Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
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
| Official URL: https://fhir.acmeexample.org.uk/PatientCareCoordination/StructureDefinition/PatientCarePlan | Version: 0.1.0 | ||||
| Draft as of 2026-11-03 | Computable Name: PatientCarePlan | ||||
Care Plan - who is doing what, for which needs, towards which goals, for any episode
of care (for example a virtual ward stay, a long term condition or a social care support
plan). Shared through IHE Dynamic Care Planning; activities reference the
referrals, monitoring and tasks that carry it out. See the
Care Plan and Execution logical model. Not a
care assessment form - that is a QuestionnaireResponse.
Equivalent FDP Canonical Data Model (CDM) v1.0.0 objects: Community Care Plan, Team.
Differences:
supportingInfo).The CDM is a downstream persistence model, used here as evidence of what NHS operations record, not as a design source. Mapping by property name - To confirm. See FDP Canonical Data Model Mapping for the full mapping.
Usages:
You can also check for usages in the FHIR IG Statistics
Description Differentials, Snapshots, and other representations.
| Name | Flags | Card. | Type | Description & Constraints Filter:  |
|---|---|---|---|---|
  CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |
  implicitRules |
0..1 | uri | A set of rules under which this content was created | |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
 basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. | |
| intent |
1..1 | code | proposal | plan | order | option Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. | |
 category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. | |
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |
| period |
0..1 | Period | Time period plan covers | |
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |
 activity |
C | 0..* | BackboneElement | Action to occur as part of plan Constraints: cpl-3 |
 modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |
 reference |
C | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| CarePlan.status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.intent | Base | required | Care Plan Intent | 📍4.0.1 | FHIR Std. |
| CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both |
detail.empty() or reference.empty()
|
| dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CarePlan | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CarePlan | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from CarePlanEuHdr
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |
 basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown | |
| intent |
1..1 | code | proposal | plan | order | option | |
| category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan | |
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |
| period |
0..1 | Period | Time period plan covers | |
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |
| activity |
0..* | BackboneElement | Action to occur as part of plan | |
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |
| reference |
0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
 extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
0..* | Identifier | External Ids for this plan | |||||
| instantiatesCanonical |
0..* | canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) | Instantiated Canonical | |||||
| instantiatesUri |
0..* | uri | Instantiated URI | |||||
| basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |||||
| replaces |
0..* | Reference(CarePlan) | CarePlan replaced by this CarePlan | |||||
| partOf |
0..* | Reference(CarePlan) | Part of referenced CarePlan | |||||
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. | |||||
| intent |
1..1 | code | proposal | plan | order | option Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. | |||||
| category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. | |||||
| title |
0..1 | string | Human-friendly name for the care plan | |||||
| description |
0..1 | string | Summary of nature of plan | |||||
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |||||
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |||||
| period |
0..1 | Period | Time period plan covers | |||||
| created |
0..1 | dateTime | Date the plan was created | |||||
| author |
0..1 | Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) | Who is the designated responsible party | |||||
| contributor |
0..* | Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) | Who provided the content of the care plan | |||||
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |||||
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |||||
| supportingInfo |
0..* | Reference(Resource) | Information considered as part of the care plan | |||||
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |||||
 activity |
C | 0..* | BackboneElement | Action to occur as part of plan Constraints: cpl-3 | ||||
 id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| outcomeCodeableConcept |
0..* | CodeableConcept | Codeable Outcome summary Binding: CarePlanActivityOutcome (example): Identifies the results of the activity. | |||||
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |||||
| progress |
0..* | Annotation | Notes about the progress of the activity | |||||
| reference |
C | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request | ||||
| detail |
C | 0..1 | BackboneElement | Deprecated in R5/R6 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| kind |
0..1 | code | Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. | |||||
| instantiatesCanonical |
0..* | canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) | Instantiates FHIR protocol or definition | |||||
| instantiatesUri |
