This profile defines the requirements for communicating a Personal Advance Care Plan (PACP) using a Composition Resource. It is used to create a person-generated document which is authored by the subject of the document (the patient). It contains information about the person’s goals, preferences, and priorities (GPPs) for care and treatment under certain future conditions.

It is possible for a PACP composition to only contain textual information and not have any encoded entries. In this case, an implementer may populate the section.text element in place of a resource reference in the section.entry element.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from ADICompositionHeader

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
author		1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
Slices for section		1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
text	S	1..1	Narrative	Text summary of the section, for human interpretation
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
entry		0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason		0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition	S	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
entry		0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience	S	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
entry		0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death	S	0..1	BackboneElement	Goals, preferences, and priorities upon death
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry		0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
section:additional_documentation	S	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry		0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	S	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry		0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information	S	0..1	BackboneElement	Administrative information associated with this personal advance care plan
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
VersionNumber	S	0..1	integer	Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-versionNumber-extension
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SC	1..1	Narrative	Text summary of the section, for human interpretation
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
entry	C	0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition	SC	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
entry	C	0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience	SC	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
entry	C	0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death	SC	0..1	BackboneElement	Goals, preferences, and priorities upon death
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry	C	0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
section:additional_documentation	SC	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	SC	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information	SC	0..1	BackboneElement	Administrative information associated with this personal advance care plan
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus
Composition.type	extensible	AdvanceDirectivesCategories
Composition.category	example	Pattern: LOINC code 42348-3
Composition.section:healthcare_agent.code	example	Pattern: LOINC code 81335-2
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS
Composition.section:gpp_for_certain_health_condition.code	example	Pattern: LOINC code 81336-0
Composition.section:gpp_personal_care_experience.code	example	Pattern: LOINC code 81338-6
Composition.section:gpp_upon_death.code	example	Pattern: LOINC code 81337-8
Composition.section:additional_documentation.code	example	Pattern: LOINC code 77599-9
Composition.section:witness_and_notary.code	example	Pattern: LOINC code 81339-4
Composition.section:administrative_information.code	example	Pattern: LOINC code 81381-6

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
VersionNumber	S	0..1	integer	Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-versionNumber-extension
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section	C	0..*	See section (Composition)	Nested Section
section:gpp_for_certain_health_condition	SC	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_personal_care_experience	SC	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_upon_death	SC	0..1	BackboneElement	Goals, preferences, and priorities upon death
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:additional_documentation	SC	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:witness_and_notary	SC	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:administrative_information	SC	0..1	BackboneElement	Administrative information associated with this personal advance care plan
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus
Composition.type	extensible	AdvanceDirectivesCategories
Composition.category	example	Pattern: LOINC code 42348-3
Composition.attester.mode	required	CompositionAttestationMode
Composition.relatesTo.code	required	DocumentRelationshipType
Composition.event.code	example	ActCode
Composition.section.code	example	DocumentSectionCodes
Composition.section.mode	required	ListMode
Composition.section.orderedBy	preferred	ListOrderCodes
Composition.section.emptyReason	preferred	ListEmptyReasons
Composition.section:healthcare_agent.code	example	Pattern: LOINC code 81335-2
Composition.section:healthcare_agent.mode	required	ListMode
Composition.section:healthcare_agent.orderedBy	preferred	ListOrderCodes
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS
Composition.section:gpp_for_certain_health_condition.code	example	Pattern: LOINC code 81336-0
Composition.section:gpp_for_certain_health_condition.mode	required	ListMode
Composition.section:gpp_for_certain_health_condition.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_for_certain_health_condition.emptyReason	preferred	ListEmptyReasons
Composition.section:gpp_personal_care_experience.code	example	Pattern: LOINC code 81338-6
Composition.section:gpp_personal_care_experience.mode	required	ListMode
Composition.section:gpp_personal_care_experience.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_personal_care_experience.emptyReason	preferred	ListEmptyReasons
Composition.section:gpp_upon_death.code	example	Pattern: LOINC code 81337-8
Composition.section:gpp_upon_death.mode	required	ListMode
Composition.section:gpp_upon_death.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_upon_death.emptyReason	preferred	ListEmptyReasons
Composition.section:additional_documentation.code	example	Pattern: LOINC code 77599-9
Composition.section:additional_documentation.mode	required	ListMode
Composition.section:additional_documentation.orderedBy	preferred	ListOrderCodes
Composition.section:additional_documentation.emptyReason	preferred	ListEmptyReasons
Composition.section:witness_and_notary.code	example	Pattern: LOINC code 81339-4
Composition.section:witness_and_notary.mode	required	ListMode
Composition.section:witness_and_notary.orderedBy	preferred	ListOrderCodes
Composition.section:witness_and_notary.emptyReason	preferred	ListEmptyReasons
Composition.section:administrative_information.code	example	Pattern: LOINC code 81381-6
Composition.section:administrative_information.mode	required	ListMode
Composition.section:administrative_information.orderedBy	preferred	ListOrderCodes
Composition.section:administrative_information.emptyReason	preferred	ListEmptyReasons

