description: This profile represents the constraints applied to the Composition resource by the PS-CA project.\r\nA Canadian Patient Summary (PS-CA) document is an electronic health record extract containing essential healthcare information about a subject of care. It is informed by the IPS-UV Composition profile, but differs in its application of Must Support flags on some of the sections to allow for jurisdictional implementors flexibility in what sections systems Must Support in order to show conformance to their respective patient summaries.\r\nThe PS-CA dataset is minimal and non-exhaustive; specialty-agnostic and condition-independent; but still clinically relevant. Its informed by the requirements specified in EN 17269 and ISO/DIS 27269, it is designed for supporting the international use case scenario for ‘unplanned, cross border care’, but is also designed to support a variety of use cases for cross-jurisdiction exchange. It is intended to guide implementation nationally while ensuring international exchange of patient summaries is not impeded.\r\n\r\nThis profile is based on the ClinicalDocument profile from the base R4 FHIR standard.
package_name: ca.infoway.io.psca
derivation: constraint
name: CompositionPSCA
type: Composition
elements:
  date: {mustSupport: true, index: 7}
  encounter: {index: 6}
  section:
    short: Sections composing the PS
    mustSupport: true
    index: 26
    elements:
      code: {type: CodeableConcept, mustSupport: true, index: 27}
      text: {mustSupport: true, index: 28}
    required: [text, code]
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: code, type: pattern}
      min: 1
      slices:
        sectionProblems:
          match:
            code:
              coding:
              - {code: 11450-4, system: 'http://loinc.org'}
          schema:
            short: PS-CA Problems Section
            mustSupport: true
            _required: true
            index: 46
            elements:
              title: {mustSupport: true, index: 47}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11450-4, system: 'http://loinc.org'}
                index: 48
              entry:
                short: Clinical problems or conditions currently being monitored for the patient.
                mustSupport: true
                index: 49
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    problem:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to data that supports this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-ca-ps']
                        index: 50
                    ProblemSectionNotSupported:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to a resource with fixed elements indicating lack of support of this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-notsupported-ca-ps']
                        index: 51
              emptyReason: {index: 52}
              section: {index: 53}
            required: [entry, title, code]
        sectionProceduresHx:
          match:
            code:
              coding:
              - {code: 47519-4, system: 'http://loinc.org'}
          schema:
            short: PS-CA History of Procedures Section
            index: 54
            elements:
              title: {mustSupport: true, index: 55}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 47519-4, system: 'http://loinc.org'}
                index: 56
              entry:
                short: Patient past procedures pertinent to the scope of this document.
                mustSupport: true
                index: 57
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    procedure:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/procedure-ca-ps']
                        _required: true
                        index: 58
                      min: 1
              emptyReason: {index: 59}
              section: {index: 60}
            required: [entry, title, code]
        sectionPlanOfCare:
          match:
            code:
              coding:
              - {code: 18776-5, system: 'http://loinc.org'}
          schema:
            short: PS-CA Plan of Care Section
            index: 114
            elements:
              title: {mustSupport: true, index: 115}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 18776-5, system: 'http://loinc.org'}
                index: 116
              entry:
                short: Optional entry used to represent structured care plans
                index: 117
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    carePlan:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/CarePlan']
                        index: 118
              emptyReason: {index: 119}
              section: {index: 120}
            required: [title, code]
        sectionMedicalDevices:
          match:
            code:
              coding:
              - {code: 46264-8, system: 'http://loinc.org'}
          schema:
            short: PS-CA Medical Devices Section
            index: 68
            elements:
              title: {mustSupport: true, index: 69}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 46264-8, system: 'http://loinc.org'}
                index: 70
              entry:
                short: Patient history of medical device use.
                mustSupport: true
                index: 71
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    deviceStatement:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/uv/ips/StructureDefinition/DeviceUseStatement-uv-ips']
                        _required: true
                        index: 72
                      min: 1
              emptyReason: {index: 73}
              section: {index: 74}
            required: [entry, title, code]
        sectionSocialHistory:
          match:
            code:
              coding:
              - {code: 29762-2, system: 'http://loinc.org'}
          schema:
            short: PS-CA Social History Section
            index: 121
            elements:
              title: {mustSupport: true, index: 122}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 29762-2, system: 'http://loinc.org'}
                index: 123
              entry:
                short: Health related "lifestyle factors" or "lifestyle observations" (e.g. smoke habits; alcohol consumption; diets, risky habits.)
