{
"description": "A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called \\\"ClinicalImpression\\\" rather than \\\"ClinicalAssessment\\\" to avoid confusion with the recording of assessment tools such as Apgar score.",
"_filename": "CareConnect-GPC-ClinicalImpression-1.json",
"package_name": "gpc.stu3.fhir-assets",
"date": "2023-08-04",
"derivation": "constraint",
"publisher": "NHS England",
"fhirVersion": "3.0.2",
"name": "CareConnect-GPC-ClinicalImpression-1",
"abstract": false,
"copyright": "Copyright © 2023 NHS England",
"type": "ClinicalImpression",
"experimental": null,
"resourceType": "StructureDefinition",
"title": null,
"package_version": "1.1.3",
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-1",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"xpath": "not(parent::f:contained and f:text)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.text.empty()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-3",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()"
} ],
"path": "ClinicalImpression",
"min": 0,
"definition": "A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called \"ClinicalImpression\" rather than \"ClinicalAssessment\" to avoid confusion with the recording of assessment tools such as Apgar score.",
"short": "A clinical assessment performed when planning treatments and management strategies for a patient",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Partial mapping for problem evaluation",
"identity": "v2"
}, {
"map": "clinical.general",
"identity": "w5"
} ],
"max": "*",
"id": "ClinicalImpression",
"base": {
"max": "*",
"min": 0,
"path": "Resource"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"short": "Logical id of this artifact",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "ClinicalImpression.id",
"condition": [ "ele-1" ],
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
"short": "Metadata about the resource",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Meta"
} ],
"max": "1",
"id": "ClinicalImpression.meta",
"condition": [ "ele-1" ],
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "ClinicalImpression.implicitRules",
"condition": [ "ele-1" ],
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"short": "Language of the resource content",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "extensible",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages"
}
},
"max": "1",
"id": "ClinicalImpression.language",
"condition": [ "ele-1" ],
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
}, {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "ClinicalImpression.text",
"condition": [ "ele-1", "dom-1" ],
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
}
}, {
"path": "ClinicalImpression.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"short": "Contained, inline Resources",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "ClinicalImpression.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ClinicalImpression.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ClinicalImpression.modifierExtension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier",
"min": 0,
"definition": "A unique identifier assigned to the clinical impression that remains consistent regardless of what server the impression is stored on.",
"short": "Business identifier",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
"identity": "v2"
}, {
"map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]",
"identity": "rim"
}, {
"map": "Identifier",
"identity": "servd"
}, {
"map": "PID-3",
"identity": "v2"
}, {
"map": "id",
"identity": "w5"
} ],
"type": [ {
"code": "Identifier"
} ],
"max": "*",
"id": "ClinicalImpression.identifier",
"condition": [ "ele-1" ],
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.identifier"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ClinicalImpression.identifier.id",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.identifier.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ClinicalImpression.identifier.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier.use",
"requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
"min": 0,
"definition": "The purpose of this identifier.",
"isModifier": true,
"short": "usual | official | temp | secondary (If known)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "v2"
}, {
"map": "Role.code or implied by context",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "IdentifierUse"
} ],
"description": "Identifies the purpose for this identifier, if known .",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-use"
}
},
"max": "1",
"id": "ClinicalImpression.identifier.use",
"condition": [ "ele-1" ],
"comment": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
"base": {
"max": "1",
"min": 0,
"path": "Identifier.use"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier.type",
"requirements": "Allows users to make use of identifiers when the identifier system is not known.",
"min": 0,
"definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
"short": "Description of identifier",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "CX.5",
"identity": "v2"
}, {
"map": "Role.code or implied by context",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "extensible",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "IdentifierType"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/identifier-type"
}
},
"max": "1",
"id": "ClinicalImpression.identifier.type",
"condition": [ "ele-1" ],
"comment": "This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. \n\nWhere the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
"base": {
"max": "1",
"min": 0,
"path": "Identifier.type"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier.system",
"requirements": "There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
"min": 0,
"definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
"short": "The namespace for the identifier value",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CX.4 / EI-2-4",
"identity": "v2"
}, {
"map": "II.root or Role.id.root",
"identity": "rim"
}, {
"map": "./IdentifierType",
"identity": "servd"
} ],
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "ClinicalImpression.identifier.system",
