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2.41 Resource Composition - Content

Structured Documents

Work Group

Maturity Level: 2

Trial Use

Security Category: Not Classified

Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson

A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).

2.41.1 Scope and Usage

A Composition is the basic structure from which FHIR Documents - immutable bundles with attested narrative - are built. A single logical composition may be associated with a series of derived documents, each of which is a frozen copy of the composition.

Note: EN 13606 uses the term "Composition" to refer to a single commit to an EHR system, and offers some common examples: a composition containing a consultation note, a progress note, a report or a letter, an investigation report, a prescription form or a set of bedside nursing observations. Using Composition for an attested EHR commit is a valid use of the Composition resource, but for FHIR purposes, it would be usual to make more granular updates with individual provenance statements.

The Clinical Document profile constrains Composition to specify a clinical document (matching CDA ). See also the comparison with CDA.

2.41.2 Boundaries and Relationships

Composition is a structure for grouping information for purposes of persistence and attestability. There are several other grouping structures in FHIR with distinct purposes:

The List resource - enumerates a flat collection of resources and provides features for managing the collection. While a particular List instance may represent a "snapshot", from a business process perspective, the notion of "list" is dynamic – items are added and removed over time. The List resource references other resources. Lists may be curated and have specific business meaning.
The Group resource - defines a group of specific people, animals, devices, etc. by enumerating them, or by describing qualities that group members have. The Group resource refers to other resources, possibly implicitly. Groups are intended to be acted upon or observed as a whole (e.g., performing therapy on a group, calculating risk for a group, etc.). This resource will commonly be used for public health (e.g., describing an at-risk population), clinical trials (e.g., defining a test subject pool) and similar purposes.
The Bundle resource - is an infrastructure container for a group of resources. It does not have narrative and is used to group collections of resources for transmission, persistence or processing (e.g., messages, documents, transactions, query responses, etc.). The content of bundles is typically algorithmically determined for a particular exchange or persistence purpose.
The Composition resource - defines a set of healthcare-related information that is assembled together into a single logical document that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. The Composition resource provides the basic structure of a FHIR document. The full content of the document is expressed using a Bundle containing the Composition and its entries.

The Composition resource organizes clinical and administrative content into sections, each of which contains a narrative, and references other resources for supporting data. The narrative content of the various sections in a Composition are supported by the resources referenced in the section entries. The complete set of content to make up a document includes the Composition resource together with various resources pointed to or indirectly connected to the Composition, all gathered together into a Bundle for transport and persistence. Resources associated with the following list of Composition references SHALL be included in the Bundle:

Other resources referred to by those resources MAY be included in the Bundle at the discretion of the authoring system as documented in the system's operation definition (such as $document operation), or as specified by any applicable profiles.

2.41.3 Background and Context

2.41.3.1 Composition Status Codes

Every composition has a status element, which describes the status of the content of the composition, taken from this list of codes:

2.41.3.2 The workflow/clinical status of the composition.

preliminary	This is a preliminary composition or document (also known as initial or interim). The content may be incomplete or unverified.
final	This version of the composition is complete and verified by an appropriate person and no further work is planned. Any subsequent updates would be on a new version of the composition.
amended	The composition content or the referenced resources have been modified (edited or added to) subsequent to being released as "final" and the composition is complete and verified by an authorized person.
entered-in-error	The composition or document was originally created/issued in error, and this is an amendment that marks that the entire series should not be considered as valid.

Composition status generally only moves down through this list - it moves from preliminary to final and then it may progress to amended. Note that in many workflows, only final compositions are made available and the preliminary status is not used.

A very few compositions are created entirely in error in the workflow - usually the composition concerns the wrong patient or is written by the wrong author, and the error is only detected after the composition has been used or documents have been derived from it. To support resolution of this case, the composition is updated to be marked as entered-in-error and a new derived document can be created. This means that the entire series of derived documents is now considered to be created in error and systems receiving derived documents based on retracted compositions SHOULD remove data taken from earlier documents from routine use and/or take other appropriate actions. Systems are not required to provide this workflow or support documents derived from retracted compositions, but they SHALL NOT ignore a status of entered-in-error. Note that systems that handle compositions or derived documents and don't support the error status need to define some other way of handling compositions that are created in error; while this is not a common occurrence, some clinical systems have no provision for removing erroneous information from a patient's record, and there is no way for a user to know that it is not fit for use - this is not safe.