                mustSupport: true
                index: 124
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    generalSocialHistory:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-socialhistory-ca-ps']
                        index: 125
                    smokingTobaccoUse:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-tobaccouse-ca-ps']
                        index: 126
                      max: 1
                    alcoholUse:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/observation-alcoholuse-ca-ps']
                        index: 127
                      max: 1
              emptyReason: {index: 128}
              section: {index: 129}
            required: [title, code]
        sectionFunctionalStatus:
          match:
            code:
              coding:
              - {code: 47420-5, system: 'http://loinc.org'}
          schema:
            short: PS-CA Functional Status
            index: 106
            elements:
              title: {mustSupport: true, index: 107}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 47420-5, system: 'http://loinc.org'}
                index: 108
              entry:
                short: Optional entry used to represent disabilities and functional assessments
                mustSupport: true
                index: 109
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    disability:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-ca-ps']
                        index: 110
                    functionalAssessment:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/ClinicalImpression']
                        index: 111
              emptyReason: {index: 112}
              section: {index: 113}
            required: [title, code]
        sectionAllergies:
          match:
            code:
              coding:
              - {code: 48765-2, system: 'http://loinc.org'}
          schema:
            short: PS-CA Allergies and Intolerances Section
            mustSupport: true
            _required: true
            index: 38
            elements:
              title: {short: Allergies and Intolerances, mustSupport: true, index: 39}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 48765-2, system: 'http://loinc.org'}
                index: 40
              entry:
                short: Relevant allergies or intolerances (conditions) for that patient.
                mustSupport: true
                index: 41
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    allergyOrIntolerance:
                      match: {}
                      schema:
                        min: 1
                        short: A reference to data that supports this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/allergyintolerance-ca-ps']
                        type: Reference
                        array: true
                        _required: true
                        index: 42
                      min: 1
                    AllergySectionNotSupported:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to a resource with fixed elements indicating lack of support of this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/allergyintolerance-notsupported-ca-ps']
                        index: 43
              emptyReason: {index: 44}
              section: {index: 45}
            required: [entry, title, code]
        sectionPregnancyHx:
          match:
            code:
              coding:
              - {code: 10162-6, system: 'http://loinc.org'}
          schema:
            short: PS-CA History of Pregnancy Section
            index: 130
            elements:
              title: {mustSupport: true, index: 131}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10162-6, system: 'http://loinc.org'}
                index: 132
              entry:
                short: Current pregnancy status and, optionally, information about the outcome of earlier pregnancies.
                mustSupport: true
                index: 133
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    pregnancyStatus:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-pregnancy-status-uv-ips']
                        index: 134
                    pregnancyOutcomeSummary:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-pregnancy-outcome-uv-ips']
                        index: 135
              emptyReason: {index: 136}
              section: {index: 137}
            required: [title, code]
        sectionAdvanceDirectives:
          match:
            code:
              coding:
              - {code: 42348-3, system: 'http://loinc.org'}
          schema:
            short: PS-CA Advance Directives Section
            index: 138
            elements:
              title: {mustSupport: true, index: 139}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 42348-3, system: 'http://loinc.org'}
                index: 140
              entry:
                short: Narrative description of the patient's advance directive.
                mustSupport: true
                index: 141
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    advanceDirectivesConsent:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Consent']
                        index: 142
              emptyReason: {index: 143}
              section: {index: 144}
            required: [title, code]
        sectionFamilyHistory:
          match:
            code:
              coding:
              - {code: 10157-6, system: 'http://loinc.org'}
          schema:
            short: PS-CA Family History Section
            index: 145
            elements:
              title: {mustSupport: true, index: 146}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10157-6, system: 'http://loinc.org'}
                index: 147
              entry:
                short: Narrative description of the patient's family history.
                mustSupport: true
                index: 148
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    FamilyMemberHistory:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/familymemberhistory-ca-ps']
                        index: 149
              emptyReason: {index: 150}
              section: {index: 151}
            required: [title, code]
        sectionVitalSigns:
          match:
            code:
              coding:
              - {code: 8716-3, system: 'http://loinc.org'}
          schema:
            short: PS-CA Vital Signs Section
            label: Vital signs
            index: 83
            elements:
              title: {mustSupport: true, index: 84}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 8716-3, system: 'http://loinc.org'}
                index: 85
              entry:
                short: Notable vital signs or physical findings.
                mustSupport: true
                index: 86
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    VitalsPanel:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/vitalspanel']
                        index: 96
                    BodyHeight:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/bodyheight']
                        index: 89
                    HeadCircum:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/headcircum']
                        index: 92
                    HeartRate:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/heartrate']
                        index: 93
                    BMI:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/bmi']
                        index: 87
                    BodyTemp:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/bodytemp']
                        index: 90
                    OxygenSat:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/oxygensat']
                        index: 94
                    BodyWeight:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/bodyweight']
                        index: 91
                    BP:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/bp']
                        index: 88
                    RespRate:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/StructureDefinition/resprate']
                        index: 95
              emptyReason: {index: 97}
              section: {index: 98}
            required: [title, code]
        sectionImmunizations:
          match:
            code:
              coding:
              - {code: 11369-6, system: 'http://loinc.org'}
          schema:
            short: PS-CA Immunizations Section
            index: 61
            elements:
              title: {mustSupport: true, index: 62}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11369-6, system: 'http://loinc.org'}
                index: 63
              entry:
                short: Patient's immunization status and pertinent history.
