FHIR Implementation Guide for ABDM CI Build v2.0.1
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This Implementation guide is published and maintained by NRCeS for NHA.
This version is based on the ABDM Health Data Interchange Specifications 1.0 and updated periodically.

StructureDefinition-WellnessRecord

This profile sets minimum expectations for the WellnessRecord to record, search, and fetch the details of daily observations such as vital signs, body measurements, physical activities, etc. collected via various healthcare devices by a patient. It identifies the mandatory core elements, vocabularies, and value sets which SHALL be present in the Composition resource when using this profile.

Examples

Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: https://nrces.in/ndhm/fhir/r4/StructureDefinition/WellnessRecord

This profile builds on Composition

Summary

Mandatory: 3 elements (15 nested mandatory elements)
Must-Support: 20 elements
Fixed Value: 9 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Composition.section is sliced based on the value of value:title (Open at End)
NameFlagsCard.TypeDescription & Constraintsdoco
.. Composition 0..*CompositionA set of resources composed into a single coherent clinical statement with clinical attestation
... status S1..1codepreliminary | final | amended | entered-in-error
... type S1..1CodeableConceptKind of composition (LOINC if possible)
.... text S0..1stringPlain text representation of the concept
Fixed Value: Wellness Record
... subject S1..1Reference(Patient)Who and/or what the composition is about
.... reference 1..1stringLiteral reference, Relative, internal or absolute URL
... encounter 0..1Reference(Encounter)Context of the Composition
... date S1..1dateTimeComposition editing time
... author S1..*Reference(Device | RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who and/or what authored the composition
... title S1..1stringHuman Readable name/title
... attester S0..*BackboneElementAttests to accuracy of composition
.... party 0..1Reference(RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who attested the composition
... custodian 0..1Reference(Organization)Organization which maintains the composition
... Slices for section S1..*BackboneElementComposition is broken into sections
Slice: Unordered, Open At End by value:title
.... section:VitalSigns 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Vital Signs
..... entry S0..*Reference(ObservationVitalSigns)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:BodyMeasurement 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Body Measurement
..... entry S0..*Reference(ObservationBodyMeasurement)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:PhysicalActivity 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Physical Activity
..... entry S0..*Reference(ObservationPhysicalActivity)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:GeneralAssessment 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: General Assessment
..... entry S0..*Reference(ObservationGeneralAssessment)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:WomenHealth 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Women Health
..... entry S0..*Reference(ObservationWomenHealth)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:Lifestyle 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Lifestyle
..... entry S0..*Reference(ObservationLifestyle)A reference to data that supports this section
.... section:OtherObservations 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Other Observations
..... entry S0..*Reference(Observation | Condition)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:DocumentReference 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Document Reference
..... entry S0..*Reference(DocumentReference)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Composition 0..*CompositionA set of resources composed into a single coherent clinical statement with clinical attestation
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..1IdentifierVersion-independent identifier for the Composition
... status ?!SΣ1..1codepreliminary | final | amended | entered-in-error
Binding: CompositionStatus (required): The workflow/clinical status of the composition.

... type SΣ1..1CodeableConceptKind of composition (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Type of a composition.

.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
.... text SΣ0..1stringPlain text representation of the concept
Fixed Value: Wellness Record
... category Σ0..*CodeableConceptCategorization of Composition
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


... subject SΣ1..1Reference(Patient)Who and/or what the composition is about
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... encounter Σ0..1Reference(Encounter)Context of the Composition
... date SΣ1..1dateTimeComposition editing time
... author SΣ1..*Reference(Device | RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who and/or what authored the composition
... title SΣ1..1stringHuman Readable name/title
... confidentiality Σ0..1codeAs defined by affinity domain
Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.

... attester S0..*BackboneElementAttests to accuracy of composition
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... mode 1..1codepersonal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.

.... time 0..1dateTimeWhen the composition was attested
.... party 0..1Reference(RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who attested the composition
... custodian Σ0..1Reference(Organization)Organization which maintains the composition
... relatesTo 0..*BackboneElementRelationships to other compositions/documents
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1codereplaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.

.... target[x] 1..1Target of the relationship
..... targetIdentifierIdentifier
..... targetReferenceReference(Composition)
... event Σ0..*BackboneElementThe clinical service(s) being documented
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ0..*CodeableConceptCode(s) that apply to the event being documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.


.... period Σ0..1PeriodThe period covered by the documentation
.... detail Σ0..*Reference(Resource)The event(s) being documented
... Slices for section SI1..*BackboneElementComposition is broken into sections
Slice: Unordered, Open At End by value:title
.... section:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 0..1stringLabel for section (e.g. for ToC)
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry I0..*Reference(Resource)A reference to data that supports this section
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:VitalSigns I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Vital Signs
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationVitalSigns)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:BodyMeasurement I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Body Measurement
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationBodyMeasurement)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:PhysicalActivity I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Physical Activity
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationPhysicalActivity)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:GeneralAssessment I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: General Assessment
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationGeneralAssessment)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:WomenHealth I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Women Health
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationWomenHealth)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:Lifestyle I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Lifestyle
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationLifestyle)A reference to data that supports this section
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:OtherObservations I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Other Observations
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(Observation | Condition)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:DocumentReference I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Document Reference
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(DocumentReference)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section

doco Documentation for this format

Summary

Mandatory: 3 elements (15 nested mandatory elements)
Must-Support: 20 elements
Fixed Value: 9 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element Composition.section is sliced based on the value of value:title (Open at End)