2.41.3.3 Note for CDA aware readers

Many users of this specification are familiar with the Clinical Document Architecture (CDA) and related specifications. CDA is a primary design input to the Composition resource (other principal inputs are other HL7 document specifications and EN13606). There are three important structural differences between CDA and the Composition resource:

A composition is a logical construct- its identifier matches to the CDA ClinicalDocument.setId. Composition resources are wrapped into Document structures, for exchange of the whole package (the composition and its parts), and this wrapped, sealed entity is equivalent to a CDA document, where the Bundle.id is equivalent in function to ClinicalDocument.id (but it is not identical when interconverting, since it's a transform between them).
The composition section defines a section (or sub-section) of the document, but unlike CDA, the section entries are actually references to other resources that hold the supporting data content for the section. This design means that the data can be reused in many other ways.
Unlike CDA, the context defined in the Composition (the confidentiality, subject, author, event, event period and encounter) apply to the composition and do not specifically apply to the resources referenced from the section.entry. There is no context flow model in FHIR, so each resource referenced from within a Composition expresses its own individual context. In this way, clinical content can safely be extracted from the composition.

In addition, note that both the code lists (e.g., Composition.status) and the Composition resource are mapped to HL7 v3 and/or CDA.

This resource is referenced by itself, Contract and Procedure

Structure

Name	Flags	Card.	Type	Description & Constraints
Composition	TU		DomainResource	A set of resources composed into a single coherent clinical statement with clinical attestation Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error CompositionStatus (Required)
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) FHIR Document Type Codes (Preferred)
category	Σ	0..*	CodeableConcept	Categorization of Composition Document Class Value Set (Example)
subject	Σ	0..1	Reference(Any)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain V3 Value SetConfidentialityClassification (Required)
attester		0..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal \| professional \| legal \| official CompositionAttestationMode (Required)
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
code		1..1	code	replaces \| transforms \| signs \| appends DocumentRelationshipType (Required)
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented v3 Code System ActCode (Example)
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Any)	The event(s) being documented
section	I	0..*	BackboneElement	Composition is broken into sections + Rule: A section must contain at least one of text, entries, or sub-sections + Rule: A section can only have an emptyReason if it is empty
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Document Section Codes (Example)
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Any)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes ListMode (Required)
orderedBy		0..1	CodeableConcept	Order of section entries List Order Codes (Preferred)
entry	I	0..*	Reference(Any)	A reference to data that supports this section
emptyReason	I	0..1	CodeableConcept	Why the section is empty List Empty Reasons (Preferred)
section	I	0..*	see section	Nested Section
Documentation for this format

UML Diagram (Legend)

XML Template

<Composition xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..1 Identifier Version-independent identifier for the Composition --></identifier>
 <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type>
 <category><!-- 0..* CodeableConcept Categorization of Composition --></category>
 <subject><!-- 0..1 Reference(Any) Who and/or what the composition is about --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter>
 <date value="[dateTime]"/><!-- 1..1 Composition editing time -->
 <author><!-- 1..* Reference(Practitioner|PractitionerRole|Device|Patient|
   RelatedPerson|Organization) Who and/or what authored the composition --></author>
 <title value="[string]"/><!-- 1..1 Human Readable name/title -->
 <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain -->
 <attester>  <!-- 0..* Attests to accuracy of composition -->
  <mode value="[code]"/><!-- 1..1 personal | professional | legal | official -->
  <time value="[dateTime]"/><!-- 0..1 When the composition was attested -->
  <party><!-- 0..1 Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|
    Organization) Who attested the composition --></party>
 </attester>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian>
 <relatesTo>  <!-- 0..* Relationships to other compositions/documents -->
  <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends -->
  <target[x]><!-- 1..1 Identifier|Reference(Composition) Target of the relationship --></target[x]>
 </relatesTo>
 <event>  <!-- 0..* The clinical service(s) being documented -->
  <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code>
  <period><!-- 0..1 Period The period covered by the documentation --></period>
  <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail>
 </event>
 <section>  <!-- 0..* Composition is broken into sections -->
  <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) -->
  <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code>
  <author><!-- 0..* Reference(Practitioner|PractitionerRole|Device|Patient|
    RelatedPerson|Organization) Who and/or what authored the section --></author>
  <focus><!-- 0..1 Reference(Any) Who/what the section is about, when it is not about the subject of composition --></focus>
  <text><!--  0..1 Narrative Text summary of the section, for human interpretation --></text>
  <mode value="[code]"/><!-- 0..1 working | snapshot | changes -->
  <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy>
  <entry><!--  0..* Reference(Any) A reference to data that supports this section --></entry>
  <emptyReason><!--  0..1 CodeableConcept Why the section is empty --></emptyReason>
  <section><!--  0..* Content as for Composition.section Nested Section --></section>
 </section>
</Composition>

