US Core Implementation Guide
8.0.1 - STU 8 United States of America flag

This page is part of the US Core (v8.0.1: STU8) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions. Page versions: R8 R7 R6 R5 R4 R3

Resource Profile: US Core CarePlan Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan Version: 8.0.1
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreCarePlanProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.15

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core CarePlan Profile inherits from the FHIR CarePlan resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the CarePlan resource to record, search, and fetch assessment and plan of treatment data associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for a care plan belonging to a Patient
  • Record or update an existing care plan

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each CarePlan Must Have:

  1. a status
  2. a category
  3. an intent
  4. a patient

Each CarePlan Must Support:

  1. a narrative summary of the patient assessment and plan of treatment*
  2. a category code of "assess-plan"

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ASTP Health IT certification testing and are included in the formal definition of the profile and the CarePlan examples.

  1. a contributor*

*see guidance below

Profile Specific Implementation Guidance:

  • *The original Assessment and Plan design in the CarePlan was to support the "Assessment and Plan" from a narrative Progress Note. Systems have advanced significantly since the introduction of this requirement in 2015. Relaxing this to 0..1 allows more sophisticated systems to discretely encode a CarePlan instead of providing the narrative portion.
  • Additional considerations for systems aligning with HL7 Consolidated (C-CDA) Care Plan requirements:
    • US Core Goal SHOULD be present in CarePlan.goal
    • US Core Condition SHOULD be present in CarePlan.addresses
    • Assessment and Plan MAY be included as narrative in CarePlan.text
  • As an alternative to the US Core CarePlan, Assessment and Plan of Treatment may be included in various types of Clinical Notes, such as Progress Notes, History & Physical (H&P), Discharge Summaries, etc.
  • *The profile element CarePlan.contributor communicates the individual level provenance author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

  • The data elements list has changed

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div SC 1..1 xhtml Limited xhtml content
    Constraints: txt-1, txt-2
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent ?!SΣ 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category SΣ 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
    .... category:AssessPlan SΣ 0..1 CodeableConcept Type of plan
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... version 0..1 string Version of the system - if relevant
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ...... 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 S | Group) Who the care plan is for
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
    CarePlan.category Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.category:AssessPlan Base example Care Plan Category 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error CarePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error CarePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
    txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

    This structure is derived from CarePlan

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div S 1..1 xhtml Limited xhtml content
    ... status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent S 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category S 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    .... category:AssessPlan S 0..1 CodeableConcept Type of plan
    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... 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 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div SC 1..1 xhtml Limited xhtml content
    Constraints: txt-1, txt-2
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier External Ids for this plan
    ... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan) Fulfills CarePlan
    ... replaces Σ 0..* Reference(CarePlan) CarePlan replaced by this CarePlan
    ... partOf Σ 0..* Reference(CarePlan) Part of referenced CarePlan
    ... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent ?!SΣ 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category SΣ 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
    .... category:AssessPlan SΣ 0..1 CodeableConcept Type of plan
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... version 0..1 string Version of the system - if relevant
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ...... 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
    ... title Σ 0..1 string Human-friendly name for the care plan
    ... description Σ 0..1 string Summary of nature of plan
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
    ... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
    ... period Σ 0..1 Period Time period plan covers
    ... created Σ 0..1 dateTime Date record was first recorded
    ... author Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who is the designated responsible party
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
    ... careTeam 0..* Reference(CareTeam) Who's involved in plan?
    ... addresses Σ 0..* Reference(Condition) Health issues this plan addresses
    ... supportingInfo 0..* Reference(Resource) Information considered as part of plan
    ... goal 0..* Reference(Goal) Desired outcome of plan
    ... activity C 0..* BackboneElement Action to occur as part of plan
    Constraints: cpl-3
    .... 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
    .... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
    Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
    .... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
    .... progress 0..* Annotation Comments about the activity status/progress
    .... reference C 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) Activity details defined in specific resource
    .... detail C 0..1 BackboneElement In-line definition of activity
    ..... 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
    ..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
    Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.
    ..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
    ..... instantiatesUri 0..* uri Instantiates external protocol or definition
    ..... code 0..1 CodeableConcept Detail type of activity
    Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.
    ..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
    Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.
    ..... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why activity is needed
    ..... goal 0..* Reference(Goal) Goals this activity relates to
    ..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
    Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
    ..... statusReason 0..1 CodeableConcept Reason for current status
    ..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
    ..... scheduled[x] 0..1 When activity is to occur
    ...... scheduledTiming Timing
    ...... scheduledPeriod Period
    ...... scheduledString string
    ..... location 0..1 Reference(Location) Where it should happen
    ..... performer 0..* Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) Who will be responsible?
    ..... product[x] 0..1 What is to be administered/supplied
    Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
    ...... productCodeableConcept CodeableConcept
    ...... productReference Reference(Medication | Substance)
    ..... dailyAmount 0..1 SimpleQuantity(4.0.1) How to consume/day?
    ..... quantity 0..1 SimpleQuantity(4.0.1) How much to administer/supply/consume
    ..... description 0..1 string Extra info describing activity to perform
    ... note 0..* Annotation Comments about the plan

