This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
This resource maintained by the Patient Care Work Group
Describes the intention of how one or more practitioners intend to deliver care for a particular patient for a period of time, possibly limited to care for a specific condition or set of conditions.
Care Plans are used in many of areas of healthcare with a variety of scopes. They can be as simple as a general practitioner keeping track of when their patient is next due for a tetanus immunization through to a detailed plan for an oncology patient covering diet, chemotherapy, radiation, lab work and counseling with detailed timing relationships, pre-conditions and goals.
This resource takes an intermediate approach. It captures basic details about who is involved and what actions are intended without dealing in discrete data about dependencies and timing relationships. These can be supported where necessary using the extension mechanisms.
Comments are welcome about the appropriateness of the proposed level of granularity, whether it's too much detail for what most systems need, or not sufficient for common essential use cases.
This resource is referenced by ClinicalAssessment and Procedure
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CarePlan | DomainResource | Healthcare plan for patient | ||
identifier | 0..* | Identifier | External Ids for this plan | |
patient | 0..1 | Patient | Who care plan is for | |
status | M | 1..1 | code | planned | active | completed CarePlanStatus (Required) |
period | 0..1 | Period | Time period plan covers | |
modified | 0..1 | dateTime | When last updated | |
concern | 0..* | Condition | Health issues this plan addresses | |
participant | 0..* | Element | Who's involved in plan? | |
role | 0..1 | CodeableConcept | Type of involvement | |
member | 1..1 | Practitioner | RelatedPerson | Patient | Organization | Who is involved | |
goal | 0..* | Element | Desired outcome of plan | |
description | 1..1 | string | What's the desired outcome? | |
status | 0..1 | code | in-progress | achieved | sustaining | cancelled CarePlanGoalStatus (Required) | |
notes | 0..1 | string | Comments about the goal | |
concern | 0..* | Condition | Health issues this goal addresses | |
activity | 0..* | Element | Action to occur as part of plan | |
goal | 0..* | uri | Goals this activity relates to | |
status | 0..1 | code | not-started | scheduled | in-progress | on-hold | completed | cancelled CarePlanActivityStatus (Required) | |
prohibited | M | 1..1 | boolean | Do NOT do |
actionResulting | 0..* | Any | Appointments, orders, etc. | |
notes | 0..1 | string | Comments about the activity | |
detail | I | 0..1 | Procedure | MedicationPrescription | DiagnosticOrder | Encounter | Supply | Activity details defined in specific resource |
simple | I | 0..1 | Element | Activity details summarised here DailyDose can only be specified if activity category is drug or food Quantity can only be specified if activity category is supply Only provide a detail reference, or a simple detail summary |
category | 1..1 | code | diet | drug | encounter | observation | procedure | supply | other CarePlanActivityCategory (Required) | |
code | 0..1 | CodeableConcept | Detail type of activity | |
scheduled[x] | When activity is to occur | |||
scheduledTiming | 0..1 | Timing | ||
scheduledPeriod | 0..1 | Period | ||
scheduledString | 0..1 | string | ||
location | 0..1 | Location | Where it should happen | |
performer | 0..* | Practitioner | Organization | RelatedPerson | Patient | Who's responsible? | |
product | 0..1 | Medication | Substance | What's administered/supplied | |
dailyAmount | I | 0..1 | Quantity | How much consumed/day? |
quantity | I | 0..1 | Quantity | How much is administered/supplied/consumed |
details | 0..1 | string | Extra info on activity occurrence | |
notes | 0..1 | string | Comments about the plan |
UML Diagram
XML Template
