description: A Care Plan is a consensus-driven dynamic plan that represents a patient's and Care Team Member's prioritized concerns, goals, and planned interventions. It serves as a blueprint shared by all Care Team Members (including the patient, their caregivers and providers), to guide the patient'ss care. A Care Plan integrates multiple interventions proposed by multiple providers and disciplines for multiple conditions.\n\nA Care Plan represents one or more Plan(s) of Care and serves to reconcile and resolve conflicts between the various Plans of Care developed for a specific patient by different providers. While both a plan of care and a care plan include the patients life goals and require Care Team Members (including patients) to prioritize goals and interventions, the reconciliation process becomes more complex as the number of plans of care increases. The Care Plan also serves to enable longitudinal coordination of care.\n\nThe CDA Care Plan represents an instance of this dynamic Care Plan at a point in time. The CDA document itself is NOT dynamic.\n\nKey differentiators between a Care Plan CDA and CCD (another snapshot in time document):\n* There are 2 required sections:\n** Health Concerns\n** Goals\n* There are 2 optional sections:\n** Activities\n** Outcomes\n* Provides the ability to identify patient and provider priorities with each act\n* Provides a header participant to indicate occurrences of Care Plan review\n\nA care plan document can include entry references from the information in these sections to the information (entries) in other sections.\n\n#### Document Sections\nAlthough document templates may contain any section, the following sections are specifically called out by this template:\n\n**Required Sections**\n- [HealthConcernsSection](StructureDefinition-HealthConcernsSection.html)\n- [GoalsSection](StructureDefinition-GoalsSection.html)\n\n**Recommended Sections**\n- [HealthStatusEvaluationsandOutcomesSection](StructureDefinition-HealthStatusEvaluationsandOutcomesSection.html)\n\n**Additional Sections**\n- [ActivitiesSection](StructureDefinition-ActivitiesSection.html)\n- [AdvanceDirectivesSection](StructureDefinition-AdvanceDirectivesSection.html)
package_name: hl7.cda.us.ccda
derivation: constraint
name: CarePlan
type: http://hl7.org/cda/stds/core/StructureDefinition/ClinicalDocument
elements:
  informationRecipient:
    elements:
      intendedRecipient:
        constraint:
          should-addr: {human: SHOULD contain addr, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: addr.exists()}
          should-telecom: {human: SHOULD contain telecom, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: telecom.exists()}
          should-informationRecipient: {human: SHOULD contain informationRecipient, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: informationRecipient.exists()}
          should-receivedOrganization: {human: SHOULD contain receivedOrganization, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: receivedOrganization.exists()}
        index: 8
        elements:
          id: {index: 9}
          addr: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/AD', index: 10}
          telecom: {index: 11}
          informationRecipient:
            index: 12
            elements:
              name: {index: 13}
          receivedOrganization:
            constraint:
              should-id: {human: SHOULD contain id, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: id.exists()}
              should-standardIndustryClassCode: {human: SHOULD contain standardIndustryClassCode, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: standardIndustryClassCode.exists()}
            index: 14
            elements:
              id: {index: 15}
              standardIndustryClassCode:
                binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066'}
                index: 16
        required: [id]
  setId: {index: 6}
  participant:
    index: 25
    slicing:
      rules: open
      discriminator:
      - {path: typeCode, type: value}
      min: null
      slices:
        verifier:
          match: {typeCode: VRF}
          schema:
            array: true
            index: 26
            elements:
              typeCode:
                pattern: {type: Code, value: VRF}
                index: 27
              functionCode:
                index: 28
                elements:
                  code:
                    pattern: {type: Code, value: '425268008'}
                    index: 29
                  codeSystem:
                    pattern: {type: String, value: 2.16.840.1.113883.6.96}
                    index: 30
                required: [codeSystem, code]
              time: {index: 31}
              associatedEntity:
                constraint:
                  should-code: {human: SHOULD contain code, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: code.exists()}
                index: 32
                elements:
                  classCode:
                    pattern: {type: Code, value: ASSIGNED}
                    index: 33
                  id: {index: 34}
                  code:
                    index: 35
                    elements:
                      code:
                        binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1'}
                        index: 36
                required: [id]
            required: [time, functionCode]
        indirect:
          match: {typeCode: IND}
          schema:
            array: true
            index: 37
            elements:
              typeCode:
                pattern: {type: Code, value: IND}
                index: 38
              associatedEntity:
                index: 39
                elements:
                  classCode:
                    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.33'}
                    index: 40
                  associatedPerson:
                    index: 41
                    elements:
                      name: {index: 42}
                    required: [name]
                required: [associatedPerson]
  versionNumber: {index: 7}
  component:
    index: 66
    elements:
      structuredBody:
        constraint:
