition:
    v: The source act fulfills (in whole or in part) the target act. Source act must be in a mood equal or more actual than the target act.
  concept:
    code:
      v: OCCR
    display:
      v: occurrence
    definition:
      v: The source act is a single occurrence of a repeatable target act. The source and target act can be in any mood on the "completion track" but the source act must be as far as or further along the track than the target act (i.e., the occurrence of an intent can be an event but not vice versa).
  concept:
    code:
      v: OREF
    display:
      v: references order
    definition:
      v: Relates either an appointment request or an appointment to the order for the service being scheduled.
  concept:
    code:
      v: SCH
    display:
      v: schedules request
    definition:
      v: Associates a specific time (and associated resources) with a scheduling request or other intent.
concept:
  code:
    v: GEN
  display:
    v: has generalization
  definition:
    v: The generalization relationship can be used to express categorical knowledge about services (e.g., amilorid, triamterene, and spironolactone have the common generalization potassium sparing diuretic).
concept:
  code:
    v: GEVL
  display:
    v: evaluates (goal)
  definition:
    v: A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly.
concept:
  code:
    v: INST
  display:
    v: instantiates (master)
  definition:
    v: Used to capture the link between a potential service ("master" or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master's defaults.
concept:
  code:
    v: MOD
  display:
    v: modifies
  definition:
    v: Definition: Used to link a newer version or 'snapshot' of a business object (source) to an older version or 'snapshot' of the same business object (target). Usage:The identifier of the Act should be the same for both source and target. If the identifiers are distinct, RPLC should be used instead. Name from source to target = "modifiesPrior" Name from target to source = "modifiesByNew"
concept:
  code:
    v: MTCH
  display:
    v: matches (trigger)
  definition:
    v: A trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is "observation of pain" and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger.
concept:
  code:
    v: OPTN
  display:
    v: has option
  definition:
    v: A relationship between a source Act that provides more detailed properties to the target Act. The source act thus is a specialization of the target act, but instead of mentioning all the inherited properties it only mentions new property bindings or refinements. The typical use case is to specify certain alternative variants of one kind of Act. The priorityNumber attribute is used to weigh refinements as preferred over other alternative refinements. Example: several routing options for a drug are specified as one SubstanceAdministration for the general treatment with attached refinements for the various routing options.
concept:
  code:
    v: RCHAL
  display:
    v: re-challenge
  definition:
    v: Description:A relationship in which the target act is carried out to determine whether an effect attributed to the source act can be recreated.
concept:
  code:
    v: REV
  display:
    v: reverses
  definition:
    v: A relationship between a source Act that seeks to reverse or undo the action of the prior target Act. Example: A posted financial transaction (e.g., a debit transaction) was applied in error and must be reversed (e.g., by a credit transaction) the credit transaction is identified as an undo (or reversal) of the prior target transaction. Constraints: the "completion track" mood of the target Act must be equally or more "actual" than the source act. I.e., when the target act is EVN the source act can be EVN, or any INT. If the target act is INT, the source act can be INT.
concept:
  code:
    v: RPLC
  display:
    v: replaces
  definition:
    v: A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.
concept:
  code:
    v: SUCC
  display:
    v: succeeds
  definition:
    v: Definition: A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be 'completed'. The original act is the target act and the successor is the source act.
concept:
  code:
    v: UPDT
  display:
    v: updates (condition)
  definition:
    v: A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread.
concept:
  code:
    v: XCRPT
  display:
    v: Excerpts
  definition:
    v: The source is an excerpt from the target.
  concept:
    code:
      v: VRXCRPT
    display:
      v: Excerpt verbatim
    definition:
      v: The source is a direct quote from the target.
concept:
  code:
    v: XFRM
  display:
    v: transformation
  definition:
    v: Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.)

code:
  v: SPRT
display:
  v: has support
definition:
  v: Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post).
concept:
  code:
    v: SPRTBND
  display:
    v: has bounded support
  definition:
    v: A specialization of "has support" (SPRT), used to relate a secondary observation to a Region of Interest on a multidimensional observation, if the ROI specifies the true boundaries of the secondary observation as opposed to only marking the approximate area. For example, if the start and end of an ST elevation episode is visible in an EKG, this relation would indicate the ROI bounds the "ST elevation" observation -- the ROI defines the true beginning and ending of the episode. Conversely, if a ROI simply contains ST elevation, but it does not define the bounds (start and end) of the episode, the more general "has support" relation is used. Likewise, if a ROI on an image defines the true bounds of a "1st degree burn", the relation "has bounded support" is used; but if the ROI only points to the approximate area of the burn, the general "has support" relation is used.

code:
  v: SUBJ
display:
  v: has subject
definition:
  v: Relates an Act to its subject Act that the first Act is primarily concerned with. Examples The first Act may be a ControlAct manipulating the subject Act The first act is a region of interest (ROI) that defines a region within the subject Act. The first act is a reporting or notification Act, that echos the subject Act for a specific new purpose. Constraints An Act may have multiple subject acts. Rationale The ActRelationshipType "has subject" is similar to the ParticipationType "subject", Acts that primarily operate on physical subjects use the Participation, those Acts that primarily operate on other Acts (other information) use the ActRelationship.
concept:
  code:
    v: QUALF
  display:
    v: has qualifier
  definition:
    v: The target observation qualifies (refines) the semantics of the source observation. UsageNote: This is not intended to replace concept refinement and qualification via vocabulary. It is used when there are multiple components which together provide the complete understanding of the source Act.

code:
  v: SUMM
display:
  v: summarized by
definition:
  v: An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period.

code:
  v: VALUE
display:
  v: has value
definition:
  v: Description:Indicates that the target Act represents the result of the source observation Act. FormalConstraint: Source Act must be an Observation or specialization there-of. Source Act must not have the value attribute specified UsageNote: This relationship allows the result of an observation to be fully expressed as RIM acts as opposed to being embedded in the value attribute. For example, sending a Document act as the result of an imaging observation, sending a list of Procedures and/or other acts as the result of a medical history observation. The valueNegationInd attribute on the source Act has the same semantics of "negated finding" when it applies to the target of a VALUE ActRelationship as it does to the value attribute. On the other hand, if the ActRelationship.negationInd is true for a VALUE ActRelationship, that means the specified observation does not have the indicated value but does not imply a negated finding. Because the semantics are extremely close, it is recommended that Observation.valueNegationInd be used, not ActRelationship.negationInd. OpenIssue: The implications of negationInd on ActRelationship and the valueNegationind on Observation.

code:
  v: CURE
display:
  v: curative indication
definition:
  v: curative indication
property:
  code:
    v: status
  value: code
    v: retired

code:
  v: CURE.ADJ
display:
  v: adjunct curative indication
definition:
  v: adjunct curative indication
property:
  code:
    v: status
  value: code
    v: retired

code:
  v: MTGT.ADJ
display:
  v: adjunct mitigation
definition:
  v: adjunct mitigation
property:
  code:
    v: status
  value: code
    v: retired

code:
  v: RACT
property:
  code:
    v: status
  value: code
    v: retired

code:
  v: SUGG
property:
  code:
    v: status
  value: code
    v: retired