                mustSupport: true
                index: 64
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    immunization:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/immunization-ca-ps']
                        _required: true
                        index: 65
                      min: 1
              emptyReason: {index: 66}
              section: {index: 67}
            required: [entry, title, code]
        sectionResults:
          match:
            code:
              coding:
              - {code: 30954-2, system: 'http://loinc.org'}
          schema:
            short: PS-CA Results Section
            index: 75
            elements:
              title: {mustSupport: true, index: 76}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 30954-2, system: 'http://loinc.org'}
                index: 77
              entry:
                short: Relevant observation results collected on the patient or produced on in-vitro biologic specimens collected from the patient.
                mustSupport: true
                index: 78
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    results-observation:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-results-laboratory-uv-ips', 'http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-results-pathology-uv-ips', 'http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-results-radiology-uv-ips', 'http://hl7.org/fhir/uv/ips/StructureDefinition/Observation-results-uv-ips']
                        index: 79
                    results-diagnosticReport:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/uv/ips/StructureDefinition/DiagnosticReport-uv-ips']
                        index: 80
              emptyReason: {index: 81}
              section: {index: 82}
            required: [entry, title, code]
        sectionMedications:
          match:
            code:
              coding:
              - {code: 10160-0, system: 'http://loinc.org'}
          schema:
            short: PS-CA Medication Summary Section
            mustSupport: true
            _required: true
            index: 29
            elements:
              title: {short: Medication Summary section, mustSupport: true, index: 30}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10160-0, system: 'http://loinc.org'}
                index: 31
              entry:
                short: Medications relevant for the scope of the patient summary
                mustSupport: true
                index: 32
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    medicationStatement:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to data that supports this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationstatement-ca-ps']
                        index: 33
                    medicationRequest:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to data that supports this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationrequest-ca-ps']
                        index: 34
                    MedicationSectionNotSupported:
                      match: {}
                      schema:
                        type: Reference
                        short: A reference to a resource with fixed elements indicating lack of support of this section
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/medicationstatement-notsupported-ca-ps']
                        index: 35
              emptyReason: {index: 36}
              section: {index: 37}
            required: [entry, title, code]
        sectionPastIllnessHx:
          match:
            code:
              coding:
              - {code: 11348-0, system: 'http://loinc.org'}
          schema:
            short: PS-CA History of Past Illness Section
            index: 99
            elements:
              title: {mustSupport: true, index: 100}
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11348-0, system: 'http://loinc.org'}
                index: 101
              entry:
                short: Conditions the patient suffered in the past.
                mustSupport: true
                index: 102
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: 1
                  slices:
                    pastProblem:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-ca-ps']
                        _required: true
                        index: 103
                      min: 1
              emptyReason: {index: 104}
              section: {index: 105}
            required: [entry, title, code]
  attester:
    mustSupport: true
    index: 11
    elements:
      mode: {mustSupport: true, index: 12}
      time: {mustSupport: true, index: 13}
      party:
        type: Reference
        mustSupport: true
        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole']
        index: 14
  type:
    short: Kind of composition ("Patient Summary")
    mustSupport: true
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: 60591-5, system: 'http://loinc.org'}
    index: 3
  title: {short: CA Patient Summary, mustSupport: true, index: 9}
  author:
    type: Reference
    short: Who and/or what authored the patient summary
    mustSupport: true
    refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps', 'http://hl7.org/fhir/StructureDefinition/Device', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner', 'http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole']
    index: 8
  event:
    index: 22
    slicing:
      rules: open
      discriminator:
      - {path: code, type: pattern}
      min: null
      slices:
        careProvisioningEvent:
          match:
            code:
              coding:
              - {code: PCPR, system: 'http://terminology.hl7.org/CodeSystem/v3-ActClass'}
          schema:
            short: The care provisioning being documented
            index: 23
            elements:
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: PCPR, system: 'http://terminology.hl7.org/CodeSystem/v3-ActClass'}
                index: 24
              period: {mustSupport: true, index: 25}
            required: [code]
  custodian:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-organization']
    index: 15
  status: {mustSupport: true, index: 2}
  identifier: {mustSupport: true, index: 1}
  relatesTo:
    index: 16
    elements:
      code: {index: 17}
      target:
        choices: [targetIdentifier, targetReference]
        index: 19
      targetIdentifier: {type: Identifier, choiceOf: target, index: 20}
      targetReference:
        type: Reference
        choiceOf: target
        refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/composition-ca-ps', 'http://hl7.org/fhir/StructureDefinition/Composition']
        index: 21
  subject:
    type: Reference
    mustSupport: true
    refers: ['http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps']
    index: 4
    elements:
      reference: {mustSupport: true, index: 5}
    required: [reference]
  confidentiality: {index: 10}
  text: {mustSupport: true, index: 0}
package_version: 1.0.0
class: profile
kind: resource
url: http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/composition-ca-ps
base: http://hl7.org/fhir/StructureDefinition/clinicaldocument
version: 1.0.0
required: [section, type]