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    CarePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
    CarePlan.category Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.category:AssessPlan Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.activity.outcomeCodeableConcept Base example Care Plan Activity Outcome 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​kind Base required Care Plan Activity Kind 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​code Base example Procedure Codes (SNOMED CT) 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
    dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error CarePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error CarePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
    txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div SC 1..1 xhtml Limited xhtml content
    Constraints: txt-1, txt-2
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent ?!SΣ 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category SΣ 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
    .... category:AssessPlan SΣ 0..1 CodeableConcept Type of plan
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... version 0..1 string Version of the system - if relevant
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ...... 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 S | Group) Who the care plan is for
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
    CarePlan.category Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.category:AssessPlan Base example Care Plan Category 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error CarePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error CarePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
    txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

    Differential View

    This structure is derived from CarePlan

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div S 1..1 xhtml Limited xhtml content
    ... status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent S 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category S 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    .... category:AssessPlan S 0..1 CodeableConcept Type of plan
    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. CarePlan 0..* CarePlan Healthcare plan for patient or group
    ... 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 0..1 code Language of the resource content
    Binding: CommonLanguages (preferred): A human language.
    Additional BindingsPurpose
    AllLanguages Max Binding
    ... text S 0..1 Narrative Text summary of the resource, for human interpretation
    This profile does not constrain the narrative in regard to content, language, or traceability to data elements
    .... id 0..1 string Unique id for inter-element referencing
    .... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    .... status S 1..1 code generated | additional
    Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
    .... div SC 1..1 xhtml Limited xhtml content
    Constraints: txt-1, txt-2
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... identifier Σ 0..* Identifier External Ids for this plan
    ... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
    ... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
    ... basedOn Σ 0..* Reference(CarePlan) Fulfills CarePlan
    ... replaces Σ 0..* Reference(CarePlan) CarePlan replaced by this CarePlan
    ... partOf Σ 0..* Reference(CarePlan) Part of referenced CarePlan
    ... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
    Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
    ... intent ?!SΣ 1..1 code proposal | plan | order | option
    Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan
    ... Slices for category SΣ 1..* CodeableConcept Type of plan
    Slice: Unordered, Open by value:$this
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
    .... category:AssessPlan SΣ 0..1 CodeableConcept Type of plan
    Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

    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://hl7.org/fhir/us/core/CodeSystem/careplan-category
    ...... version 0..1 string Version of the system - if relevant
    ...... code 1..1 code Symbol in syntax defined by the system
    Fixed Value: assess-plan
    ...... 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
    ... title Σ 0..1 string Human-friendly name for the care plan
    ... description Σ 0..1 string Summary of nature of plan
    ... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
    ... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
    ... period Σ 0..1 Period Time period plan covers
    ... created Σ 0..1 dateTime Date record was first recorded
    ... author Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who is the designated responsible party
    ... contributor 0..* Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
    ... careTeam 0..* Reference(CareTeam) Who's involved in plan?
    ... addresses Σ 0..* Reference(Condition) Health issues this plan addresses
    ... supportingInfo 0..* Reference(Resource) Information considered as part of plan
    ... goal 0..* Reference(Goal) Desired outcome of plan
    ... activity C 0..* BackboneElement Action to occur as part of plan
    Constraints: cpl-3
    .... 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
    .... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
    Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
    .... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
    .... progress 0..* Annotation Comments about the activity status/progress
    .... reference C 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) Activity details defined in specific resource
    .... detail C 0..1 BackboneElement In-line definition of activity
    ..... 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
    ..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
    Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.
    ..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
    ..... instantiatesUri 0..* uri Instantiates external protocol or definition
    ..... code 0..1 CodeableConcept Detail type of activity
    Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.
    ..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
    Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.
    ..... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why activity is needed
    ..... goal 0..* Reference(Goal) Goals this activity relates to
    ..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
    Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.
    ..... statusReason 0..1 CodeableConcept Reason for current status
    ..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
    ..... scheduled[x] 0..1 When activity is to occur
    ...... scheduledTiming Timing
    ...... scheduledPeriod Period
    ...... scheduledString string
    ..... location 0..1 Reference(Location) Where it should happen
    ..... performer 0..* Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) Who will be responsible?
    ..... product[x] 0..1 What is to be administered/supplied
    Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.
    ...... productCodeableConcept CodeableConcept
    ...... productReference Reference(Medication | Substance)
    ..... dailyAmount 0..1 SimpleQuantity(4.0.1) How to consume/day?
    ..... quantity 0..1 SimpleQuantity(4.0.1) How much to administer/supply/consume
    ..... description 0..1 string Extra info describing activity to perform
    ... note 0..* Annotation Comments about the plan