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Composition 0..*CompositionA set of resources composed into a single coherent clinical statement with clinical attestation
... status S1..1codepreliminary | final | amended | entered-in-error
... type S1..1CodeableConceptKind of composition (LOINC if possible)
.... text S0..1stringPlain text representation of the concept
Fixed Value: Wellness Record
... subject S1..1Reference(Patient)Who and/or what the composition is about
.... reference 1..1stringLiteral reference, Relative, internal or absolute URL
... encounter 0..1Reference(Encounter)Context of the Composition
... date S1..1dateTimeComposition editing time
... author S1..*Reference(Device | RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who and/or what authored the composition
... title S1..1stringHuman Readable name/title
... attester S0..*BackboneElementAttests to accuracy of composition
.... party 0..1Reference(RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who attested the composition
... custodian 0..1Reference(Organization)Organization which maintains the composition
... Slices for section S1..*BackboneElementComposition is broken into sections
Slice: Unordered, Open At End by value:title
.... section:VitalSigns 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Vital Signs
..... entry S0..*Reference(ObservationVitalSigns)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:BodyMeasurement 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Body Measurement
..... entry S0..*Reference(ObservationBodyMeasurement)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:PhysicalActivity 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Physical Activity
..... entry S0..*Reference(ObservationPhysicalActivity)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:GeneralAssessment 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: General Assessment
..... entry S0..*Reference(ObservationGeneralAssessment)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:WomenHealth 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Women Health
..... entry S0..*Reference(ObservationWomenHealth)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:Lifestyle 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Lifestyle
..... entry S0..*Reference(ObservationLifestyle)A reference to data that supports this section
.... section:OtherObservations 0..1BackboneElementComposition is broken into sections
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Other Observations
..... entry S0..*Reference(Observation | Condition)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL
.... section:DocumentReference 0..1BackboneElementComposition is broken into sections
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Document Reference
..... entry S0..*Reference(DocumentReference)A reference to data that supports this section
...... reference 1..1stringLiteral reference, Relative, internal or absolute URL

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Composition 0..*CompositionA set of resources composed into a single coherent clinical statement with clinical attestation
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..1IdentifierVersion-independent identifier for the Composition
... status ?!SΣ1..1codepreliminary | final | amended | entered-in-error
Binding: CompositionStatus (required): The workflow/clinical status of the composition.

... type SΣ1..1CodeableConceptKind of composition (LOINC if possible)
Binding: FHIRDocumentTypeCodes (preferred): Type of a composition.

.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
.... text SΣ0..1stringPlain text representation of the concept
Fixed Value: Wellness Record
... category Σ0..*CodeableConceptCategorization of Composition
Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.


... subject SΣ1..1Reference(Patient)Who and/or what the composition is about
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... encounter Σ0..1Reference(Encounter)Context of the Composition
... date SΣ1..1dateTimeComposition editing time
... author SΣ1..*Reference(Device | RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who and/or what authored the composition
... title SΣ1..1stringHuman Readable name/title
... confidentiality Σ0..1codeAs defined by affinity domain
Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.

... attester S0..*BackboneElementAttests to accuracy of composition
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... mode 1..1codepersonal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.

.... time 0..1dateTimeWhen the composition was attested
.... party 0..1Reference(RelatedPerson | Patient | Practitioner | PractitionerRole | Organization)Who attested the composition
... custodian Σ0..1Reference(Organization)Organization which maintains the composition
... relatesTo 0..*BackboneElementRelationships to other compositions/documents
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1codereplaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.

.... target[x] 1..1Target of the relationship
..... targetIdentifierIdentifier
..... targetReferenceReference(Composition)
... event Σ0..*BackboneElementThe clinical service(s) being documented
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code Σ0..*CodeableConceptCode(s) that apply to the event being documented
Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.


.... period Σ0..1PeriodThe period covered by the documentation
.... detail Σ0..*Reference(Resource)The event(s) being documented
... Slices for section SI1..*BackboneElementComposition is broken into sections
Slice: Unordered, Open At End by value:title
.... section:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 0..1stringLabel for section (e.g. for ToC)
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry I0..*Reference(Resource)A reference to data that supports this section
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:VitalSigns I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Vital Signs
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationVitalSigns)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:BodyMeasurement I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Body Measurement
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationBodyMeasurement)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:PhysicalActivity I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Physical Activity
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationPhysicalActivity)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:GeneralAssessment I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: General Assessment
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationGeneralAssessment)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:WomenHealth I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Women Health
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationWomenHealth)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:Lifestyle I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Lifestyle
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(ObservationLifestyle)A reference to data that supports this section
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:OtherObservations I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title 1..1stringLabel for section (e.g. for ToC)
Fixed Value: Other Observations
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(Observation | Condition)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section
.... section:DocumentReference I0..1BackboneElementComposition is broken into sections
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... title S1..1stringLabel for section (e.g. for ToC)
Fixed Value: Document Reference
..... code 0..1CodeableConceptClassification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.

..... author 0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)Who and/or what authored the section
..... focus 0..1Reference(Resource)Who/what the section is about, when it is not about the subject of composition
..... text I0..1NarrativeText summary of the section, for human interpretation
..... mode 0..1codeworking | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.

..... orderedBy 0..1CodeableConceptOrder of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.

..... entry SI0..*Reference(DocumentReference)A reference to data that supports this section
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣI1..1stringLiteral reference, Relative, internal or absolute URL
...... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

...... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
...... display Σ0..1stringText alternative for the resource
..... emptyReason I0..1CodeableConceptWhy the section is empty
Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.

..... section I0..*See section (Composition)Nested Section

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