"condition": [ "ele-1" ],
"comment": "see http://en.wikipedia.org/wiki/Uniform_resource_identifier",
"example": [ {
"label": "General",
"valueUri": "http://www.acme.com/identifiers/patient"
} ],
"base": {
"max": "1",
"min": 0,
"path": "Identifier.system"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.identifier.value",
"min": 0,
"definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
"short": "The value that is unique",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CX.1 / EI.1",
"identity": "v2"
}, {
"map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
"identity": "rim"
}, {
"map": "./Value",
"identity": "servd"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ClinicalImpression.identifier.value",
"condition": [ "ele-1" ],
"comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html).",
"example": [ {
"label": "General",
"valueString": "123456"
} ],
"base": {
"max": "1",
"min": 0,
"path": "Identifier.value"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Period",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "per-1",
"human": "If present, start SHALL have a lower value than end",
"xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)",
"source": "http://hl7.org/fhir/StructureDefinition/Period",
"severity": "error",
"expression": "start.empty() or end.empty() or (start <= end)"
} ],
"path": "ClinicalImpression.identifier.period",
"min": 0,
"definition": "Time period during which identifier is/was valid for use.",
"short": "Time period when id is/was valid for use",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "DR",
"identity": "v2"
}, {
"map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]",
"identity": "rim"
}, {
"map": "CX.7 + CX.8",
"identity": "v2"
}, {
"map": "Role.effectiveTime or implied by context",
"identity": "rim"
}, {
"map": "./StartDate and ./EndDate",
"identity": "servd"
} ],
"type": [ {
"code": "Period"
} ],
"max": "1",
"id": "ClinicalImpression.identifier.period",
"condition": [ "ele-1" ],
"comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\"). If duration is required, specify the type as Interval|Duration.",
"base": {
"max": "1",
"min": 0,
"path": "Identifier.period"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.identifier.assigner",
"min": 0,
"definition": "Organization that issued/manages the identifier.",
"short": "Organization that issued id (may be just text)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "CX.4 / (CX.4,CX.9,CX.10)",
"identity": "v2"
}, {
"map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper",
"identity": "rim"
}, {
"map": "./IdentifierIssuingAuthority",
"identity": "servd"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
} ],
"max": "1",
"id": "ClinicalImpression.identifier.assigner",
"condition": [ "ele-1" ],
"comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
"base": {
"max": "1",
"min": 0,
"path": "Identifier.assigner"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.status",
"min": 1,
"definition": "Identifies the workflow status of the assessment.",
"isModifier": true,
"short": "draft | completed | entered-in-error",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "PRB-14",
"identity": "v2"
}, {
"map": "status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClinicalImpressionStatus"
} ],
"description": "The workflow state of a clinical impression.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/clinical-impression-status"
}
},
"max": "1",
"id": "ClinicalImpression.status",
"condition": [ "ele-1" ],
"comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid.",
"base": {
"max": "1",
"min": 1,
"path": "ClinicalImpression.status"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.code",
"min": 0,
"definition": "Categorizes the type of clinical assessment performed.",
"short": "Kind of assessment performed",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "what",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClinicalImpressionCode"
} ],
"description": "Identifies categories of clinical impressions. This is a place-holder only. It may be removed"
},
"alias": [ "type" ],
"max": "1",
"id": "ClinicalImpression.code",
"condition": [ "ele-1" ],
"comment": "This is present as a place-holder only and may be removed based on feedback/work group opinion.",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.code"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.description",
"min": 0,
"definition": "A summary of the context and/or cause of the assessment - why / where was it performed, and what patient events/status prompted it.",
"short": "Why/how the assessment was performed",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ClinicalImpression.description",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.description"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.subject",
"requirements": "Group is typically for veterinary and/or public health purposes.",
"min": 1,
"definition": "The patient or group of individuals assessed as part of this record.",
"short": "Patient or group assessed",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "PID-3",
"identity": "v2"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Group"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Patient-1"
} ],
"max": "1",
"id": "ClinicalImpression.subject",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 1,
"path": "ClinicalImpression.subject"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.context",
"min": 0,
"definition": "The encounter or episode of care this impression was created as part of.",
"short": "Encounter or Episode created from",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "context",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Encounter-1"
} ],
"alias": [ "encounter" ],
"max": "1",
"id": "ClinicalImpression.context",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.context"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.effective[x]",
"min": 0,
"definition": "The point in time or period over which the subject was assessed.",
"short": "Time of assessment",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "PRB-2",
"identity": "v2"
}, {
"map": "when.done",
"identity": "w5"
} ],
"type": [ {
"code": "dateTime"
}, {
"code": "Period"