JSON Template

{
  "resourceType" : "Composition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : { Identifier }, // Version-independent identifier for the Composition
  "status" : "<code>", // R!  preliminary | final | amended | entered-in-error
  "type" : { CodeableConcept }, // R!  Kind of composition (LOINC if possible)
  "category" : [{ CodeableConcept }], // Categorization of Composition
  "subject" : { Reference(Any) }, // Who and/or what the composition is about
  "encounter" : { Reference(Encounter) }, // Context of the Composition
  "date" : "<dateTime>", // R!  Composition editing time
  "author" : [{ Reference(Practitioner|PractitionerRole|Device|Patient|
   RelatedPerson|Organization) }], // R!  Who and/or what authored the composition
  "title" : "<string>", // R!  Human Readable name/title
  "confidentiality" : "<code>", // As defined by affinity domain
  "attester" : [{ // Attests to accuracy of composition
    "mode" : "<code>", // R!  personal | professional | legal | official
    "time" : "<dateTime>", // When the composition was attested
    "party" : { Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|
    Organization) } // Who attested the composition
  }],
  "custodian" : { Reference(Organization) }, // Organization which maintains the composition
  "relatesTo" : [{ // Relationships to other compositions/documents
    "code" : "<code>", // R!  replaces | transforms | signs | appends
    // target[x]: Target of the relationship. One of these 2:
    "targetIdentifier" : { Identifier }
    "targetReference" : { Reference(Composition) }
  }],
  "event" : [{ // The clinical service(s) being documented
    "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented
    "period" : { Period }, // The period covered by the documentation
    "detail" : [{ Reference(Any) }] // The event(s) being documented
  }],
  "section" : [{ // Composition is broken into sections
    "title" : "<string>", // Label for section (e.g. for ToC)
    "code" : { CodeableConcept }, // Classification of section (recommended)
    "author" : [{ Reference(Practitioner|PractitionerRole|Device|Patient|
    RelatedPerson|Organization) }], // Who and/or what authored the section
    "focus" : { Reference(Any) }, // Who/what the section is about, when it is not about the subject of composition
    "text" : { Narrative }, // C? Text summary of the section, for human interpretation
    "mode" : "<code>", // working | snapshot | changes
    "orderedBy" : { CodeableConcept }, // Order of section entries
    "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section
    "emptyReason" : { CodeableConcept }, // C? Why the section is empty
    "section" : [{ Content as for Composition.section }] // C? Nested Section
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Composition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Composition.identifier [ Identifier ]; # 0..1 Version-independent identifier for the Composition
  fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error
  fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible)
  fhir:Composition.category [ CodeableConcept ], ... ; # 0..* Categorization of Composition
  fhir:Composition.subject [ Reference(Any) ]; # 0..1 Who and/or what the composition is about
  fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition
  fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time
  fhir:Composition.author [ Reference(Practitioner|PractitionerRole|Device|Patient|RelatedPerson|Organization) ], ... ; # 1..* Who and/or what authored the composition
  fhir:Composition.title [ string ]; # 1..1 Human Readable name/title
  fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain
  fhir:Composition.attester [ # 0..* Attests to accuracy of composition
    fhir:Composition.attester.mode [ code ]; # 1..1 personal | professional | legal | official
    fhir:Composition.attester.time [ dateTime ]; # 0..1 When the composition was attested
    fhir:Composition.attester.party [ Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|Organization) ]; # 0..1 Who attested the composition
  ], ...;
  fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition
  fhir:Composition.relatesTo [ # 0..* Relationships to other compositions/documents
    fhir:Composition.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends
    # Composition.relatesTo.target[x] : 1..1 Target of the relationship. One of these 2
      fhir:Composition.relatesTo.targetIdentifier [ Identifier ]
      fhir:Composition.relatesTo.targetReference [ Reference(Composition) ]
  ], ...;
  fhir:Composition.event [ # 0..* The clinical service(s) being documented
    fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented
    fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation
    fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented
  ], ...;
  fhir:Composition.section [ # 0..* Composition is broken into sections
    fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC)
    fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended)
    fhir:Composition.section.author [ Reference(Practitioner|PractitionerRole|Device|Patient|RelatedPerson|Organization) ], ... ; # 0..* Who and/or what authored the section
    fhir:Composition.section.focus [ Reference(Any) ]; # 0..1 Who/what the section is about, when it is not about the subject of composition
    fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation
    fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes
    fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries
    fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section
    fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty
    fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section
  ], ...;
]

