R4 Ballot #1 (Mixed Normative/Trial use) Current Build
This page was published as part of FHIR v3.3.0: R4 Ballot #1 : Mixed Normative/Trial use (First Normative ballot). It has been superceded by R4 . For a full list of available versions, see the Directory of published versions .
Patient Care Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner , RelatedPerson

Detailed Descriptions for the elements in the CarePlan resource.

Alternate Names encounter Control
CarePlan
Element Id CarePlan
Definition

Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

Control Cardinality 1..1 0..*
Type DomainResource
Alternate Names Care Team
CarePlan.identifier
Element Id CarePlan.identifier
Definition

Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Note This is a business identifer, identifier, not a resource identifier (see discussion )
Control Cardinality 0..*
Type Identifier
Requirements

Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers.

Summary true
Comments

This is a business identifier, not a resource identifier (see discussion ).  ). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types.  types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

CarePlan.instantiates CarePlan.instantiatesCanonical
Element Id CarePlan.instantiates CarePlan.instantiatesCanonical
Definition

Identifies the The URL pointing to a FHIR-defined protocol, questionnaire, guideline guideline, questionnaire or other specification the care plan should be conducted definition that is adhered to in accordance with. whole or in part by this CarePlan.

Control Cardinality 0..*
Type canonical ( PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition )
Summary true
CarePlan.instantiatesUri
Element Id CarePlan.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.

Cardinality 0..*
Type uri
Summary true
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

CarePlan.basedOn
Element Id CarePlan.basedOn
Definition

A care plan that is fulfilled in whole or in part by this care plan.

Control Cardinality 0..*
Type Reference ( CarePlan )
Hierarchy This reference is part of a strict Hierarchy
Requirements

Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.

Alternate Names fulfills
Summary true
CarePlan.replaces
Element Id CarePlan.replaces
Definition

Completed or terminated care plan whose function is taken by this new care plan.

Control Cardinality 0..*
Type Reference ( CarePlan )
Hierarchy This reference is part of a strict Hierarchy
Requirements

Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.

Alternate Names supersedes
Summary true
Comments

The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.

CarePlan.partOf
Element Id CarePlan.partOf
Definition

A larger care plan of which this particular care plan is a component or step.

Control Cardinality 0..*
Type Reference ( CarePlan )
Hierarchy This reference is part of a strict Hierarchy
Summary true
Comments

Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.

CarePlan.status
Element Id CarePlan.status
Definition

Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

Control Cardinality 1..1
Terminology Binding CarePlanStatus RequestStatus ( Required )
Type code
Is Modifier true (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Requirements

Allows clinicians to determine whether the plan is actionable or not.

Summary true
Comments

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.

CarePlan.intent
Element Id CarePlan.intent
Definition

Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.

Control Cardinality 1..1
Terminology Binding CarePlanIntent Care Plan Intent ( Required )
Type code
Is Modifier true (Reason: This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request) request")
Requirements

Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

Summary true
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. This element is expected to be immutable. E.g. A "proposal" instance should never change to be a "plan" instance or "order" instance. Instead, a new instance 'basedOn' the prior instance should be created with the new 'intent' value.

CarePlan.category
Element Id CarePlan.category
Definition

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

Control Cardinality 0..*
Terminology Binding Care Plan Category ( Example )
Type CodeableConcept
Requirements

Used for filtering what plan(s) are retrieved and displayed to different types of users.

Summary true
Comments

There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

CarePlan.title
Element Id CarePlan.title
Definition

Human-friendly name for the care plan.

Control Cardinality 0..1
Type string
Summary true
CarePlan.description
Element Id CarePlan.description
Definition

A description of the scope and nature of the plan.

Control Cardinality 0..1
Type string
Requirements

Provides more detail than conveyed by category.

Summary true
CarePlan.subject
Element Id CarePlan.subject
Definition

Identifies the patient or group whose intended care is described by the plan.

Control Cardinality 1..1
Type Reference ( Patient | Group )
Patterns Reference(Patient,Group): Common patterns = Participant
Alternate Names patient
Summary true
CarePlan.context CarePlan.encounter
Element Id CarePlan.context CarePlan.encounter
Definition

Identifies the original context in The Encounter during which this particular care plan CarePlan was created. created or to which the creation of this record is tightly associated.