} ],
"max": "1",
"id": "ClinicalImpression.effective[x]",
"condition": [ "ele-1" ],
"comment": "This SHOULD be accurate to at least the minute, though some assessments only have a known date.",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.effective[x]"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.date",
"min": 0,
"definition": "Indicates when the documentation of the assessment was complete.",
"short": "When the assessment was documented",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "when.recorded",
"identity": "w5"
} ],
"type": [ {
"code": "dateTime"
} ],
"max": "1",
"id": "ClinicalImpression.date",
"condition": [ "ele-1" ],
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.date"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.assessor",
"min": 0,
"definition": "The clinician performing the assessment.",
"short": "The clinician performing the assessment",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "ROL-4",
"identity": "v2"
}, {
"map": "who.author",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Practitioner-1"
} ],
"max": "1",
"id": "ClinicalImpression.assessor",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.assessor"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.previous",
"min": 0,
"definition": "A reference to the last assesment that was conducted bon this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changes.",
"short": "Reference to last assessment",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1"
} ],
"max": "1",
"id": "ClinicalImpression.previous",
"condition": [ "ele-1" ],
"comment": "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).",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.previous"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.problem",
"min": 0,
"definition": "This a list of the relevant problems/conditions for a patient.",
"short": "Relevant impressions of patient state",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "PRB-3 / IAM-7",
"identity": "v2"
}, {
"map": "why",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Condition-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-AllergyIntolerance-1"
} ],
"max": "*",
"id": "ClinicalImpression.problem",
"condition": [ "ele-1" ],
"comment": "e.g. The patient is a pregnant, and cardiac congestive failure, Adenocarcinoma, and is allergic to penicillin.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.problem"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.investigation",
"min": 0,
"definition": "One or more sets of investigations (signs, symptions, etc.). The actual grouping of investigations vary greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes.",
"short": "One or more sets of investigations (signs, symptions, etc.)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"max": "*",
"id": "ClinicalImpression.investigation",
"condition": [ "ele-1" ],
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.investigation"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.investigation.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ClinicalImpression.investigation.id",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.investigation.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ClinicalImpression.investigation.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.investigation.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ClinicalImpression.investigation.modifierExtension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.investigation.code",
"min": 1,
"definition": "A name/code for the group (\"set\") of investigations. Typically, this will be something like \"signs\", \"symptoms\", \"clinical\", \"diagnostic\", but the list is not constrained, and others such groups such as (exposure|family|travel|nutitirional) history may be used.",
"short": "A name/code for the set",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "InvestigationGroupType"
} ],
"description": "A name/code for a set of investigations.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/investigation-sets"
}
},
"max": "1",
"id": "ClinicalImpression.investigation.code",
"condition": [ "ele-1" ],
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"base": {
"max": "1",
"min": 1,
"path": "ClinicalImpression.investigation.code"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.investigation.item",
"min": 0,
"definition": "A record of a specific investigation that was undertaken.",
"short": "Record of a specific investigation",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "OBX-21",
"identity": "v2"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RiskAssessment"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/ImagingStudy"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-DiagnosticReport-1"
} ],
"max": "*",
"id": "ClinicalImpression.investigation.item",
"condition": [ "ele-1" ],
"comment": "Most investigations are observations of one kind of or another but some other specific types of data collection resources can also be used.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.investigation.item"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.protocol",
"min": 0,
"definition": "Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosis.",
"short": "Clinical Protocol followed",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "uri"
} ],
"max": "*",
"id": "ClinicalImpression.protocol",
"condition": [ "ele-1" ],
"comment": "see http://en.wikipedia.org/wiki/Uniform_resource_identifier",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.protocol"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.summary",
"min": 1,
"definition": "A text summary of the investigations and the diagnosis.",
"short": "Summary of the assessment",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "OBX",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ClinicalImpression.summary",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.summary"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.finding",
"min": 0,
"definition": "Specific findings or diagnoses that was considered likely or relevant to ongoing treatment.",
"short": "Possible or likely findings and diagnoses",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"max": "*",