Changes since R3

Composition

Composition.status

Change value set from http://hl7.org/fhir/ValueSet/composition-status to http://hl7.org/fhir/ValueSet/composition-status|4.0.1

Composition.category

Renamed from class to category
Max Cardinality changed from 1 to *

Composition.subject

Min Cardinality changed from 1 to 0

Composition.author

Type Reference: Added Target Types PractitionerRole, Organization

Composition.confidentiality

Change value set from http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification to http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26
No longer marked as Modifier

Composition.attester.mode

Max Cardinality changed from * to 1
Change value set from http://hl7.org/fhir/ValueSet/composition-attestation-mode to http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1

Composition.attester.party

Type Reference: Added Target Types RelatedPerson, PractitionerRole

Composition.relatesTo.code

Change value set from http://hl7.org/fhir/ValueSet/document-relationship-type to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1

Composition.section.author

Added Element

Composition.section.focus

Added Element

Composition.section.mode

Change value set from http://hl7.org/fhir/ValueSet/list-mode to http://hl7.org/fhir/ValueSet/list-mode|4.0.1
No longer marked as Modifier

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)

Structure

Name	Flags	Card.	Type	Description & Constraints
Composition	TU		DomainResource	A set of resources composed into a single coherent clinical statement with clinical attestation Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary \| final \| amended \| entered-in-error CompositionStatus (Required)
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) FHIR Document Type Codes (Preferred)
category	Σ	0..*	CodeableConcept	Categorization of Composition Document Class Value Set (Example)
subject	Σ	0..1	Reference(Any)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain V3 Value SetConfidentialityClassification (Required)
attester		0..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal \| professional \| legal \| official CompositionAttestationMode (Required)
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole \| Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
code		1..1	code	replaces \| transforms \| signs \| appends DocumentRelationshipType (Required)
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented v3 Code System ActCode (Example)
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Any)	The event(s) being documented
section	I	0..*	BackboneElement	Composition is broken into sections + Rule: A section must contain at least one of text, entries, or sub-sections + Rule: A section can only have an emptyReason if it is empty
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Document Section Codes (Example)
author		0..*	Reference(Practitioner \| PractitionerRole \| Device \| Patient \| RelatedPerson \| Organization)	Who and/or what authored the section
focus		0..1	Reference(Any)	Who/what the section is about, when it is not about the subject of composition
text	I	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working \| snapshot \| changes ListMode (Required)
orderedBy		0..1	CodeableConcept	Order of section entries List Order Codes (Preferred)
entry	I	0..*	Reference(Any)	A reference to data that supports this section
emptyReason	I	0..1	CodeableConcept	Why the section is empty List Empty Reasons (Preferred)
section	I	0..*	see section	Nested Section
Documentation for this format

