CarePlan - FHIR v0.0.82

This page is part of the FHIR Specification (v0.0.82: DSTU 1). 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

4.3.6 Resource CarePlan - Formal Definitions

Formal definitions for the elements in the CarePlan resource.

CarePlan
Definition	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.
Control	1..1
Aliases	Care Team
CarePlan.identifier
Definition	This records identifiers associated with this care plan that are defined by business processed 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).
Control	0..*
Type	Identifier
Requirements	Need to allow connection to a wider workflow.
CarePlan.patient
Definition	Identifies the patient/subject whose intended care is described by the plan.
Control	0..1
Type	Resource(Patient)
Requirements	Care plans are associated with the patient the plan is for.
CarePlan.status
Definition	Indicates whether the plan is currently being acted upon, represents future intentions or is now just historical record.
Control	1..1
Binding	CarePlanStatus: Indicates whether the plan is currently being acted upon, represents future intentions or is now just historical record. (see http://hl7.org/fhir/care-plan-status for values)
Type	code
Is Modifier	true
Requirements	Allows clinicians to determine whether the plan is actionable or not.
CarePlan.period
Definition	Indicates when the plan did (or is intended to) come into effect and end.
Control	0..1
Type	Period
Requirements	Allows tracking what plan(s) are in effect at a particular time.
Comments	Any activities scheduled as part of the plan should be constrained to the specified period.
CarePlan.modified
Definition	Identifies the most recent date on which the plan has been revised.
Control	0..1
Type	dateTime
Requirements	Indicates how current the plan is.
CarePlan.concern
Definition	Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.
Control	0..*
Type	Resource(Condition)
Requirements	Links plan to the conditions it manages. Also scopes plans - multiple plans may exist addressing different concerns.
CarePlan.participant
Definition	Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.
Control	0..*
Requirements	Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.
Aliases	Care Team
CarePlan.participant.role
Definition	Indicates specific responsibility of an individual within the care plan. E.g. "Primary physician", "Team coordinator", "Caregiver", etc.
Control	0..1
Binding	CarePlanParticipantRole: Indicates specific responsibility of an individual within the care plan. E.g. "Primary physician", "Team coordinator", "Caregiver", etc.
Type	CodeableConcept
Comments	Roles may sometimes be inferred by type of Practitioner. These are relationships that hold only within the context of the care plan. General relationships should be handled as properties of the Patient resource directly.
CarePlan.participant.member
Definition	The specific person or organization who is participating/expected to participate in the care plan.
Control	1..1
Type	Resource(Practitioner \| RelatedPerson \| Patient \| Organization)
Comments	Patient only needs to be listed if they have a role other than "subject of care".
CarePlan.goal
Definition	Describes the intended objective(s) of carrying out the Care Plan.
Control	0..*
Requirements	Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.
Comments	Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
CarePlan.goal.description
Definition	Human-readable description of a specific desired objective of the care plan.
Control	1..1
Type	string
Requirements	Without a description of what's trying to be achieved, element has no purpose.
CarePlan.goal.status
Definition	Indicates whether the goal has been reached and is still considered relevant.
Control	0..1
Binding	CarePlanGoalStatus: Indicates whether the goal has been met and is still being targeted (see http://hl7.org/fhir/care-plan-goal-status for values)
Type	code
Requirements	Allows measuring outcome and also indicates relevance of goal to plan.
CarePlan.goal.notes
Definition	Any comments related to the goal.
Control	0..1
Type	string
Requirements	There's a need to capture information about the goal that doesn't actually describe the goal.
Comments	May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
CarePlan.goal.concern
Definition	The identified conditions that this goal relates to - the condition that caused it to be created, or that it is intended to address.
Control	0..*
Type	Resource(Condition)
Requirements	Allows specific goals to explicitly linked to conditions - makes the plan more understandable.
Comments	The concerns do not also need to be listed under CarePlan.concern, but may be.
CarePlan.activity
Definition	Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.
Control	0..*
Requirements	Allows systems to prompt for performance of planned activities, validate plans against best practice.
CarePlan.activity.goal
Definition	Internal reference that identifies the goals that this activity is intended to contribute towards meeting.
Control	0..*
Type	idref
Requirements	So that participants know the link explicitly.
CarePlan.activity.status
Definition	Identifies what progress is being made for the specific activity.
Control	0..1
