description: An United States Patient Care Summary (US-PCS) is FHIR document that captures key information for care transitions. It aligns with the International Patient Summary and is intended as a modern, streamlined summary that uses US Core resources to populate specific sections. The US-PCS profiles 7 sections (with 10 additional optional sections from IPS) with a primary use case of providing a minimal, non-exhaustive summary that supports clinical decision-making at the point of care for both planned and unplanned care across organizational boundaries.  The US-PCS aligns with the IPS but formally derives its Composition profile from the FHIR Clinical Documents Implementation Guide. The US-PCS definition of [MustSupport](./general-guidance.html#must-support-elements) is provided in this guide although implementers should also refer to the [US Core Implementation Guide definition of Must Support](https://hl7.org/fhir/us/core/STU6.1/must-support.html) in the context of populating those resources.
package_name: hl7.fhir.us.pcs
derivation: constraint
name: CompositionUsPcs
type: Composition
elements:
  meta:
    elements:
      profile: {short: The conformance of this Composition to a specific US-PCS version., mustSupport: true, index: 0}
  section:
    short: Sections composing the US-PCS
    array: true
    min: 3
    index: 17
    extensions:
      section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 18}
    elements:
      extension:
        type: Extension
        short: Additional notes that apply to the section (but not to specific resource).
        url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
        index: 18
        slicing:
          slices:
            section-note:
              match: {}
              schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 18}
              min: 0
      code: {index: 19}
      text: {index: 20}
      section: {index: 21}
    required: [text, code]
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: code, type: value}
      min: 3
      slices:
        sectionProblems:
          match:
            code:
              coding:
              - {code: 11450-4, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Problems Section
            mustSupport: true
            _required: true
            index: 22
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 23}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 23
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 23}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11450-4, system: 'http://loinc.org'}
                index: 24
              entry:
                type: Reference
                short: Clinical problems or conditions currently being monitored for the patient.
                refers: ['http://hl7.org/fhir/StructureDefinition/Condition', 'http://hl7.org/fhir/StructureDefinition/DocumentReference']
                index: 25
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    problem:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns']
                        array: true
                        index: 26
                      min: 0
              emptyReason: {mustSupport: true, index: 27}
        sectionAllergies:
          match:
            code:
              coding:
              - {code: 48765-2, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Allergies and Intolerances Section
            mustSupport: true
            _required: true
            index: 28
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 29}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 29
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 29}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 48765-2, system: 'http://loinc.org'}
                index: 30
              entry:
                type: Reference
                short: Relevant allergies or intolerances for that patient.
                refers: ['http://hl7.org/fhir/StructureDefinition/AllergyIntolerance', 'http://hl7.org/fhir/StructureDefinition/DocumentReference']
                index: 31
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    allergyOrIntolerance:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance']
                        array: true
                        index: 32
                      min: 0
              emptyReason: {mustSupport: true, index: 33}
        sectionMedications:
          match:
            code:
              coding:
              - {code: 10160-0, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Medication Summary Section
            mustSupport: true
            _required: true
            index: 34
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 35}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 35
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 35}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10160-0, system: 'http://loinc.org'}
                index: 36
              entry:
                type: Reference
                short: Medications relevant for the scope of the patient summary
                refers: ['http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/MedicationAdministration', 'http://hl7.org/fhir/StructureDefinition/MedicationDispense', 'http://hl7.org/fhir/StructureDefinition/MedicationRequest', 'http://hl7.org/fhir/StructureDefinition/MedicationStatement']
                index: 37
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    medicationStatementOrRequest:
                      match: {}
                      schema:
                        type: Reference
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest']
                        array: true
                        index: 38
                      min: 0
              emptyReason: {mustSupport: true, index: 39}
        sectionEncounters:
          match:
            code:
              coding:
              - {code: 46240-8, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Encounters Section
            mustSupport: true
            index: 40
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 41}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 41
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 41}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 46240-8, system: 'http://loinc.org'}
                index: 42
              entry:
                type: Reference
                short: Relevant encounters of the patient in the context of a patient summary.
                refers: ['http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/Encounter']
                index: 43
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    encounter:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter']
                        array: true
                        index: 44
                      min: 0
        sectionImmunizations:
          match:
            code:
              coding:
              - {code: 11369-6, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Immunizations Section
            mustSupport: true
            index: 45
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 46}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 46
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 46}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11369-6, system: 'http://loinc.org'}
                index: 47
              entry:
                type: Reference
                short: Patient's immunization status and pertinent history.