UML Diagram (Legend)

XML Template

<Composition xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..1 Identifier Version-independent identifier for the Composition --></identifier>
 <status value="[code]"/><!-- 1..1 preliminary | final | amended | entered-in-error -->
 <type><!-- 1..1 CodeableConcept Kind of composition (LOINC if possible) --></type>
 <category><!-- 0..* CodeableConcept Categorization of Composition --></category>
 <subject><!-- 0..1 Reference(Any) Who and/or what the composition is about --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Context of the Composition --></encounter>
 <date value="[dateTime]"/><!-- 1..1 Composition editing time -->
 <author><!-- 1..* Reference(Practitioner|PractitionerRole|Device|Patient|
   RelatedPerson|Organization) Who and/or what authored the composition --></author>
 <title value="[string]"/><!-- 1..1 Human Readable name/title -->
 <confidentiality value="[code]"/><!-- 0..1 As defined by affinity domain -->
 <attester>  <!-- 0..* Attests to accuracy of composition -->
  <mode value="[code]"/><!-- 1..1 personal | professional | legal | official -->
  <time value="[dateTime]"/><!-- 0..1 When the composition was attested -->
  <party><!-- 0..1 Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|
    Organization) Who attested the composition --></party>
 </attester>
 <custodian><!-- 0..1 Reference(Organization) Organization which maintains the composition --></custodian>
 <relatesTo>  <!-- 0..* Relationships to other compositions/documents -->
  <code value="[code]"/><!-- 1..1 replaces | transforms | signs | appends -->
  <target[x]><!-- 1..1 Identifier|Reference(Composition) Target of the relationship --></target[x]>
 </relatesTo>
 <event>  <!-- 0..* The clinical service(s) being documented -->
  <code><!-- 0..* CodeableConcept Code(s) that apply to the event being documented --></code>
  <period><!-- 0..1 Period The period covered by the documentation --></period>
  <detail><!-- 0..* Reference(Any) The event(s) being documented --></detail>
 </event>
 <section>  <!-- 0..* Composition is broken into sections -->
  <title value="[string]"/><!-- 0..1 Label for section (e.g. for ToC) -->
  <code><!-- 0..1 CodeableConcept Classification of section (recommended) --></code>
  <author><!-- 0..* Reference(Practitioner|PractitionerRole|Device|Patient|
    RelatedPerson|Organization) Who and/or what authored the section --></author>
  <focus><!-- 0..1 Reference(Any) Who/what the section is about, when it is not about the subject of composition --></focus>
  <text><!--  0..1 Narrative Text summary of the section, for human interpretation --></text>
  <mode value="[code]"/><!-- 0..1 working | snapshot | changes -->
  <orderedBy><!-- 0..1 CodeableConcept Order of section entries --></orderedBy>
  <entry><!--  0..* Reference(Any) A reference to data that supports this section --></entry>
  <emptyReason><!--  0..1 CodeableConcept Why the section is empty --></emptyReason>
  <section><!--  0..* Content as for Composition.section Nested Section --></section>
 </section>
</Composition>

