Care Coordination and 360 Referrals (Proof of Concept)
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Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Care Plan - virtual ward remote monitoring

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/CarePlan/VirtualWardPlan> a fhir:CarePlan ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "VirtualWardPlan"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/PatientCarePlan" ;
       fhir:index -1 ;
       fhir:link <https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/PatientCarePlan>
     ]
  ] ;
  fhir:Resource.language [ fhir:value "en"] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CarePlan VirtualWardPlan</b></p><a name=\"VirtualWardPlan\"> </a><a name=\"hcVirtualWardPlan\"> </a><div style=\"display: inline-block; background-color: #fbffeb; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-PatientCarePlan.html\">Care Plan</a></p></div><p><b>status</b>: Completed</p><p><b>intent</b>: Plan</p><p><b>category</b>: <span title=\"Codes:{http://snomed.info/sct 960751000000107}\">Remote health monitoring care plan</span></p><p><b>title</b>: Respiratory virtual ward plan</p><p><b>subject</b>: <a href=\"Patient-Patient-Manchester.html\">Sansa MANCHESTER  Female, DoB: 1972-09-21 ( National Health Plan Identifier: NHS Number#9737383192)</a></p><p><b>encounter</b>: <a href=\"Encounter-VirtualWardStay.html\">Encounter: extension = Discharged on clinical advice; identifier = Account number: VW-20261006-01; status = finished; class = inpatient encounter (ActCode#IMP); serviceType = Pulmonary medicine; period = 2026-10-06 11:00:00+0100 --&gt; 2026-10-13 10:00:00+0100</a></p><p><b>period</b>: 2026-10-06 --&gt; 2026-10-13</p><p><b>author</b>: <a href=\"Organization-R0A.html\">Manchester University NHS Foundation Trust (https://fhir.nhs.uk/Id/ods-organization-code#ODS Organisation Code#R0A)</a></p><p><b>addresses</b>: <a href=\"Condition-ConditionCOPDExacerbation.html\">Condition Acute exacerbation of chronic obstructive airways disease</a></p><blockquote><p><b>activity</b></p><h3>Details</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Status</b></td><td><b>Description</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://loinc.org 59408-5}\">Oxygen saturation in Arterial blood by Pulse oximetry</span></td><td>Completed</td><td>Patient records SpO2 twice daily; escalate to the virtual ward clinician if below 88%.</td></tr></table></blockquote></div>"
  ] ;
  fhir:CarePlan.status [ fhir:value "completed"] ;
  fhir:CarePlan.intent [ fhir:value "plan"] ;
  fhir:CarePlan.category [
     fhir:index -1 ;
     fhir:CodeableConcept.coding [
       fhir:index -1 ;
       a sct:960751000000107 ;
       fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
       fhir:Coding.code [ fhir:value "960751000000107" ] ;
       fhir:Coding.display [ fhir:value "Remote health monitoring care plan" ]
     ]
  ] ;
  fhir:CarePlan.title [ fhir:value "Respiratory virtual ward plan"] ;
  fhir:CarePlan.subject [
     fhir:link <http://hl7.org/fhir/Patient/Patient-Manchester> ;
     fhir:Reference.reference [ fhir:value "Patient/Patient-Manchester" ]
  ] ;
  fhir:CarePlan.encounter [
     fhir:link <http://hl7.org/fhir/Encounter/VirtualWardStay> ;
     fhir:Reference.reference [ fhir:value "Encounter/VirtualWardStay" ]
  ] ;
  fhir:CarePlan.period [
     fhir:Period.start [ fhir:value "2026-10-06"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2026-10-13"^^xsd:date ]
  ] ;
  fhir:CarePlan.author [
     fhir:link <http://hl7.org/fhir/Organization/R0A> ;
     fhir:Reference.reference [ fhir:value "Organization/R0A" ]
  ] ;
  fhir:CarePlan.addresses [
     fhir:index -1 ;
     fhir:link <http://hl7.org/fhir/Condition/ConditionCOPDExacerbation> ;
     fhir:Reference.reference [ fhir:value "Condition/ConditionCOPDExacerbation" ]
  ] ;
  fhir:CarePlan.activity [
     fhir:index -1 ;
     fhir:CarePlan.activity.detail [
       fhir:CarePlan.activity.detail.code [
         fhir:CodeableConcept.coding [
           fhir:index -1 ;
           a loinc:59408-5 ;
           fhir:Coding.system [ fhir:value "http://loinc.org" ] ;
           fhir:Coding.code [ fhir:value "59408-5" ] ;
           fhir:Coding.display [ fhir:value "Oxygen saturation in Arterial blood by Pulse oximetry" ]
         ]
       ] ;
       fhir:CarePlan.activity.detail.status [ fhir:value "completed" ] ;
       fhir:CarePlan.activity.detail.description [ fhir:value "Patient records SpO2 twice daily; escalate to the virtual ward clinician if below 88%." ]
     ]
  ] .

<http://hl7.org/fhir/Patient/Patient-Manchester> a fhir:Patient .

<http://hl7.org/fhir/Encounter/VirtualWardStay> a fhir:Encounter .

<http://hl7.org/fhir/Organization/R0A> a fhir:Organization .

<http://hl7.org/fhir/Condition/ConditionCOPDExacerbation> a fhir:Condition .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/CarePlan/VirtualWardPlan.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/CarePlan/VirtualWardPlan.ttl> .