                refers: ['http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/Immunization']
                index: 48
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    immunization:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization']
                        array: true
                        index: 49
                      min: 0
        sectionProceduresHx:
          match:
            code:
              coding:
              - {code: 47519-4, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS History of Procedures Section
            mustSupport: true
            index: 50
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 51}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 51
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 51}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 47519-4, system: 'http://loinc.org'}
                index: 52
              entry:
                type: Reference
                short: Patient past procedures pertinent to the scope of this document.
                refers: ['http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/Procedure']
                index: 53
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    procedure:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure']
                        array: true
                        index: 54
                      min: 0
        sectionResults:
          match:
            code:
              coding:
              - {code: 30954-2, system: 'http://loinc.org'}
          schema:
            constraint:
              cmp-uspcs-1: {human: Either section.entry or emptyReason are present, source: 'http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs', severity: error, expression: (entry.reference.exists() or emptyReason.exists())}
            short: US-PCS Results Section
            mustSupport: true
            index: 55
            extensions:
              section-note: {url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', min: 0, type: Extension, short: Additional notes that apply to the section (but not to specific resource)., index: 56}
            elements:
              extension:
                type: Extension
                short: Additional notes that apply to the section (but not to specific resource).
                url: http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1
                index: 56
                slicing:
                  slices:
                    section-note:
                      match: {}
                      schema: {type: Extension, short: Additional notes that apply to the section (but not to specific resource)., url: 'http://hl7.org/fhir/StructureDefinition/note|5.3.0-ballot-tc1', index: 56}
                      min: 0
              code:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 30954-2, system: 'http://loinc.org'}
                index: 57
              entry:
                type: Reference
                short: Relevant observation results collected on the patient or produced on in-vitro biologic specimens collected from the patient.
                refers: ['http://hl7.org/fhir/StructureDefinition/DiagnosticReport', 'http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/Observation']
                index: 58
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    results-observation-lab-imaging:
                      match: {}
                      schema:
                        short: Observation results can include laboratory, imaging, microbiology/pathology, and other observations.
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-clinical-result', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab']
                        type: Reference
                        mustSupport: true
                        array: true
                        index: 59
                      min: 0
                    results-diagnosticReport-lab-imaging-note:
                      match: {}
                      schema:
                        short: Diagnostic reports can include laboratory, imaging, clinical notes, impressions and other report data. These can reference other resources in the Bundle. References generally will not include large files in the summary (e.g. images would not be included).
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-note']
                        type: Reference
                        mustSupport: true
                        array: true
                        index: 60
                      min: 0
  type:
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: 60591-5, system: 'http://loinc.org'}
    index: 2
  author:
    type: Reference
    refers: ['http://hl7.org/fhir/StructureDefinition/Device', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson']
    index: 5
  event:
    index: 13
    slicing:
      rules: open
      discriminator:
      - {path: code, type: value}
      min: null
      slices:
        careProvisioningEvent:
          match:
            code:
              coding:
              - {code: PCPR, system: 'http://terminology.hl7.org/CodeSystem/v3-ActClass'}
          schema:
            short: The care provisioning being documented
            mustSupport: true
            index: 14
            elements:
              code:
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: PCPR, system: 'http://terminology.hl7.org/CodeSystem/v3-ActClass'}
                index: 15
              period: {mustSupport: true, index: 16}
            required: [code]
  custodian:
    type: Reference
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization']
    index: 7
  language:
    pattern: {type: Code, value: en-US}
    index: 1
  relatesTo:
    index: 8
    elements:
      target:
        choices: [targetIdentifier, targetReference]
        index: 10
      targetIdentifier: {type: Identifier, choiceOf: target, index: 11}
      targetReference:
        type: Reference
        choiceOf: target
        refers: ['http://hl7.org/fhir/StructureDefinition/Composition', 'http://hl7.org/fhir/uv/ips/StructureDefinition/Composition-uv-ips']
        index: 12
  subject:
    type: Reference
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient']
    index: 3
    elements:
      reference: {mustSupport: true, index: 4}
    required: [reference]
  confidentiality: {mustSupport: true, index: 6}
package_version: 1.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/pcs/StructureDefinition/Composition-us-pcs
base: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/clinical-document-composition
version: 1.0.0-ballot
required: [confidentiality, custodian]