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

Differential View

This structure is derived from ADICompositionHeader

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
author		1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
Slices for section		1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
text	S	1..1	Narrative	Text summary of the section, for human interpretation
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
entry		0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason		0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition	S	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
entry		0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience	S	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
entry		0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death	S	0..1	BackboneElement	Goals, preferences, and priorities upon death
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry		0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
section:additional_documentation	S	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry		0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	S	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry		0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information	S	0..1	BackboneElement	Administrative information associated with this personal advance care plan
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
VersionNumber	S	0..1	integer	Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-versionNumber-extension
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SC	1..1	Narrative	Text summary of the section, for human interpretation
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
entry	C	0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section:gpp_for_certain_health_condition	SC	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
entry	C	0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
section:gpp_personal_care_experience	SC	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
entry	C	0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
section:gpp_upon_death	SC	0..1	BackboneElement	Goals, preferences, and priorities upon death
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry	C	0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
section:additional_documentation	SC	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	SC	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
section:administrative_information	SC	0..1	BackboneElement	Administrative information associated with this personal advance care plan
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus
Composition.type	extensible	AdvanceDirectivesCategories
Composition.category	example	Pattern: LOINC code 42348-3
Composition.section:healthcare_agent.code	example	Pattern: LOINC code 81335-2
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS
Composition.section:gpp_for_certain_health_condition.code	example	Pattern: LOINC code 81336-0
Composition.section:gpp_personal_care_experience.code	example	Pattern: LOINC code 81338-6
Composition.section:gpp_upon_death.code	example	Pattern: LOINC code 81337-8
Composition.section:additional_documentation.code	example	Pattern: LOINC code 77599-9
Composition.section:witness_and_notary.code	example	Pattern: LOINC code 81339-4
Composition.section:administrative_information.code	example	Pattern: LOINC code 81381-6

