description: This template represents a risk concern. \n\nIt is a wrapper for a single risk concern which may be derived from a variety of sources within an EHR (such as Problem List, Family History, Social History, Social Worker Note, etc.). \n\nA Risk Concern Act represents a health concern that is a risk. A risk is a clinical or socioeconomic condition that the patient does not currently have, but the probability of developing that condition rises to the level of concern such that an intervention and/or monitoring is needed.
package_name: hl7.cda.us.ccda
derivation: constraint
name: RiskConcernAct
type: http://hl7.org/cda/stds/core/StructureDefinition/Act
elements:
  entryRelationship:
    short: Where a Health Concern needs to reference another entry already described in the CDA document instance, rather than repeating the full content of the entry, the Entry Reference template may be used to reference this entry.
    index: 17
    slicing:
      rules: open
      discriminator:
      - {path: typeCode, type: value}
      - {path: observation, type: profile}
      - {path: act, type: profile}
      - {path: organizer, type: profile}
      min: null
      slices:
        caregiverCharacteristics:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 93
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 94
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 95}
            required: [observation]
        priorityPreference2:
          match: {typeCode: REFR}
          schema:
            short: The following entryRelationship represents the priority that the provider puts on the health concern.
            array: true
            index: 111
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 112
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 113}
            required: [observation]
        functionalStatusObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 51
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 52
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 53}
            required: [observation]
        assessmentScaleObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 30
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 31
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 32}
            required: [observation]
        priorityPreference1:
          match: {typeCode: REFR}
          schema:
            short: The following entryRelationship represents the priority that the patient puts on the health concern.
            array: true
            index: 108
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 109
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 110}
            required: [observation]
        problemObservation2:
          match: {typeCode: SPRT}
          schema:
            short: The following entryRelationship represents the relationship Health Concern HAS SUPPORT Observation.
            array: true
            index: 90
            elements:
              typeCode:
                pattern: {type: Code, value: SPRT}
                index: 91
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 92}
            required: [observation]
        problemConcernAct:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 114
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 115
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 116}
            required: [act]
        nutritionalStatusObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 102
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 103
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 104}
            required: [observation]
        culturalandReligiousObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 96
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 97
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 98}
            required: [observation]
        entryReferenceComp:
          match: {typeCode: COMP}
          schema:
            short: The following entryRelationship represents the relationship between two Health Concern Acts where the target is a component of the source (Health Concern HAS COMPONENT Health Concern). The Enry Reference template is used here because the target Health Concern Act will be defined elsewhere in the Health Concerns Section and thus a reference to that template is all that is required.
            array: true
            index: 27
            elements:
              typeCode:
                pattern: {type: Code, value: COMP}
                index: 28
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 29}
            required: [act]
        self-CareActivitiesADLandIADL:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 36
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 37
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 38}
            required: [observation]
        nutritionAssessment:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 57
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 58
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 59}
            required: [observation]
        entryReferenceRefr:
          match: {typeCode: REFR}
          schema:
            short: The following entryRelationship represents the relationship between two Health Concern Acts where there is a general relationship between the source and the target (Health Concern RELATES TO Health Concern). It can also represent the relationship between a Health Concern and another entry already described in the CDA document instance. The Entry Reference template is used here because the target entry will be defined elsewhere and thus a reference to that instance is all that is required.
            array: true
            index: 24
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 25
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 26}
            required: [act]
        pregnancyStatusObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 63
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 64
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 65}
            required: [observation]
        mentalStatusObservation1:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 33
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 34
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 35}
            required: [observation]
        entryRelationship11:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 48
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 49
              organizer: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Organizer', index: 50}
            required: [organizer]
        problemObservation1:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 18
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 19
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 20}
            required: [observation]
        smokingStatus:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 42
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 43
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 44}
            required: [observation]
        hospitalAdmissionDiagnosis:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 54
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 55
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 56}
            required: [act]
        socialHistoryObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 78
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 79
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 80}
            required: [observation]
        preoperativeDiagnosis:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 66
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 67
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 68}
            required: [act]
        resultOrganizer:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 105
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 106
              organizer: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Organizer', index: 107}
            required: [organizer]
        reactionObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 69
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 70
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 71}
            required: [observation]
        allergy-IntoleranceObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 21
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 22
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 23}
            required: [observation]
        characteristicsofHomeEnvironment:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 99
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 100
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 101}
            required: [observation]
        longitudinalCareWoundObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 87
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 88
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 89}
            required: [observation]
        vitalSignObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 84
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 85
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 86}
            required: [observation]
        mentalStatusObservation2:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 39
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 40
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 41}
            required: [observation]
        encounterDiagnosis:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 45
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 46
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 47}
            required: [act]
        sensoryStatus:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 75
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 76
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 77}
            required: [observation]
        resultObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 72
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 73
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 74}
            required: [observation]
        postprocedureDiagnosis:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 60
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 61
              act: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Act', index: 62}
            required: [act]
        substanceorDeviceAllergy-IntoleranceObservation:
          match: {typeCode: REFR}
          schema:
            array: true
            index: 81
            elements:
              typeCode:
                pattern: {type: Code, value: REFR}
                index: 82
              observation: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Observation', index: 83}
            required: [observation]
  classCode:
    pattern: {type: Code, value: ACT}
    index: 4
  author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', index: 16}
  reference:
    index: 117
    elements:
      typeCode:
        pattern: {type: Code, value: REFR}
        index: 118
      externalDocument: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument', index: 119}
    required: [externalDocument]
  id: {index: 6}
  code:
    short: At risk - finding
    index: 7
    elements:
      code:
        pattern: {type: Code, value: '281694009'}
        index: 8
      codeSystem:
        short: SNOMED CT
        pattern: {type: String, value: 2.16.840.1.113883.6.96}
        index: 9
    required: [codeSystem, code]
  moodCode:
    pattern: {type: Code, value: EVN}
    index: 5
  effectiveTime: {index: 15}
  templateId:
    index: 0
    slicing:
      rules: open
      discriminator:
      - {path: root, type: value}
      - {path: extension, type: value}
      min: 1
      slices:
        risk-concern-act:
          match: {root: 2.16.840.1.113883.10.20.22.4.136, extension: '2015-08-01'}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.136}
                index: 2
              extension:
                pattern: {type: String, value: '2015-08-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  statusCode:
    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/RiskConcernAct', 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/RiskConcernAct
base: http://hl7.org/cda/stds/core/StructureDefinition/Act
version: 4.0.0-ballot
required: [id, statusCode, templateId]