description: 'This template reflects an ongoing concern on behalf of the provider that placed the concern on a patient''s problem list. So long as the underlying condition is of concern to the provider (i.e., as long as the condition, whether active or resolved, is of ongoing concern and interest to the provider), the statusCode is \"active\". Only when the underlying condition is no longer of concern is the statusCode set to \"completed\". The effectiveTime reflects the time that the underlying condition was felt to be a concern; it may or may not correspond to the effectiveTime of the condition (e.g., even five years later, the clinician may remain concerned about a prior heart attack).\n\nThe statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.\n\nThe effectiveTime/low of the Problem Concern Act asserts when the concern became active. The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).\n\nA Problem Concern Act can contain one Problem Observation (templateId 2.16.840.1.113883.10.20.22.4.4). The Problem Observation is a discrete observation of a condition, and therefore will have a statusCode of \"completed\". For instance, a Concern may contain a Problem Observation of \"chest pain\" that is still ongoing:\n - Problem Concern 1\n   --- Problem Observation: Chest Pain (effectiveTime.high is empty) \nOr a Concern may contain a Problem Observation of \"chest pain\" that is still worrisome but the problem happened in the past:\n - Problem Concern 1\n   --- Problem Observation: Chest Pain (effectiveTime.high is present and in the past) \nMany systems display the nested Problem Observation with the most recent author time stamp, and provide a mechanism for viewing prior observations.'
package_name: hl7.cda.us.ccda
derivation: constraint
name: ProblemConcernAct
type: http://hl7.org/cda/stds/core/StructureDefinition/Act
elements:
  entryRelationship:
    short: The following entryRelationship represents the importance of the concern to a provider.
    index: 19
    slicing:
      rules: open
      discriminator:
      - {path: observation, type: profile}
      min: 1
      slices:
        problem:
          match: {}
          schema:
            _required: true
            index: 20
            elements:
              typeCode:
                pattern: {type: Code, value: SUBJ}
                index: 21
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 22}
            required: [observation]
        priority:
          match: {}
          schema:
            array: true
            index: 23
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 24
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 25}
            required: [observation]
  classCode:
    pattern: {type: Code, value: ACT}
    index: 4
  author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', index: 18}
  id: {index: 6}
  code:
    index: 7
    elements:
      code:
        pattern: {type: Code, value: CONC}
        index: 8
      codeSystem:
        pattern: {type: String, value: 2.16.840.1.113883.5.6}
        index: 9
    required: [codeSystem, code]
  moodCode:
    pattern: {type: Code, value: EVN}
    index: 5
  effectiveTime:
    index: 15
    elements:
      low: {short: The effectiveTime/low of the Problem Concern Act asserts when the concern became active., index: 16}
      high: {short: 'The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).', index: 17}
    required: [low]
  templateId:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: root, type: value}
      - {path: extension, type: value}
      min: 1
      slices:
        problem-concern-act:
          match: {root: 2.16.840.1.113883.10.20.22.4.3, extension: '2024-05-01'}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.3}
                index: 2
              extension:
                pattern: {type: String, value: '2024-05-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  statusCode:
    short: The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    index: 12
    elements:
      nullFlavor: {index: 13}
      code:
        binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19'}
        index: 14
    required: [code]
  text:
    short: SHOULD reference the portion of section narrative text corresponding to this entry
    index: 10
    elements:
      reference:
        constraint:
          value-starts-octothorpe: {human: 'If reference/@value is present, it SHALL begin with a ''#'' and SHALL point to its corresponding narrative', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct', severity: error, expression: value.exists() implies value.startsWith('#')}
        index: 11
package_version: 4.0.0-ballot
class: logical
kind: logical
url: http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct
base: http://hl7.org/cda/stds/core/StructureDefinition/Act
version: 4.0.0-ballot
required: [id, effectiveTime, statusCode, templateId, entryRelationship]