description: This profile constrains the [US Core FHIR Care Plan Resource](http://hl7.org/fhir/us/core/STU6.1/StructureDefinition-us-core-careplan.html) to represent the requirements of a care plan for patients with multiple chronic conditions.
package_name: hl7.fhir.us.mcc
derivation: constraint
name: MCCCarePlan
type: CarePlan
elements:
  extension:
    type: Extension
    short: When populated, the custodian is responsible for the care and maintenance of the care plan. The care plan is attributed to the custodian. The custodian might or might not be a contributor. This CarePlan.custodian extension should be used instead of CarePlan.author which in R4 is currently identified as the designated responsible party and in R5 has been removed.
    url: http://hl7.org/fhir/us/mcc/StructureDefinition/custodian
    index: 0
    slicing:
      slices:
        custodian:
          match: {}
          schema: {type: Extension, short: 'When populated, the custodian is responsible for the care and maintenance of the care plan. The care plan is attributed to the custodian. The custodian might or might not be a contributor. This CarePlan.custodian extension should be used instead of CarePlan.author which in R4 is currently identified as the designated responsible party and in R5 has been removed.', url: 'http://hl7.org/fhir/us/mcc/StructureDefinition/custodian', index: 0}
          max: 1
  author: {short: 'Use the CarePlan custodian extension instead. Use of CarePlan.author is discouraged, it is removed in R5.', index: 1}
  contributor:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/StructureDefinition/Device', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam', '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/mcc/StructureDefinition/MCCCareTeam']
    index: 2
  careTeam:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCCareTeam']
    index: 3
  addresses:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-encounter-diagnosis', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCChronCondHealthConcern']
    index: 4
  supportingInfo:
    type: Reference
    short: Please see the libraries of available value sets pertinent for use with the appropriate Multiple Chronic Condition Care Plan Profile for use within the referenced profiles at CarePlan.supportingInfo
    mustSupport: true
    refers: ['http://hl7.org/fhir/StructureDefinition/Resource', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-occupation', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson', 'http://hl7.org/fhir/us/mcc/StructureDefinition/DocRefPACP', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCCaregiverConsiderationsObservation', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCChronCondHealthConcern', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCClinicalImpression', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCClinicalResultObservation', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCDiagnosticReportAndNote', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCFamilyHistory', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCImmunization', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCLaboratoryResultObservation', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCNutritionOrder', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCObservationSDOHAssessment', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCPatientCaregiverConditionStatus', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCProcedure', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCQuestionnaireResponse', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCServiceRequest', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCSymptomObservation', 'http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse']
    index: 5
  goal:
    type: Reference
    short: This Goal represents one or more overarching goal applicable to the entire care plan
    mustSupport: false
    refers: ['http://hl7.org/fhir/us/mcc/StructureDefinition/MCCGoal']
    index: 6
  activity:
    short: Action to occur as part of plan. This is the backbone element of the care plan that is the root of care coordination activities. While there can be many activities in a care plan, each activity has only one planned.activityRefence
    mustSupport: true
    index: 7
    elements:
      outcomeReference:
        type: Reference
        short: This CarePlan element represents a PERFORMED ACTIVITY. Please see the libraries of available value sets pertinent for use with the appropriate Multiple Chronic Condition Care Plan Profile for use within the referenced profiles at CarePlan.activity.outcomeReference
        mustSupport: true
        refers: ['http://hl7.org/fhir/StructureDefinition/Resource', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-blood-pressure', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-body-weight', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCChronCondHealthConcern', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCDiagnosticReportAndNote', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCGoal', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCLaboratoryResultObservation', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCMedicationRequest', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCProcedure', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCSymptomObservation']
        index: 8
      reference:
        type: Reference
        label: Label
        short: This CarePlan element represents a PLANNED ACTIVITY. Please see the libraries of available value sets pertinent for use with the appropriate Multiple Chronic Condition Care Plan Profile for use within the referenced profiles at CarePlan.activity.reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/StructureDefinition/Appointment', 'http://hl7.org/fhir/StructureDefinition/CommunicationRequest', 'http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/StructureDefinition/RequestGroup', 'http://hl7.org/fhir/StructureDefinition/ServiceRequest', 'http://hl7.org/fhir/StructureDefinition/Task', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'http://hl7.org/fhir/us/mcc/StructureDefinition/MCCMedicationRequest']
        index: 9
      detail: {label: Machine assisted dynamic care planning and coordination required referencing and re-use of profiles., short: CarePlan.activity.detail SHALL NOT be used in the MCC eCare Plan, index: 10}
package_version: 1.0.0
extensions:
  custodian: {url: 'http://hl7.org/fhir/us/mcc/StructureDefinition/custodian', max: 1, type: Extension, short: 'When populated, the custodian is responsible for the care and maintenance of the care plan. The care plan is attributed to the custodian. The custodian might or might not be a contributor. This CarePlan.custodian extension should be used instead of CarePlan.author which in R4 is currently identified as the designated responsible party and in R5 has been removed.', index: 0}
class: profile
kind: resource
url: http://hl7.org/fhir/us/mcc/StructureDefinition/mccCarePlan
base: http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan
version: 1.0.0