"id": "ClinicalImpression.finding",
"condition": [ "ele-1" ],
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.finding"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.finding.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "ClinicalImpression.finding.id",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.finding.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "ClinicalImpression.finding.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "ClinicalImpression.finding.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "ClinicalImpression.finding.modifierExtension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.finding.item[x]",
"min": 1,
"definition": "Specific text, code or reference for finding or diagnosis, which may include ruled-out or resolved conditions.",
"short": "What was found",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "OBX",
"identity": "v2"
} ],
"type": [ {
"code": "CodeableConcept"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ProblemHeader-Condition-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Observation-1"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionKind"
} ],
"description": "Identification of the Condition or diagnosis.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/condition-code"
}
},
"max": "1",
"id": "ClinicalImpression.finding.item[x]",
"condition": [ "ele-1" ],
"base": {
"max": "1",
"min": 1,
"path": "ClinicalImpression.finding.item[x]"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.finding.basis",
"min": 0,
"definition": "Which investigations support finding or diagnosis.",
"short": "Which investigations support finding",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "ClinicalImpression.finding.basis",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "ClinicalImpression.finding.basis"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.prognosisCodeableConcept",
"min": 0,
"definition": "Estimate of likely outcome.",
"short": "Estimate of likely outcome",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "PRB-22",
"identity": "v2"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ClinicalImpressionPrognosis"
} ],
"description": "Prognosis or outlook findings",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/clinicalimpression-prognosis"
}
},
"max": "*",
"id": "ClinicalImpression.prognosisCodeableConcept",
"condition": [ "ele-1" ],
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.prognosisCodeableConcept"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.prognosisReference",
"min": 0,
"definition": "RiskAssessment expressing likely outcome.",
"short": "RiskAssessment expressing likely outcome",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RiskAssessment"
} ],
"max": "*",
"id": "ClinicalImpression.prognosisReference",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.prognosisReference"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "ClinicalImpression.action",
"min": 0,
"definition": "Action taken as part of assessment procedure.",
"short": "Action taken as part of assessment procedure",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Procedure"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ReferralRequest-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ProcedureRequest-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-MedicationRequest-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Appointment-1"
} ],
"max": "*",
"id": "ClinicalImpression.action",
"condition": [ "ele-1" ],
"comment": "Actions recommended as a result of the impression should not be captured using the 'action' element.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.action"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "ClinicalImpression.note",
"min": 0,
"definition": "Commentary about the impression, typically recorded after the impression itself was made, though supplemental notes by the original author could also appear.",
"short": "Comments made about the ClinicalImpression",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "v2"
}, {
"map": "Act",
"identity": "rim"
} ],
"type": [ {
"code": "Annotation"
} ],
"max": "*",
"id": "ClinicalImpression.note",
"condition": [ "ele-1" ],
"comment": "Don't use this element for content that should more properly appear as one of the specific elements of the impression.",
"base": {
"max": "*",
"min": 0,
"path": "ClinicalImpression.note"
}
} ]
},
"status": "draft",
"id": "a8e4a2d0-c1ff-490c-9336-fc71adf35eb3",
"kind": "resource",
"url": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1",
"version": "1.1.0",
"differential": {
"element": [ {
"id": "ClinicalImpression.identifier.assigner",
"path": "ClinicalImpression.identifier.assigner",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Organization-1"
} ]
}, {
"id": "ClinicalImpression.subject",
"path": "ClinicalImpression.subject",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Group"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Patient-1"
} ]
}, {
"id": "ClinicalImpression.context",
"path": "ClinicalImpression.context",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/EpisodeOfCare"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Encounter-1"
} ]
}, {
"id": "ClinicalImpression.assessor",
"path": "ClinicalImpression.assessor",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Practitioner-1"
} ]
}, {
"id": "ClinicalImpression.previous",
"path": "ClinicalImpression.previous",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-ClinicalImpression-1"
} ]
}, {
"id": "ClinicalImpression.problem",
"path": "ClinicalImpression.problem",
"type": [ {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-Condition-1"
}, {
"code": "Reference",
"targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-AllergyIntolerance-1"
} ]
}, {
"id": "ClinicalImpression.investigation.item",
"path": "ClinicalImpression.investigation.item",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory"
}, {
"code": "Reference",
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} ]
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} ]
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},
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}