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation HCA-section-cardinality: If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) HCA-section-emptyReason-required: section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries.
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
VersionNumber	S	0..1	integer	Version Number URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-versionNumber-extension
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Patient Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:healthcare_agent	C	0..1	BackboneElement	Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations HCA-section-entries: If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81335-2
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Participant Consent | ADI Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	This is only MS (must support) if the document types are supported. Binding: No Healthcare Agent Included Reason (required)
section	C	0..*	See section (Composition)	Nested Section
section:gpp_for_certain_health_condition	SC	0..1	BackboneElement	Preference care plans defined for specific situations and/or conditions
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81336-0
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Preference Care Plan)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_personal_care_experience	SC	0..1	BackboneElement	Quality of Life related personal care experiences, personal goals, and priorities
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81338-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_upon_death	SC	0..1	BackboneElement	Goals, preferences, and priorities upon death
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Preference Care Plan | Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation | ADI Personal Goal)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:additional_documentation	SC	0..1	BackboneElement	Observations regarding the existence of other advance directive related information
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:witness_and_notary	SC	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Witness | ADI Notary)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:administrative_information	SC	0..1	BackboneElement	Administrative information associated with this personal advance care plan
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81381-6
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus
Composition.type	extensible	AdvanceDirectivesCategories
Composition.category	example	Pattern: LOINC code 42348-3
Composition.attester.mode	required	CompositionAttestationMode
Composition.relatesTo.code	required	DocumentRelationshipType
Composition.event.code	example	ActCode
Composition.section.code	example	DocumentSectionCodes
Composition.section.mode	required	ListMode
Composition.section.orderedBy	preferred	ListOrderCodes
Composition.section.emptyReason	preferred	ListEmptyReasons
Composition.section:healthcare_agent.code	example	Pattern: LOINC code 81335-2
Composition.section:healthcare_agent.mode	required	ListMode
Composition.section:healthcare_agent.orderedBy	preferred	ListOrderCodes
Composition.section:healthcare_agent.emptyReason	required	ADINoHealthcareAgentIncludedReasonVS
Composition.section:gpp_for_certain_health_condition.code	example	Pattern: LOINC code 81336-0
Composition.section:gpp_for_certain_health_condition.mode	required	ListMode
Composition.section:gpp_for_certain_health_condition.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_for_certain_health_condition.emptyReason	preferred	ListEmptyReasons
Composition.section:gpp_personal_care_experience.code	example	Pattern: LOINC code 81338-6
Composition.section:gpp_personal_care_experience.mode	required	ListMode
Composition.section:gpp_personal_care_experience.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_personal_care_experience.emptyReason	preferred	ListEmptyReasons
Composition.section:gpp_upon_death.code	example	Pattern: LOINC code 81337-8
Composition.section:gpp_upon_death.mode	required	ListMode
Composition.section:gpp_upon_death.orderedBy	preferred	ListOrderCodes
Composition.section:gpp_upon_death.emptyReason	preferred	ListEmptyReasons
Composition.section:additional_documentation.code	example	Pattern: LOINC code 77599-9
Composition.section:additional_documentation.mode	required	ListMode
Composition.section:additional_documentation.orderedBy	preferred	ListOrderCodes
Composition.section:additional_documentation.emptyReason	preferred	ListEmptyReasons
Composition.section:witness_and_notary.code	example	Pattern: LOINC code 81339-4
Composition.section:witness_and_notary.mode	required	ListMode
Composition.section:witness_and_notary.orderedBy	preferred	ListOrderCodes
Composition.section:witness_and_notary.emptyReason	preferred	ListEmptyReasons
Composition.section:administrative_information.code	example	Pattern: LOINC code 81381-6
Composition.section:administrative_information.mode	required	ListMode
Composition.section:administrative_information.orderedBy	preferred	ListOrderCodes
Composition.section:administrative_information.emptyReason	preferred	ListEmptyReasons

Constraints

Id	Grade	Path(s)	Details	Requirements
HCA-section-cardinality	error	Composition	If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) : (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required	error	Composition	section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. : section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries	error	Composition.section:healthcare_agent	If healthcare agent section entry exists, then the HCA consent entry and HCA relatedPerson entry must exist : entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is relatedPerson).exists())

This structure is derived from ADICompositionHeader

Summary

Mandatory: 2 elements (14 nested mandatory elements)
Must-Support: 14 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• ADI Participant Consent (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ParticipantConsent)
• ADI Participant (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Participant)
• ADI Preference Care Plan (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan)
• ADI Care Experience Preference (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference)
• ADI Personal Priorities Organizer (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalPrioritiesOrganizer)
• ADI Personal Goal (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalGoal)
• Personal Intervention Preference (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference)
• ADI Autopsy Observation (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-AutopsyObservation)
• ADI Organ Donation (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-OrganDonationObservation)
• ADI Documentation Observation (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation)
• ADI Witness (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Witness)
• ADI Notary (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Notary)

Slices

This structure defines the following Slices:

• The element Composition.section is sliced based on the value of pattern:code