Control Cardinality 0..1
Type Reference ( Encounter | EpisodeOfCare )
Summary true
Comments

Activities This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters/episodes. encounters.

CarePlan.period
Element Id CarePlan.period
Definition

Indicates when the plan did (or is intended to) come into effect and end.

Control Cardinality 0..1
Type Period
Requirements

Allows tracking what plan(s) are in effect at a particular time.

Alternate Names timing
Summary true
Comments

Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).

CarePlan.created
Element Id CarePlan.created
Definition

Represents when this particular CarePlan record was created in the system, which is often a system-generated date.

Cardinality 0..1
Type dateTime
Alternate Names authoredOn
Summary true
CarePlan.author
Element Id CarePlan.author
Definition

When populated, the author is responsible for the care plan. The care plan is attributed to the author.

Cardinality 0..1
Type Reference ( Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam )
Patterns Reference(Patient,Practitioner,PractitionerRole,Device,RelatedPerson,Organization,CareTeam): Common patterns = Participant
Summary true
Comments

The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.

CarePlan.contributor
Element Id CarePlan.contributor
Definition

Identifies the individual(s) or organization who is responsible for provided the content contents of the care plan.

Control Cardinality 0..*
Type Reference ( Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam )
Summary Patterns true Reference(Patient,Practitioner,PractitionerRole,Device,RelatedPerson,Organization,CareTeam): Common patterns = Participant
Comments

Collaborative care plans may have multiple authors. contributors.

CarePlan.careTeam
Element Id CarePlan.careTeam
Definition

Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.

Control Cardinality 0..*
Type Reference ( CareTeam )
Requirements

Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.

CarePlan.addresses CarePlan.addressesCode
Element Id CarePlan.addresses CarePlan.addressesCode
Definition

Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

Control Cardinality 0..*
Type CodeableConcept
Requirements

The element can identify risks addressed by the plan as well as concerns. Also scopes plans - multiple plans may exist addressing different concerns.

Summary true
Comments

Use CarePlan.addressesCode when a code sufficiently describes the concern (e.g. condition, problem, diagnosis, risk). Use CarePlan.addressesReference when referencing a resource, which allows more information to be conveyed, such as onset date. CarePlan.addressesCode and CarePlan.addressesReference are not meant to be duplicative. For a single concern, either CarePlan.addressesCode or CarePlan.addressesReference can be used. CarePlan.addressesCode may be a summary code, or CarePlan.addressesReference may be used to reference a very precise definition of the concern using Condition. Both CarePlan.addressesCode and CarePlan.addressesReference can be used if they are describing different concerns for the care plan.

CarePlan.addressesReference
Element Id CarePlan.addressesReference
Definition

Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

Cardinality 0..*
Type Reference ( Condition )
Requirements

Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.

Summary true
Comments

When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance. Use CarePlan.addressesCode when a code sufficiently describes the concern (e.g. condition, problem, diagnosis, risk). Use CarePlan.addressesReference when referencing a resource, which allows more information to be conveyed, such as onset date. CarePlan.addressesCode and CarePlan.addressesReference are not meant to be duplicative. For a single concern, either CarePlan.addressesCode or CarePlan.addressesReference can be used. CarePlan.addressesCode may be a summary code, or CarePlan.addressesReference may be used to reference a very precise definition of the concern using Condition. Both CarePlan.addressesCode and CarePlan.addressesReference can be used if they are describing different concerns for the care plan.

CarePlan.supportingInfo
Element Id CarePlan.supportingInfo
Definition

Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.

Control Cardinality 0..*
Type Reference ( Any )
Requirements

Identifies barriers and other considerations associated with the care plan.

Comments

Use "concern" to identify specific conditions addressed by the care plan. supportingInfo can be used to convey one or more Advance Directives or Medical Treatment Consent Directives by referencing Consent or any other request resource with intent = directive.

CarePlan.goal
Element Id CarePlan.goal
Definition

Describes the intended objective(s) of carrying out the care plan.

Control Cardinality 0..*
Type Reference ( Goal )
Requirements

Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.

Comments

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

CarePlan.activity
Element Id CarePlan.activity
Definition

Identifies an action that has occurred or is a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, self-monitoring that has occurred, education etc.