JSON Template

{
  "resourceType" : "Composition",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : { Identifier }, // Version-independent identifier for the Composition
  "status" : "<code>", // R!  preliminary | final | amended | entered-in-error
  "type" : { CodeableConcept }, // R!  Kind of composition (LOINC if possible)
  "category" : [{ CodeableConcept }], // Categorization of Composition
  "subject" : { Reference(Any) }, // Who and/or what the composition is about
  "encounter" : { Reference(Encounter) }, // Context of the Composition
  "date" : "<dateTime>", // R!  Composition editing time
  "author" : [{ Reference(Practitioner|PractitionerRole|Device|Patient|
   RelatedPerson|Organization) }], // R!  Who and/or what authored the composition
  "title" : "<string>", // R!  Human Readable name/title
  "confidentiality" : "<code>", // As defined by affinity domain
  "attester" : [{ // Attests to accuracy of composition
    "mode" : "<code>", // R!  personal | professional | legal | official
    "time" : "<dateTime>", // When the composition was attested
    "party" : { Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|
    Organization) } // Who attested the composition
  }],
  "custodian" : { Reference(Organization) }, // Organization which maintains the composition
  "relatesTo" : [{ // Relationships to other compositions/documents
    "code" : "<code>", // R!  replaces | transforms | signs | appends
    // target[x]: Target of the relationship. One of these 2:
    "targetIdentifier" : { Identifier }
    "targetReference" : { Reference(Composition) }
  }],
  "event" : [{ // The clinical service(s) being documented
    "code" : [{ CodeableConcept }], // Code(s) that apply to the event being documented
    "period" : { Period }, // The period covered by the documentation
    "detail" : [{ Reference(Any) }] // The event(s) being documented
  }],
  "section" : [{ // Composition is broken into sections
    "title" : "<string>", // Label for section (e.g. for ToC)
    "code" : { CodeableConcept }, // Classification of section (recommended)
    "author" : [{ Reference(Practitioner|PractitionerRole|Device|Patient|
    RelatedPerson|Organization) }], // Who and/or what authored the section
    "focus" : { Reference(Any) }, // Who/what the section is about, when it is not about the subject of composition
    "text" : { Narrative }, // C? Text summary of the section, for human interpretation
    "mode" : "<code>", // working | snapshot | changes
    "orderedBy" : { CodeableConcept }, // Order of section entries
    "entry" : [{ Reference(Any) }], // C? A reference to data that supports this section
    "emptyReason" : { CodeableConcept }, // C? Why the section is empty
    "section" : [{ Content as for Composition.section }] // C? Nested Section
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:Composition;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Composition.identifier [ Identifier ]; # 0..1 Version-independent identifier for the Composition
  fhir:Composition.status [ code ]; # 1..1 preliminary | final | amended | entered-in-error
  fhir:Composition.type [ CodeableConcept ]; # 1..1 Kind of composition (LOINC if possible)
  fhir:Composition.category [ CodeableConcept ], ... ; # 0..* Categorization of Composition
  fhir:Composition.subject [ Reference(Any) ]; # 0..1 Who and/or what the composition is about
  fhir:Composition.encounter [ Reference(Encounter) ]; # 0..1 Context of the Composition
  fhir:Composition.date [ dateTime ]; # 1..1 Composition editing time
  fhir:Composition.author [ Reference(Practitioner|PractitionerRole|Device|Patient|RelatedPerson|Organization) ], ... ; # 1..* Who and/or what authored the composition
  fhir:Composition.title [ string ]; # 1..1 Human Readable name/title
  fhir:Composition.confidentiality [ code ]; # 0..1 As defined by affinity domain
  fhir:Composition.attester [ # 0..* Attests to accuracy of composition
    fhir:Composition.attester.mode [ code ]; # 1..1 personal | professional | legal | official
    fhir:Composition.attester.time [ dateTime ]; # 0..1 When the composition was attested
    fhir:Composition.attester.party [ Reference(Patient|RelatedPerson|Practitioner|PractitionerRole|Organization) ]; # 0..1 Who attested the composition
  ], ...;
  fhir:Composition.custodian [ Reference(Organization) ]; # 0..1 Organization which maintains the composition
  fhir:Composition.relatesTo [ # 0..* Relationships to other compositions/documents
    fhir:Composition.relatesTo.code [ code ]; # 1..1 replaces | transforms | signs | appends
    # Composition.relatesTo.target[x] : 1..1 Target of the relationship. One of these 2
      fhir:Composition.relatesTo.targetIdentifier [ Identifier ]
      fhir:Composition.relatesTo.targetReference [ Reference(Composition) ]
  ], ...;
  fhir:Composition.event [ # 0..* The clinical service(s) being documented
    fhir:Composition.event.code [ CodeableConcept ], ... ; # 0..* Code(s) that apply to the event being documented
    fhir:Composition.event.period [ Period ]; # 0..1 The period covered by the documentation
    fhir:Composition.event.detail [ Reference(Any) ], ... ; # 0..* The event(s) being documented
  ], ...;
  fhir:Composition.section [ # 0..* Composition is broken into sections
    fhir:Composition.section.title [ string ]; # 0..1 Label for section (e.g. for ToC)
    fhir:Composition.section.code [ CodeableConcept ]; # 0..1 Classification of section (recommended)
    fhir:Composition.section.author [ Reference(Practitioner|PractitionerRole|Device|Patient|RelatedPerson|Organization) ], ... ; # 0..* Who and/or what authored the section
    fhir:Composition.section.focus [ Reference(Any) ]; # 0..1 Who/what the section is about, when it is not about the subject of composition
    fhir:Composition.section.text [ Narrative ]; # 0..1 Text summary of the section, for human interpretation
    fhir:Composition.section.mode [ code ]; # 0..1 working | snapshot | changes
    fhir:Composition.section.orderedBy [ CodeableConcept ]; # 0..1 Order of section entries
    fhir:Composition.section.entry [ Reference(Any) ], ... ; # 0..* A reference to data that supports this section
    fhir:Composition.section.emptyReason [ CodeableConcept ]; # 0..1 Why the section is empty
    fhir:Composition.section.section [ See Composition.section ], ... ; # 0..* Nested Section
  ], ...;
]

