description: Base StructureDefinition for ClinicalImpression Resource
package_name: hl7.fhir.r2b.examples
derivation: specialization
name: ClinicalImpression
type: null
elements:
  patient:
    isModifier: false
    short: The patient being assessed
    index: 0
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.patient}
    isSummary: true
  description:
    isModifier: false
    short: Why/how the assessment was performed
    type: string
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.description}
    isSummary: true
    index: 4
  investigations:
    isModifier: false
    short: One or more sets of investigations (signs, symptions, etc.)
    index: 11
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      code:
        isModifier: false
        short: A name/code for the set
        index: 12
        type: CodeableConcept
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClinicalImpression.investigations.code}
        isSummary: false
      item:
        isModifier: false
        short: Record of a specific investigation
        index: 13
        comments: Most investigations are observations of one kind of or another but some other specific types of data collection resources can also be used.
        type: Reference
        mustSupport: false
        array: true
        maxLength: 0
        base: {max: '*', min: 0, path: ClinicalImpression.investigations.item}
        isSummary: false
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.investigations}
    required: [code]
    isSummary: false
  date:
    isModifier: false
    short: When the assessment occurred
    index: 3
    comments: This SHOULD be accurate to at least the minute, though some assessments only have a known date.
    type: dateTime
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.date}
    isSummary: true
  triggerReference:
    isModifier: false
    short: Request or event that necessitated this assessment
    index: 10
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClinicalImpression.trigger[x]'}
    choiceOf: trigger
    isSummary: false
  protocol:
    isModifier: false
    short: Clinical Protocol followed
    type: uri
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.protocol}
    isSummary: false
    index: 14
  assessor:
    isModifier: false
    short: The clinician performing the assessment
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.assessor}
    isSummary: true
    index: 1
  problem:
    isModifier: false
    short: General assessment of patient state
    index: 6
    comments: e.g. The patient is a pregnant, and cardiac congestive failure, ‎Adenocarcinoma, and is allergic to penicillin.
    type: Reference
    mustSupport: false
    array: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.problem}
    isSummary: true
  resolved:
    isModifier: false
    short: Diagnoses/conditions resolved since previous assessment
    index: 19
    type: CodeableConcept
    mustSupport: false
    array: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.resolved}
    isSummary: false
  summary:
    isModifier: false
    short: Summary of the assessment
    type: string
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.summary}
    isSummary: false
    index: 15
  status:
    isModifier: true
    short: in-progress | completed | entered-in-error
    index: 2
    type: code
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.status}
    isSummary: true
  previous:
    isModifier: false
    short: Reference to last assessment
    index: 5
    comments: It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved).
    type: Reference
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.previous}
    isSummary: false
  ruledOut:
    isModifier: false
    short: Diagnosis considered not possible
    index: 20
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      item:
        isModifier: false
        short: Specific text of code for diagnosis
        index: 21
        type: CodeableConcept
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClinicalImpression.ruledOut.item}
        isSummary: false
      reason:
        isModifier: false
        short: Grounds for elimination
        type: string
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClinicalImpression.ruledOut.reason}
        isSummary: false
        index: 22
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.ruledOut}
    required: [item]
    isSummary: false
  action:
    isModifier: false
    short: Actions taken during assessment
    index: 25
    type: Reference
    mustSupport: false
    array: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.action}
    isSummary: false
  finding:
    isModifier: false
    short: Possible or likely findings and diagnoses
    index: 16
    type: BackboneElement
    mustSupport: false
    array: true
    elements:
      item:
        isModifier: false
        short: Specific text or code for finding
        index: 17
        type: CodeableConcept
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClinicalImpression.finding.item}
        isSummary: false
      cause:
        isModifier: false
        short: Which investigations support finding
        type: string
        mustSupport: false
        maxLength: 0
        base: {max: '1', min: 0, path: ClinicalImpression.finding.cause}
        isSummary: false
        index: 18
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.finding}
    required: [item]
    isSummary: false
  trigger:
    isModifier: false
    short: Request or event that necessitated this assessment
    mustSupport: false
    choices: [triggerCodeableConcept, triggerReference]
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClinicalImpression.trigger[x]'}
    isSummary: false
    index: 8
  triggerCodeableConcept:
    isModifier: false
    short: Request or event that necessitated this assessment
    index: 9
    type: CodeableConcept
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: 'ClinicalImpression.trigger[x]'}
    choiceOf: trigger
    isSummary: false
  plan:
    isModifier: false
    short: Plan of action after assessment
    index: 24
    type: Reference
    mustSupport: false
    array: true
    maxLength: 0
    base: {max: '*', min: 0, path: ClinicalImpression.plan}
    isSummary: false
  prognosis:
    isModifier: false
    short: Estimate of likely outcome
    type: string
    mustSupport: false
    maxLength: 0
    base: {max: '1', min: 0, path: ClinicalImpression.prognosis}
    isSummary: false
    index: 23
package_version: 1.4.0
class: resource
kind: resource
url: http://hl7.org/fhir/StructureDefinition/ClinicalImpression
base: http://hl7.org/fhir/StructureDefinition/DomainResource
version: null
required: [status, patient]