Control Cardinality 0..*
Requirements

Allows systems to prompt for performance of planned activities, and validate plans against best practice.

Invariants
Defined on this element
cpl-3 : Rule Provide a reference or detail, not both ( expression : detail.empty() or reference.empty(), xpath: not(exists(f:detail)) or not(exists(f:reference))) reference.empty()
CarePlan.activity.outcomeCodeableConcept
Element Id CarePlan.activity.outcomeCodeableConcept
Definition

Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).

Control Cardinality 0..*
Terminology Binding Care Plan Activity Outcome ( Example )
Type CodeableConcept
Comments

Note that this should not duplicate the activity status (e.g. completed or in progress).

CarePlan.activity.outcomeReference
Element Id CarePlan.activity.outcomeReference
Definition

Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” “request” resource).

Control Cardinality 0..*
Type Reference ( Any )
Requirements

Links plan to resulting actions.

Comments

The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.

CarePlan.activity.progress
Element Id CarePlan.activity.progress
Definition

Notes about the adherence/status/progress of the activity.

Control Cardinality 0..*
Type Annotation
Requirements

Can be used to capture information about adherence, progress, concerns, etc.

Comments

This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.

CarePlan.activity.reference
Element Id CarePlan.activity.reference
Definition

The details of the proposed activity represented in a specific resource.

Control Cardinality 0..1
Type Reference ( Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup | ImmunizationRecommendation )
Patterns Reference(Appointment,CommunicationRequest,DeviceRequest,MedicationRequest,NutritionOrder,Task,ServiceRequest,VisionPrescription,RequestGroup,ImmunizationRecommendation): No common pattern
Requirements

Details in a form consistent with other applications and contexts of use.

Comments

Standard extension exists ( resource-pertainsToGoal ) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference.
The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan.

Invariants
Affect this element
cpl-3 : Rule Provide a reference or detail, not both ( expression : detail.empty() or reference.empty(), xpath: not(exists(f:detail)) or not(exists(f:reference))) reference.empty()
CarePlan.activity.detail
Element Id CarePlan.activity.detail
Definition

A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.

Control Cardinality 0..1
Requirements

Details in a simple form for generic care plan systems.

Invariants
Affect this element
cpl-3 : Rule Provide a reference or detail, not both ( expression : detail.empty() or reference.empty(), xpath: not(exists(f:detail)) or not(exists(f:reference))) reference.empty()
CarePlan.activity.detail.kind
Element Id CarePlan.activity.detail.kind
Definition

A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.

Control Cardinality 0..1
Terminology Binding Care Plan Activity Kind ( Required )
Type code
Requirements

May determine what types of extensions are permitted.

CarePlan.activity.detail.instantiates CarePlan.activity.detail.instantiatesCanonical
Element Id CarePlan.activity.detail.instantiates CarePlan.activity.detail.instantiatesCanonical
Definition

Identifies the The URL pointing to a FHIR-defined protocol, questionnaire, guideline guideline, questionnaire or other specification definition that is adhered to in whole or in part by this CarePlan activity.

Cardinality 0..*
Type canonical ( PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition )
Requirements

Allows Questionnaires that the planned activity patient (or practitioner) should be conducted fill in accordance with. to fulfill the care plan activity.

CarePlan.activity.detail.instantiatesUri
Element Id CarePlan.activity.detail.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.

Cardinality 0..1 0..*
Type uri
Requirements

Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.

Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

CarePlan.activity.detail.code
Element Id CarePlan.activity.detail.code
Definition

Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.

Control Cardinality 0..1
Terminology Binding Procedure Codes (SNOMED CT) ( Example )
Type CodeableConcept
Requirements

Allows matching performed to planned as well as validation against protocols.

Comments

Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.

CarePlan.activity.detail.reasonCode
Element Id CarePlan.activity.detail.reasonCode
Definition

Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.

Control Cardinality 0..*
Terminology Binding SNOMED CT Clinical Findings ( Example )
Type CodeableConcept
Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.

CarePlan.activity.detail.reasonReference
Element Id CarePlan.activity.detail.reasonReference
Definition

Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.

Control Cardinality 0..*
Type Reference ( Condition | Observation | DiagnosticReport | DocumentReference )
Patterns Reference(Condition,Observation,DiagnosticReport,DocumentReference): Common patterns = Event
Comments

Conditions can be identified at the activity level that are not identified as reasons for the overall plan.

