EOLDocument

COFE-EndOfLifeCarePlan-CarePlan-1

COFE-EndOfLifeCarePlan-CarePlan-1

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 0..*
Type CarePlan
Aliases Care Team
Comments
CarePlan.extension(Care Funding Details)
Definition

Optional Extensions Element - found in all resources.

Control 0..1
Type Extension
Comments
CarePlan.extension(Planned Review Date)
Definition

Date the record is due for review. Date to be set at creation of the record and at review date by professional, in consultation with the person.

Control 0..1
Type Extension
Comments
CarePlan.identifier
Definition

This records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

Control 1..1
Type Identifier
Requirements

Need to allow connection to a wider workflow.

Comments
CarePlan.identifier.value
Definition

The portion of the identifier typically displayed to the user and which is unique within the context of the system.

Control 1..1
Type String
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.

Example 11a98de8-4c44-424c-bb6d-0049c4d2b777
CarePlan.subject
Definition

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

Control 0..1
Comments
CarePlan.status
Definition

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

Control 1..1
Binding

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

The codes SHALL be taken from http://hl7.org/fhir/ValueSet/care-plan-status

Type Code
Is Modifier True
Requirements

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

Comments
Fixed Value active
CarePlan.period
Definition

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

Control 1..1
Type Period
Requirements

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

Comments

Any activities scheduled as part of the plan should be constrained to the specified period.

CarePlan.period.start
Definition

The start of the period. The boundary is inclusive.

Control 1..1 ?
Type DateTime
Comments

If the low element is missing, the meaning is that the low boundary is not known.

CarePlan.period.end
Definition

The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

Control 0..1 ?
Type DateTime
Comments

The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

CarePlan.author
Definition

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

Control 0..2
Type Choice of:
Comments

Collaborative care plans may have multiple authors.

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 1..1
Binding

A set of codes to identify observation type used in the End of Life CDA domain.

The codes SHALL be taken from http://fhir.nhs.net/ValueSet/eol-cda-observation-type-1

Type CodeableConcept
Requirements

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

Comments

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

CarePlan.category.coding
Definition

A reference to a code defined by a terminology system.

Control 1..1
Binding

A set of codes to identify observation type used in the End of Life CDA domain.

The codes SHALL be taken from http://fhir.nhs.net/ValueSet/eol-cda-observation-type-1

Type Coding
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labelled as UserSelected = true.

CarePlan.category.coding.system
Definition

The identification of the code system that defines the meaning of the symbol in the code.

Control 1..1
Type Uri
Requirements

Need to be unambiguous about the source of the definition of the symbol.

Comments

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

Fixed Value http://fhir.nhs.net/ValueSet/eol-cda-observation-type-1
CarePlan.category.coding.code
Definition

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Control 1..1
Type Code
Requirements

Need to refer to a particular code in the system.

Comments
Fixed Value EOLCP
CarePlan.category.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

Control 1..1
Type String
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Comments
Fixed Value EOL Care Plan
CarePlan.note(Plan Agreed)
Definition

General notes about the care plan not covered elsewhere.

Control 0..1
Type Annotation
Requirements

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

Comments
CarePlan.note.text
Definition

The text of the annotation.

Control 1..1
Type String
Comments