          1198-31044: {human: 'This structuredBody **SHALL NOT** contain a Plan of Treatment Section (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.2.10:2014-06-09) (CONF:1198-31044).', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: error, expression: 'component.where(section.hasTemplateIdOf(''http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection'')).empty()'}
          should-section-healthstatus: {human: SHOULD contain a Health Status Evaluations and Outcomes Section, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan', severity: warning, expression: 'component.where(section.hasTemplateIdOf(''http://hl7.org/cda/us/ccda/StructureDefinition/HealthStatusEvaluationsandOutcomesSection''))'}
        index: 67
        elements:
          component:
            array: true
            min: 2
            index: 68
            slicing:
              rules: open
              discriminator:
              - {path: section, type: profile}
              min: 2
              slices:
                healthConcerns:
                  match: {}
                  schema:
                    _required: true
                    index: 69
                    elements:
                      section: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Section', index: 70}
                goals:
                  match: {}
                  schema:
                    _required: true
                    index: 71
                    elements:
                      section: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Section', index: 72}
                activities:
                  match: {}
                  schema:
                    index: 73
                    elements:
                      section: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Section', index: 74}
                healthStatusEvalOutcm:
                  match: {}
                  schema:
                    index: 75
                    elements:
                      section: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Section', index: 76}
                advDirectives:
                  match: {}
                  schema:
                    index: 77
                    elements:
                      section: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Section', index: 78}
    required: [structuredBody]
  documentationOf:
    short: The serviceEvent describes the provision of healthcare over a period of time. The duration over which care was provided is indicated in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
    index: 43
    slicing:
      rules: open
      discriminator:
      - {path: serviceEvent.classCode, type: value}
      min: 1
      slices:
        care-provision:
          match:
            serviceEvent: {classCode: PCPR}
          schema:
            _required: true
            index: 44
            elements:
              serviceEvent:
                short: The serviceEvent describes the provision of healthcare over a period of time. The duration over which care was provided is indicated in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
                index: 45
                elements:
                  classCode:
                    pattern: {type: Code, value: PCPR}
                    index: 46
                  effectiveTime:
                    index: 47
                    elements:
                      low: {index: 48}
                      high: {index: 49}
                  performer:
                    index: 50
                    elements:
                      assignedEntity:
                        index: 51
                        elements:
                          id: {index: 52}
                          code: {index: 53}
                          assignedPerson:
                            index: 54
                            elements:
                              name: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/PN', index: 55}
                            required: [name]
                        required: [assignedPerson]
                required: [classCode, performer]
  code:
    binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.10'}
    index: 5
  templateId:
    array: true
    min: 2
    index: 0
    slicing:
      slices:
        care-plan:
          match: {}
          schema:
            _required: true
            index: 1
            elements:
              root:
                pattern: {type: String, value: 2.16.840.1.113883.10.20.22.1.15}
                index: 2
              extension:
                pattern: {type: String, value: '2024-05-01'}
                index: 3
            required: [root, extension]
            extensions: {}
  sdtcCategory: {short: 'Used to categorize the document as a Care Plan. If present, there SHALL be a category of 18776-5 (Plan of care note).', index: 4}
  relatedDocument:
    index: 56
    slicing:
      rules: open
      discriminator:
      - {path: parentDocument, type: exists}
      min: null
      slices:
        relatedDocument1:
          match: {}
          schema:
            array: true
            index: 57
            elements:
              typeCode:
                binding: {strength: required, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.1.11.11610'}
                index: 58
              parentDocument:
                index: 59
                elements:
                  id: {index: 60}
                  setId: {index: 61}
                  versionNumber: {index: 62}
                required: [setId, versionNumber]
  componentOf:
    index: 63
    elements:
      encompassingEncounter:
        index: 64
        elements:
          effectiveTime: {index: 65}
  authenticator:
    elements:
      time: {index: 17}
      signatureCode: {index: 18}
      sdtcSignatureText: {short: 'The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the signatureText element', index: 19}
      assignedEntity:
        index: 20
        elements:
          id: {index: 21}
          code:
            index: 22
            elements:
              code:
                pattern: {type: Code, value: ONESELF}
                index: 23
              codeSystem:
                pattern: {type: String, value: 2.16.840.1.113883.5.111}
                index: 24
            required: [codeSystem, code]
        required: [code]
package_version: 4.0.0-ballot
class: logical
kind: logical
url: http://hl7.org/cda/us/ccda/StructureDefinition/CarePlan
base: http://hl7.org/cda/us/ccda/StructureDefinition/USRealmHeader
version: 4.0.0-ballot
required: [documentationOf]