Changes since Release 3

Composition

Composition.status

Change value set from http://hl7.org/fhir/ValueSet/composition-status to http://hl7.org/fhir/ValueSet/composition-status|4.0.1

Composition.category

Renamed from class to category
Max Cardinality changed from 1 to *

Composition.subject

Min Cardinality changed from 1 to 0

Composition.author

Type Reference: Added Target Types PractitionerRole, Organization

Composition.confidentiality

Change value set from http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification to http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26
No longer marked as Modifier

Composition.attester.mode

Max Cardinality changed from * to 1
Change value set from http://hl7.org/fhir/ValueSet/composition-attestation-mode to http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1

Composition.attester.party

Type Reference: Added Target Types RelatedPerson, PractitionerRole

Composition.relatesTo.code

Change value set from http://hl7.org/fhir/ValueSet/document-relationship-type to http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1

Composition.section.author

Added Element

Composition.section.focus

Added Element

Composition.section.mode

Change value set from http://hl7.org/fhir/ValueSet/list-mode to http://hl7.org/fhir/ValueSet/list-mode|4.0.1
No longer marked as Modifier

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

2.41.4.1 Terminology Bindings

Path	Definition	Type	Reference
Composition.status	The workflow/clinical status of the composition.	Required	CompositionStatus
Composition.type	Type of a composition.	Preferred	FHIRDocumentTypeCodes
Composition.category	High-level kind of a clinical document at a macro level.	Example	DocumentClassValueSet
Composition.confidentiality	Codes specifying the level of confidentiality of the composition.	Required	v3.ConfidentialityClassification
Composition.attester.mode	The way in which a person authenticated a composition.	Required	CompositionAttestationMode
Composition.relatesTo.code	The type of relationship between documents.	Required	DocumentRelationshipType
Composition.event.code	This list of codes represents the main clinical acts being documented.	Example	v3.ActCode
Composition.section.code	Classification of a section of a composition/document.	Example	DocumentSectionCodes
Composition.section.mode	The processing mode that applies to this section.	Required	ListMode
Composition.section.orderedBy	What order applies to the items in the entry.	Preferred	ListOrderCodes
Composition.section.emptyReason	If a section is empty, why it is empty.	Preferred	ListEmptyReasons

Path

Definition

Type

Reference

Composition.status

The workflow/clinical status of the composition.

Required

CompositionStatus

Composition.type

Type of a composition.

Preferred

FHIRDocumentTypeCodes

Composition.category

High-level kind of a clinical document at a macro level.

Example

DocumentClassValueSet

Composition.confidentiality

Codes specifying the level of confidentiality of the composition.

Required

v3.ConfidentialityClassification

Composition.attester.mode

The way in which a person authenticated a composition.

Required

CompositionAttestationMode

Composition.relatesTo.code

The type of relationship between documents.

Required

DocumentRelationshipType

Composition.event.code

This list of codes represents the main clinical acts being documented.

Example

v3.ActCode

Composition.section.code

Classification of a section of a composition/document.