0..* | uri | Instantiates external protocol or definition | |||||
| code |
0..1 | CodeableConcept | Detail type of activity Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. | |||||
| reasonCode |
0..* | CodeableConcept | Why activity should be done or why activity was prohibited Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. | |||||
| reasonReference |
0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why activity is needed | |||||
| goal |
0..* | Reference(Goal) | Goals this activity relates to | |||||
| status |
1..1 | code | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. | |||||
| statusReason |
0..1 | CodeableConcept | Reason for current status | |||||
| doNotPerform |
0..1 | boolean | If true, activity is prohibiting action | |||||
 scheduled[x] |
0..1 | When activity is to occur | ||||||
| scheduledTiming |
Timing | |||||||
| scheduledPeriod |
Period | |||||||
| scheduledString |
string | |||||||
| location |
0..1 | Reference(Location) | Where it should happen | |||||
| performer |
0..* | Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) | Who will be responsible? | |||||
| product[x] |
0..1 | What is to be administered/supplied Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity. | ||||||
| productCodeableConcept |
CodeableConcept | |||||||
| productReference |
Reference(Medication | Substance) | |||||||
| dailyAmount |
C | 0..1 | SimpleQuantity(4.0.1) | How to consume/day? Constraints: sqty-1 | ||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | How much to administer/supply/consume Constraints: sqty-1 | ||||
| description |
0..1 | string | Extra info describing activity to perform | |||||
| note |
0..* | Annotation | Comments about the plan | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| CarePlan.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| CarePlan.status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.intent | Base | required | Care Plan Intent | 📍4.0.1 | FHIR Std. |
| CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.outcomeCodeableConcept | Base | example | Care Plan Activity Outcome | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.kind | Base | required | Care Plan Activity Kind | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.code | Base | example | Procedure Codes (SNOMED CT) | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.status | Base | required | CarePlanActivityStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.product[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both |
detail.empty() or reference.empty()
|
| dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CarePlan | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CarePlan | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| sqty-1 | error | CarePlan.activity.detail.dailyAmount, CarePlan.activity.detail.quantity | The comparator is not used on a SimpleQuantity |
comparator.empty()
|
This structure is derived from CarePlanEuHdr
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |
| basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. | |
| intent |
1..1 | code | proposal | plan | order | option Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. | |
| category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. | |
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |
| period |
0..1 | Period | Time period plan covers | |
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |
| activity |
C | 0..* | BackboneElement | Action to occur as part of plan Constraints: cpl-3 |
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |
| reference |
C | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| CarePlan.status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.intent | Base | required | Care Plan Intent | 📍4.0.1 | FHIR Std. |
| CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both |
detail.empty() or reference.empty()
|
| dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CarePlan | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CarePlan | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from CarePlanEuHdr
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |
| basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown | |
| intent |
1..1 | code | proposal | plan | order | option | |
| category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan | |
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |
| period |
0..1 | Period | Time period plan covers | |
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |
| activity |
0..* | BackboneElement | Action to occur as part of plan | |
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |
| reference |
0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request | |
| Documentation for this format | ||||
Snapshot ViewView
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| CarePlan |
0..* | CarePlanEuHdr | Healthcare plan for patient | |||||
| id |
0..1 | id | Logical id of this artifact | |||||
| meta |
0..1 | Meta | Metadata about the resource | |||||
| implicitRules |
0..1 | uri | A set of rules under which this content was created | |||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored | |||||
| identifier |
0..* | Identifier | External Ids for this plan | |||||
| instantiatesCanonical |
0..* | canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) | Instantiated Canonical | |||||
| instantiatesUri |
0..* | uri | Instantiated URI | |||||
| basedOn |
0..* | Reference(CarePlan) | Parent care plan (e.g. the GP or community care plan) | |||||
| replaces |
0..* | Reference(CarePlan) | CarePlan replaced by this CarePlan | |||||
| partOf |
0..* | Reference(CarePlan) | Part of referenced CarePlan | |||||
| status |
1..1 | code | draft | active | on-hold | revoked | completed | entered-in-error | unknown Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. | |||||