CarePlan.activity.detail.goal
Element Id CarePlan.activity.detail.goal
Definition

Internal reference that identifies the goals that this activity is intended to contribute towards meeting.

Control Cardinality 0..*
Type Reference ( Goal )
Requirements

So that participants know the link explicitly.

CarePlan.activity.detail.status
Element Id CarePlan.activity.detail.status
Definition

Identifies what progress is being made for the specific activity.

Control Cardinality 1..1
Terminology Binding CarePlanActivityStatus ( Required )
Type code
Is Modifier true (Reason: Not known why this This element is labelled as a modifier) modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid)
Requirements

Indicates progress against the plan, whether the activity is still relevant for the plan.

Comments

Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated.
The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.

CarePlan.activity.detail.statusReason
Element Id CarePlan.activity.detail.statusReason
Definition

Provides reason why the activity isn't yet started, is on hold, was cancelled, etc.

Control Cardinality 0..1
Type string CodeableConcept
Comments

Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.

CarePlan.activity.detail.doNotPerform
Element Id CarePlan.activity.detail.doNotPerform
Definition

If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.

Control Cardinality 0..1
Type boolean
Is Modifier true (Reason: If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur.)
Meaning if Missing If missing indicates that the described activity is one that should be engaged in when following the plan.
Requirements

Captures intention to not do something that may have been previously typical.

Comments

This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.

CarePlan.activity.detail.scheduled[x]
Element Id CarePlan.activity.detail.scheduled[x]
Definition

The period, timing or frequency upon which the described activity is to occur.

Control Cardinality 0..1
Type Timing | Period | string
[x] Note See Choice of Data Types for further information about how to use [x]
Requirements

Allows prompting for activities and detection of missed planned activities.

CarePlan.activity.detail.location
Element Id CarePlan.activity.detail.location
Definition

Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.

Control Cardinality 0..1
Type Reference ( Location )
Requirements

Helps in planning of activity.

Comments

May reference a specific clinical location or may identify a type of location.

CarePlan.activity.detail.reported[x]
Element Id CarePlan.activity.detail.reported[x]
Definition

Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.

Cardinality 0..1
Type boolean | Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization )
Patterns Reference(Patient,RelatedPerson,Practitioner,PractitionerRole,Organization): Common patterns = Participant
[x] Note See Choice of Data Types for further information about how to use [x]
Requirements

Reported data may have different rules on editing and may be visually distinguished from primary data.

Alternate Names informer
CarePlan.activity.detail.performer
Element Id CarePlan.activity.detail.performer
Definition

Identifies who's expected to be involved in the activity.

Control Cardinality 0..*
Type Reference ( Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device )
Patterns Reference(Practitioner,PractitionerRole,Organization,RelatedPerson,Patient,CareTeam,HealthcareService,Device): Common patterns = Participant
Requirements

Helps in planning of activity.

Comments

A performer MAY also be a participant in the care plan.

CarePlan.activity.detail.product[x]
Element Id CarePlan.activity.detail.product[x]
Definition

Identifies the food, drug or other product to be consumed or supplied in the activity.

Control Cardinality 0..1
Terminology Binding SNOMED CT Medication Codes ( Example )
Type CodeableConcept | Reference ( Medication | Substance )
Patterns Reference(Medication,Substance): No common pattern
[x] Note See Choice of Data Types for further information about how to use [x]
CarePlan.activity.detail.dailyAmount
Element Id CarePlan.activity.detail.dailyAmount
Definition

Identifies the quantity expected to be consumed in a given day.

Control Cardinality 0..1
Type SimpleQuantity
Requirements

Allows rough dose checking.

Alternate Names daily dose
CarePlan.activity.detail.quantity
Element Id CarePlan.activity.detail.quantity
Definition

Identifies the quantity expected to be supplied, administered or consumed by the subject.

Control Cardinality 0..1
Type SimpleQuantity
CarePlan.activity.detail.description
Element Id CarePlan.activity.detail.description
Definition

This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.

Control Cardinality 0..1
Type string
CarePlan.note
Element Id CarePlan.note
Definition

General notes about the care plan not covered elsewhere.

Control Cardinality 0..*
Type Annotation
Requirements

Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.