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    CarePlan.language Base preferred Common Languages 📍4.0.1 FHIR Std.
    CarePlan.text.status Base required US Core Narrative Status 📦8.0.1 This IG
    CarePlan.status Base required RequestStatus 📦4.0.1 FHIR Std.
    CarePlan.intent Base required Care Plan Intent 📦4.0.1 FHIR Std.
    CarePlan.category Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.category:AssessPlan Base example Care Plan Category 📍4.0.1 FHIR Std.
    CarePlan.activity.outcomeCodeableConcept Base example Care Plan Activity Outcome 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​kind Base required Care Plan Activity Kind 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​code Base example Procedure Codes (SNOMED CT) 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​reasonCode Base example SNOMED CT Clinical Findings 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​status Base required CarePlanActivityStatus 📍4.0.1 FHIR Std.
    CarePlan.activity.detail.​product[x] Base example SNOMED CT Medication Codes 📍4.0.1 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    cpl-3 error CarePlan.activity Provide a reference or detail, not both detail.empty() or reference.empty()
    dom-2 error CarePlan If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
    dom-3 error CarePlan If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
    dom-4 error CarePlan If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
    dom-5 error CarePlan If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
    dom-6 best practice CarePlan A resource should have narrative for robust management text.`div`.exists()
    ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
    ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
    txt-1 error CarePlan.text.div The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
    txt-2 error CarePlan.text.div The narrative SHALL have some non-whitespace content htmlChecks()

     

    Other representations of profile: CSV, Excel, Schematron

    Notes:

    Quick Start

    Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

    • See the Scopes Format section for a description of the SMART scopes syntax.
    • See the Search Syntax section for a description of the US Core search syntax.
    • See the General Requirements section for additional rules and expectations when a Server requires status parameters.
    • See the General Guidance section for additional guidance on searching for multiple patients.

    US Core Scopes

    Servers providing access to care plan data SHALL support these US Core SMART Scopes:

    Mandatory Search Parameters:

    The following search parameters and search parameter combinations SHALL be supported:

    1. SHALL support searching using the combination of the patient and category search parameters:

      GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan

      Example:

      1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan

      Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan (how to search by reference and how to search by token)

    Optional Search Parameters:

    The following search parameter combinations SHOULD be supported:

    1. SHOULD support searching using the combination of the patient and category and date search parameters:
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date=ge2019-01-01T00:00:00Z
      2. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date=ge2018-01-01T00:00:00Z&date=le2019-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and date (how to search by reference and how to search by token and how to search by date)

    2. SHOULD support searching using the combination of the patient and category and status search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

      GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status={system|}[code]{,{system|}[code],...}

      Example:

      1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active

      Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and status=active (how to search by reference and how to search by token)

    3. SHOULD support searching using the combination of the patient and category and status and date search parameters:
      • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
      • including support for these date comparators: gt,lt,ge,le
      • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

      GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

      Example:

      1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active&date=ge2019-01-01T00:00:00Z
      2. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active&date=ge2018-01-01T00:00:00Z&date=le2019-01-01T00:00:00Z

      Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and status=active and date (how to search by reference and how to search by token and how to search by date)