| intent |
1..1 | code | proposal | plan | order | option Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. | |||||
| category |
1..* | CodeableConcept | Type of plan, e.g. SNOMED CT 960751000000107 Remote health monitoring care plan Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. | |||||
| title |
0..1 | string | Human-friendly name for the care plan | |||||
| description |
0..1 | string | Summary of nature of plan | |||||
| subject |
1..1 | Reference(Patient) | Who the care plan is for | |||||
| encounter |
0..1 | Reference(Encounter) | The episode the plan belongs to, if any (e.g. a virtual ward stay) | |||||
| period |
0..1 | Period | Time period plan covers | |||||
| created |
0..1 | dateTime | Date the plan was created | |||||
| author |
0..1 | Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) | Who is the designated responsible party | |||||
| contributor |
0..* | Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) | Who provided the content of the care plan | |||||
| careTeam |
0..* | Reference(CareTeam) | Participants in the care plan | |||||
| addresses |
0..* | Reference(Condition (EU core)) | Health issues this plan addresses | |||||
| supportingInfo |
0..* | Reference(Resource) | Information considered as part of the care plan | |||||
| goal |
0..* | Reference(Goal (HDR)) | Desired outcome of plan | |||||
| activity |
C | 0..* | BackboneElement | Action to occur as part of plan Constraints: cpl-3 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| outcomeCodeableConcept |
0..* | CodeableConcept | Codeable Outcome summary Binding: CarePlanActivityOutcome (example): Identifies the results of the activity. | |||||
| outcomeReference |
0..* | Reference(Resource) | Outcome evidence | |||||
| progress |
0..* | Annotation | Notes about the progress of the activity | |||||
| reference |
C | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) | The request that carries out the activity, e.g. a Referral Request | ||||
| detail |
C | 0..1 | BackboneElement | Deprecated in R5/R6 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
0..* | Extension | Extensions that cannot be ignored even if unrecognized | |||||
| kind |
0..1 | code | Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. | |||||
| instantiatesCanonical |
0..* | canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) | Instantiates FHIR protocol or definition | |||||
| instantiatesUri |
0..* | uri | Instantiates external protocol or definition | |||||
| code |
0..1 | CodeableConcept | Detail type of activity Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. | |||||
| reasonCode |
0..* | CodeableConcept | Why activity should be done or why activity was prohibited Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. | |||||
| reasonReference |
0..* | Reference(Condition | Observation | DiagnosticReport | DocumentReference) | Why activity is needed | |||||
| goal |
0..* | Reference(Goal) | Goals this activity relates to | |||||
| status |
1..1 | code | not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. | |||||
| statusReason |
0..1 | CodeableConcept | Reason for current status | |||||
| doNotPerform |
0..1 | boolean | If true, activity is prohibiting action | |||||
| scheduled[x] |
0..1 | When activity is to occur | ||||||
| scheduledTiming |
Timing | |||||||
| scheduledPeriod |
Period | |||||||
| scheduledString |
string | |||||||
| location |
0..1 | Reference(Location) | Where it should happen | |||||
| performer |
0..* | Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) | Who will be responsible? | |||||
| product[x] |
0..1 | What is to be administered/supplied Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity. | ||||||
| productCodeableConcept |
CodeableConcept | |||||||
| productReference |
Reference(Medication | Substance) | |||||||
| dailyAmount |
C | 0..1 | SimpleQuantity(4.0.1) | How to consume/day? Constraints: sqty-1 | ||||
| quantity |
C | 0..1 | SimpleQuantity(4.0.1) | How much to administer/supply/consume Constraints: sqty-1 | ||||
| description |
0..1 | string | Extra info describing activity to perform | |||||
| note |
0..* | Annotation | Comments about the plan | |||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| CarePlan.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| CarePlan.status | Base | required | RequestStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.intent | Base | required | Care Plan Intent | 📍4.0.1 | FHIR Std. |
| CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.outcomeCodeableConcept | Base | example | Care Plan Activity Outcome | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.kind | Base | required | Care Plan Activity Kind | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.code | Base | example | Procedure Codes (SNOMED CT) | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.status | Base | required | CarePlanActivityStatus | 📍4.0.1 | FHIR Std. |
| CarePlan.activity.detail.product[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both |
detail.empty() or reference.empty()
|
| dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | CarePlan | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource |
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
|
| dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated |
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
|
| dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | CarePlan | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
| sqty-1 | error | CarePlan.activity.detail.dailyAmount, CarePlan.activity.detail.quantity | The comparator is not used on a SimpleQuantity |
comparator.empty()
|
This structure is derived from CarePlanEuHdr
Other representations of profile: CSV, Excel, Schematron