<CarePlan xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier External Ids for this plan --></identifier> <patient><!-- 0..1 Reference(Patient) Who care plan is for --></patient> <status value="[code]"/><!-- 1..1 planned | active | completed --> <period><!-- 0..1 Period Time period plan covers --></period> <modified value="[dateTime]"/><!-- 0..1 When last updated --> <concern><!-- 0..* Reference(Condition) Health issues this plan addresses --></concern> <participant> <!-- 0..* Who's involved in plan? --> <role><!-- 0..1 CodeableConcept Type of involvement --></role> <member><!-- 1..1 Reference(Practitioner|RelatedPerson|Patient|Organization) Who is involved --></member> </participant> <goal> <!-- 0..* Desired outcome of plan --> <description value="[string]"/><!-- 1..1 What's the desired outcome? --> <status value="[code]"/><!-- 0..1 in-progress | achieved | sustaining | cancelled --> <notes value="[string]"/><!-- 0..1 Comments about the goal --> <concern><!-- 0..* Reference(Condition) Health issues this goal addresses --></concern> </goal> <activity> <!-- 0..* Action to occur as part of plan --> <goal value="[uri]"/><!-- 0..* Goals this activity relates to --> <status value="[code]"/><!-- 0..1 not-started | scheduled | in-progress | on-hold | completed | cancelled --> <prohibited value="[boolean]"/><!-- 1..1 Do NOT do --> <actionResulting><!-- 0..* Reference(Any) Appointments, orders, etc. --></actionResulting> <notes value="[string]"/><!-- 0..1 Comments about the activity --> <detail><!-- 0..1 Reference(Procedure|MedicationPrescription|DiagnosticOrder| Encounter|Supply) Activity details defined in specific resource --></detail> <simple> <!-- 0..1 Activity details summarised here --> <category value="[code]"/><!-- 1..1 diet | drug | encounter | observation | procedure | supply | other --> <code><!-- 0..1 CodeableConcept Detail type of activity --></code> <scheduled[x]><!-- 0..1 Timing|Period|string When activity is to occur --></scheduled[x]> <location><!-- 0..1 Reference(Location) Where it should happen --></location> <performer><!-- 0..* Reference(Practitioner|Organization|RelatedPerson|Patient) Who's responsible? --></performer> <product><!-- 0..1 Reference(Medication|Substance) What's administered/supplied --></product> <dailyAmount><!-- 0..1 Quantity How much consumed/day? --></dailyAmount> <quantity><!-- 0..1 Quantity How much is administered/supplied/consumed --></quantity> <details value="[string]"/><!-- 0..1 Extra info on activity occurrence --> </simple> </activity> <notes value="[string]"/><!-- 0..1 Comments about the plan --> </CarePlan>
JSON Template
{ "resourceType" : "CarePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Ids for this plan "patient" : { Reference(Patient) }, // Who care plan is for "status" : "<code>", // R! planned | active | completed "period" : { Period }, // Time period plan covers "modified" : "<dateTime>", // When last updated "concern" : [{ Reference(Condition) }], // Health issues this plan addresses "participant" : [{ // Who's involved in plan? "role" : { CodeableConcept }, // Type of involvement "member" : { Reference(Practitioner|RelatedPerson|Patient|Organization) } // R! Who is involved }], "goal" : [{ // Desired outcome of plan "description" : "<string>", // R! What's the desired outcome? "status" : "<code>", // in-progress | achieved | sustaining | cancelled "notes" : "<string>", // Comments about the goal "concern" : [{ Reference(Condition) }] // Health issues this goal addresses }], "activity" : [{ // Action to occur as part of plan "goal" : ["<uri>"], // Goals this activity relates to "status" : "<code>", // not-started | scheduled | in-progress | on-hold | completed | cancelled "prohibited" : <boolean>, // R! Do NOT do "actionResulting" : [{ Reference(Any) }], // Appointments, orders, etc. "notes" : "<string>", // Comments about the activity "detail" : { Reference(Procedure|MedicationPrescription|DiagnosticOrder| Encounter|Supply) }, // C? Activity details defined in specific resource "simple" : { // C? Activity details summarised here "category" : "<code>", // R! diet | drug | encounter | observation | procedure | supply | other "code" : { CodeableConcept }, // Detail type of activity // scheduled[x]: When activity is to occur. One of these 3: "scheduledTiming" : { Timing }, "scheduledPeriod" : { Period }, "scheduledString" : "<string>", "location" : { Reference(Location) }, // Where it should happen "performer" : [{ Reference(Practitioner|Organization|RelatedPerson|Patient) }], // Who's responsible? "product" : { Reference(Medication|Substance) }, // What's administered/supplied "dailyAmount" : { Quantity }, // C? How much consumed/day? "quantity" : { Quantity }, // C? How much is administered/supplied/consumed "details" : "<string>" // Extra info on activity occurrence } }], "notes" : "<string>" // Comments about the plan }
Structure
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
CarePlan | DomainResource | Healthcare plan for patient | ||
identifier | 0..* | Identifier | External Ids for this plan | |
patient | 0..1 | Patient | Who care plan is for | |
status | M | 1..1 | code | planned | active | completed CarePlanStatus (Required) |
period | 0..1 | Period | Time period plan covers | |