Example

DocumentSectionCodes

Composition.section.mode

The processing mode that applies to this section.

Required

ListMode

Composition.section.orderedBy

What order applies to the items in the entry.

Preferred

ListOrderCodes

Composition.section.emptyReason

If a section is empty, why it is empty.

Preferred

ListEmptyReasons

2.41.4.2 Constraints

Level

Location

Description

Expression

cmp-1

Rule

Composition.section

A section must contain at least one of text, entries, or sub-sections

text.exists() or entry.exists() or section.exists()

cmp-2

Rule

Composition.section

A section can only have an emptyReason if it is empty

emptyReason.empty() or entry.empty()

2.41.5 Notes:

The author and the attester are often the same person, but this might not be the case in some clinical workflows.
The attester attests contents of the document resource, the subject resource and the resources referred to in the Composition.section.content references. Because documents are often derived Compositions and the attestation from the composition is held to apply to the document, the method for presenting a document should be used when/if attesters review the content of the composition.
The custodian is responsible for the maintenance of the composition and any documents derived from it. With regard to the documents, they are responsible for the policy regarding persistence of the documents. Although they need not actually retain a copy of the document, they SHOULD do so.
It is acceptable for a Composition to contain only narrative (Composition.section.text) and no entries (Composition.section.entry)

2.41.6 Compositions about multiple entities

Typically, a composition is made about the subject - e.g. a patient, or group of patients, location, or device - and the distinction between the subject and the composition describes the subject. Some kinds of documents contain data about other parties or entities that are relevant to the subject of the document. Some examples:

A neonatal discharge summary that contains information about the mother
A family history document that contains multiple sections for different family members
A social health evaluation document that contains information about the patient's family members
A procedure report that contains details about a device implanted in the patient

In all these cases, the subject of the document is a single patient, but some of the details are actually related to other persons or entities. When this happens, these other entities are detailed in the Composition.section.focus element. In the absence of a focus, it is assumed that the subject of the composition is the focus.

If a focus is specified, then the resources referred to from the section SHALL either:

specify that their subject (however named e.g. patient) or focus element (if present) is the focus indicated
not have a subject element

A few compositions genuinely cover multiple subjects - different sections are about different subjects. In such case, Composition.subject is omitted, and the extension section-subject is used on each section to indicate the subject.

Trial-Use Note: Feedback is welcome on two issues related to Composition:

For many compositions, the title is the same as the text or a display name of Composition.type (e.g., a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here during the trial use period.

A client can ask a server to generate a fully bundled document from a Composition resource using the $snapshot operation. This operation definition does not resolve the question how document signatures are created. This is an open issue during the period of trial use, and feedback is requested regarding this question.

Feedback here .

2.41.7 Search Parameters

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	Expression	In Common
attester	reference	Who attested the composition	Composition.attester.party (Practitioner, Organization, Patient, PractitionerRole, RelatedPerson)
author	reference	Who and/or what authored the composition	Composition.author (Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson)
category	token	Categorization of Composition	Composition.category
confidentiality	token	As defined by affinity domain	Composition.confidentiality
context	token	Code(s) that apply to the event being documented	Composition.event.code
date	date	Composition editing time	Composition.date	17 Resources
encounter	reference	Context of the Composition	Composition.encounter (Encounter)	12 Resources
entry	reference	A reference to data that supports this section	Composition.section.entry (Any)
identifier	token	Version-independent identifier for the Composition	Composition.identifier	30 Resources
patient	reference	Who and/or what the composition is about	Composition.subject.where(resolve() is Patient) (Patient)	33 Resources
period	date	The period covered by the documentation	Composition.event.period
related-id	token	Target of the relationship	(Composition.relatesTo.target as Identifier)
related-ref	reference	Target of the relationship	(Composition.relatesTo.target as Reference) (Composition)
section	token	Classification of section (recommended)	Composition.section.code
status	token	preliminary \| final \| amended \| entered-in-error	Composition.status
subject	reference	Who and/or what the composition is about	Composition.subject (Any)
title	string	Human Readable name/title	Composition.title
type	token	Kind of composition (LOINC if possible)	Composition.type	5 Resources