Binding	CarePlanActivityStatus: Indicates where the activity is at in its overall life cycle (see http://hl7.org/fhir/care-plan-activity-status for values)
Type	code
Requirements	Indicates progress against the plan, whether the activity is still relevant for the plan.
Comments	Some aspects of Status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated.
CarePlan.activity.prohibited
Definition	If true, indicates that the described activity is one that must NOT be engaged in when following the plan.
Control	1..1
Type	boolean
Is Modifier	true
Requirements	Captures intention to not do something that may have been previously typical.
CarePlan.activity.actionResulting
Definition	Resources that describe follow-on actions resulting from the plan, such as drug prescriptions, encounter records, appointments, etc.
Control	0..*
Type	Resource(Any)
Requirements	Links plan to resulting actions.
CarePlan.activity.notes
Definition	Notes about the execution of the activity.
Control	0..1
Type	string
Requirements	Can be used to capture information about adherence, progress, concerns, etc.
Comments	Doesn't describe the activity - that goes in details.
CarePlan.activity.detail
Definition	The details of the proposed activity represented in a specific resource.
Control	0..1
Type	Resource(Procedure \| MedicationPrescription \| DiagnosticOrder \| Encounter)
Requirements	Details in a form consistent with other applications and contexts of use.
Invariants	Affect this element Inv-3: Only provide a detail reference, or a simple detail summary (xpath: not(exists(f:detail)) or not(exists(f:simple)))
CarePlan.activity.simple
Definition	A simple summary of details suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.
Control	0..1
Requirements	Details in a simple form for generic care plan systems.
Invariants	Defined on this element Inv-1: DailyDose can only be specified if activity category is drug or food (xpath: (f:category/@value=('drug','diet')) = exists(f:dailyAmount)) Inv-2: Quantity can only be specified if activity category is supply (xpath: (f:category/@value=('supply')) = exists(f:quantity)) Inv-3: Only provide a detail reference, or a simple detail summary (xpath: not(exists(f:detail)) or not(exists(f:simple))) Affect this element Inv-3: Only provide a detail reference, or a simple detail summary (xpath: not(exists(f:detail)) or not(exists(f:simple)))
CarePlan.activity.simple.category
Definition	High-level categorization of the type of activity in a care plan.
Control	1..1
Binding	CarePlanActivityCategory: High-level categorization of the type of activity in a care plan. (see http://hl7.org/fhir/care-plan-activity-category for values)
Type	code
Requirements	May determine what types of extensions are permitted.
CarePlan.activity.simple.code
Definition	Detailed description of the type of activity. E.g. What lab test, what procedure, what kind of encounter.
Control	0..1
Binding	CarePlanActivityType: Detailed description of the type of activity. E.g. What lab test, what procedure, what kind of encounter.
Type	CodeableConcept
Requirements	Allows matching performed to planned as well as validation against protocols.
Comments	Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.
CarePlan.activity.simple.timing[x]
Definition	The period, timing or frequency upon which the described activity is to occur.
Control	0..1
Type	Schedule\|Period\|string
Requirements	Allows prompting for activities and detection of missed planned activities.
CarePlan.activity.simple.location
Definition	Identifies the facility where the activity will occur. E.g. home, hospital, specific clinic, etc.
Control	0..1
Type	Resource(Location)
Requirements	Helps in planning of activity.
Comments	May reference a specific clinical location or may just identify a type of location.
CarePlan.activity.simple.performer
Definition	Identifies who's expected to be involved in the activity.
Control	0..*
Type	Resource(Practitioner \| Organization \| RelatedPerson \| Patient)
Requirements	Helps in planning of activity.
Comments	A performer MAY also be a participant in the care plan.
CarePlan.activity.simple.product
Definition	Identifies the food, drug or other product being consumed or supplied in the activity.
Control	0..1
Type	Resource(Medication \| Substance)
CarePlan.activity.simple.dailyAmount
Definition	Identifies the quantity expected to be consumed in a given day.
Control	0..1
Type	Quantity
Requirements	Allows rough dose checking.
Aliases	daily dose
Invariants	Affect this element Inv-1: DailyDose can only be specified if activity category is drug or food (xpath: (f:category/@value=('drug','diet')) = exists(f:dailyAmount))
CarePlan.activity.simple.quantity
Definition	Identifies the quantity expected to be supplied.
Control	0..1
Type	Quantity
Invariants	Affect this element Inv-2: Quantity can only be specified if activity category is supply (xpath: (f:category/@value=('supply')) = exists(f:quantity))
CarePlan.activity.simple.details
Definition	This provides a textual description of constraints on the activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.
Control	0..1
Type	string
CarePlan.notes
Definition	General notes about the care plan not covered elsewhere.
Control	0..1
Type	string
Requirements	Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.