modified | 0..1 | dateTime | When last updated | |
concern | 0..* | Condition | Health issues this plan addresses | |
participant | 0..* | Element | Who's involved in plan? | |
role | 0..1 | CodeableConcept | Type of involvement | |
member | 1..1 | Practitioner | RelatedPerson | Patient | Organization | Who is involved | |
goal | 0..* | Element | Desired outcome of plan | |
description | 1..1 | string | What's the desired outcome? | |
status | 0..1 | code | in-progress | achieved | sustaining | cancelled CarePlanGoalStatus (Required) | |
notes | 0..1 | string | Comments about the goal | |
concern | 0..* | Condition | Health issues this goal addresses | |
activity | 0..* | Element | Action to occur as part of plan | |
goal | 0..* | uri | Goals this activity relates to | |
status | 0..1 | code | not-started | scheduled | in-progress | on-hold | completed | cancelled CarePlanActivityStatus (Required) | |
prohibited | M | 1..1 | boolean | Do NOT do |
actionResulting | 0..* | Any | Appointments, orders, etc. | |
notes | 0..1 | string | Comments about the activity | |
detail | I | 0..1 | Procedure | MedicationPrescription | DiagnosticOrder | Encounter | Supply | Activity details defined in specific resource |
simple | I | 0..1 | Element | Activity details summarised here DailyDose can only be specified if activity category is drug or food Quantity can only be specified if activity category is supply Only provide a detail reference, or a simple detail summary |
category | 1..1 | code | diet | drug | encounter | observation | procedure | supply | other CarePlanActivityCategory (Required) | |
code | 0..1 | CodeableConcept | Detail type of activity | |
scheduled[x] | When activity is to occur | |||
scheduledTiming | 0..1 | Timing | ||
scheduledPeriod | 0..1 | Period | ||
scheduledString | 0..1 | string | ||
location | 0..1 | Location | Where it should happen | |
performer | 0..* | Practitioner | Organization | RelatedPerson | Patient | Who's responsible? | |
product | 0..1 | Medication | Substance | What's administered/supplied | |
dailyAmount | I | 0..1 | Quantity | How much consumed/day? |
quantity | I | 0..1 | Quantity | How much is administered/supplied/consumed |
details | 0..1 | string | Extra info on activity occurrence | |
notes | 0..1 | string | Comments about the plan |
XML Template
<CarePlan xmlns="http://hl7.org/fhir"> <!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier External Ids for this plan --></identifier> <patient><!-- 0..1 Reference(Patient) Who care plan is for --></patient> <status value="[code]"/><!-- 1..1 planned | active | completed --> <period><!-- 0..1 Period Time period plan covers --></period> <modified value="[dateTime]"/><!-- 0..1 When last updated --> <concern><!-- 0..* Reference(Condition) Health issues this plan addresses --></concern> <participant> <!-- 0..* Who's involved in plan? --> <role><!-- 0..1 CodeableConcept Type of involvement --></role> <member><!-- 1..1 Reference(Practitioner|RelatedPerson|Patient|Organization) Who is involved --></member> </participant> <goal> <!-- 0..* Desired outcome of plan --> <description value="[string]"/><!-- 1..1 What's the desired outcome? --> <status value="[code]"/><!-- 0..1 in-progress | achieved | sustaining | cancelled --> <notes value="[string]"/><!-- 0..1 Comments about the goal --> <concern><!-- 0..* Reference(Condition) Health issues this goal addresses --></concern> </goal> <activity> <!-- 0..* Action to occur as part of plan --> <goal value="[uri]"/><!-- 0..* Goals this activity relates to --> <status value="[code]"/><!-- 0..1 not-started | scheduled | in-progress | on-hold | completed | cancelled --> <prohibited value="[boolean]"/><!-- 1..1 Do NOT do --> <actionResulting><!-- 0..* Reference(Any) Appointments, orders, etc. --></actionResulting> <notes value="[string]"/><!-- 0..1 Comments about the activity --> <detail><!-- 0..1 Reference(Procedure|MedicationPrescription|DiagnosticOrder| Encounter|Supply) Activity details defined in specific resource --></detail> <simple> <!-- 0..1 Activity details summarised here --> <category value="[code]"/><!-- 1..1 diet | drug | encounter | observation | procedure | supply | other --> <code><!-- 0..1 CodeableConcept Detail type of activity --></code> <scheduled[x]><!-- 0..1 Timing|Period|string When activity is to occur --></scheduled[x]> <location><!-- 0..1 Reference(Location) Where it should happen --></location> <performer><!-- 0..* Reference(Practitioner|Organization|RelatedPerson|Patient) Who's responsible? --></performer> <product><!-- 0..1 Reference(Medication|Substance) What's administered/supplied --></product> <dailyAmount><!-- 0..1 Quantity How much consumed/day? --></dailyAmount> <quantity><!-- 0..1 Quantity How much is administered/supplied/consumed --></quantity> <details value="[string]"/><!-- 0..1 Extra info on activity occurrence --> </simple> </activity> <notes value="[string]"/><!-- 0..1 Comments about the plan --> </CarePlan>
JSON Template
{ "resourceType" : "CarePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Ids for this plan "patient" : { Reference(Patient) }, // Who care plan is for "status" : "<code>", // R! planned | active | completed "period" : { Period }, // Time period plan covers "modified" : "<dateTime>", // When last updated "concern" : [{ Reference(Condition) }], // Health issues this plan addresses "participant" : [{ // Who's involved in plan? "role" : { CodeableConcept }, // Type of involvement "member" : { Reference(Practitioner|RelatedPerson|Patient|Organization) } // R! Who is involved }], "goal" : [{ // Desired outcome of plan "description" : "<string>", // R! What's the desired outcome? "status" : "<code>", // in-progress | achieved | sustaining | cancelled "notes" : "<string>", // Comments about the goal "concern" : [{ Reference(Condition) }] // Health issues this goal addresses }], "activity" : [{ // Action to occur as part of plan "goal" : ["<uri>"], // Goals this activity relates to "status" : "<code>", // not-started | scheduled | in-progress | on-hold | completed | cancelled "prohibited" : <boolean>, // R! Do NOT do "actionResulting" : [{ Reference(Any) }], // Appointments, orders, etc. "notes" : "<string>", // Comments about the activity "detail" : { Reference(Procedure|MedicationPrescription|DiagnosticOrder| Encounter|Supply) }, // C? Activity details defined in specific resource "simple" : { // C? Activity details summarised here "category" : "<code>", // R! diet | drug | encounter | observation | procedure | supply | other "code" : { CodeableConcept }, // Detail type of activity // scheduled[x]: When activity is to occur. One of these 3: "scheduledTiming" : { Timing }, "scheduledPeriod" : { Period }, "scheduledString" : "<string>", "location" : { Reference(Location) }, // Where it should happen "performer" : [{ Reference(Practitioner|Organization|RelatedPerson|Patient) }], // Who's responsible? "product" : { Reference(Medication|Substance) }, // What's administered/supplied "dailyAmount" : { Quantity }, // C? How much consumed/day? "quantity" : { Quantity }, // C? How much is administered/supplied/consumed "details" : "<string>" // Extra info on activity occurrence } }], "notes" : "<string>" // Comments about the plan }
Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire
Path | Definition | Type | Reference |
---|---|---|---|
CarePlan.status | Indicates whether the plan is currently being acted upon, represents future intentions or is now just historical record. | Fixed | http://hl7.org/fhir/care-plan-status |
CarePlan.participant.role | Indicates specific responsibility of an individual within the care plan. E.g. "Primary physician", "Team coordinator", "Caregiver", etc. | Unknown | No details provided yet |
CarePlan.goal.status | Indicates whether the goal has been met and is still being targeted | Fixed | http://hl7.org/fhir/care-plan-goal-status |
CarePlan.activity.status | Indicates where the activity is at in its overall life cycle | Fixed | http://hl7.org/fhir/care-plan-activity-status |
CarePlan.activity.simple.category | High-level categorization of the type of activity in a care plan. | Fixed | http://hl7.org/fhir/care-plan-activity-category |
CarePlan.activity.simple.code | Detailed description of the type of activity. E.g. What lab test, what procedure, what kind of encounter. | Unknown | No details provided yet |
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
Name | Type | Description | Paths |
activitycode | token | Detail type of activity | CarePlan.activity.simple.code |
activitydate | date | Specified date occurs within period specified by CarePlan.activity.timingSchedule | CarePlan.activity.simple.scheduled[x] |
activitydetail | reference | Activity details defined in specific resource | CarePlan.activity.detail (Supply, MedicationPrescription, Encounter, Procedure, DiagnosticOrder) |
condition | reference | Health issues this plan addresses | CarePlan.concern (Condition) |
date | date | Time period plan covers | CarePlan.period |
participant | reference | Who is involved | CarePlan.participant.member (Organization, Patient, Practitioner, RelatedPerson) |
patient | reference | Who care plan is for | CarePlan.patient (Patient) |