Scope and usage

The KLCommonCareSocialPlannedIntervention may be instatiated whenever an intervention is planned for a citizen in Danish municipalities. One or more planned interventions (ydelser/indsatser) may relate to a CommonCareSocialCarePlan, which are more overall in scope, and is mainly used for FFB sociale indsatser. CommonCareSocialPlannedIntervention is only used for planning ahead, when documentation is related to treatment or care, which is already carried out, use CommonCareSocialCompletedIntervention instead.

When a planned intervention is carried out, the resulting encounters may be linked to the planned intervention through the CarePlan.activity.outcomeReference. Planned interventions are only used for interventions that requires a plan, which is autorized by the municipality. Incomming “orders” e.g. referals from general practitioners for the acute nursing teams, are handled using CommonCareSocialServiceRequest, CommonCareSocialEncounter and CommonCareSocialCompletedIntervention.

CarePlan.activity.detail.code.coding holds the intervention code, which may come from FSIII or FFB.

CarePlan.activity.detail.description is a description of the intervention that should be carried out. It is important to support for FSIII, where it is almost always relevant. It is not used in FFB.

It is important to distiguish correctly between the dates and times stated in the model. CarePlan.created is when the PlannedIntervention was first created, also is it only has draft status at the time. CarePlan.period.start is when the PlannedIntervention was authorized (bevillingstid). The planned end-date is CarePlan.period.end, unless the date has already occured and the status is “completed”, then it is the actual end-date. Sometimes you might be interested in the time where the the first activities were performed in connection to the plannedIntervention, this might be tracked through the earliest enconter referred to in CarePlan.activity.outcomeReference.

CarePlan.activity.outcomeReference generally holds all information about known encounters, where PlannedInterventions have been acted upon.

CarePlan.status and CarePlan.intent are mandatory in the FHIR CarePlan resource. It is important that the intent is set to “order”, when the intervention have been approved by municipality authorities (når bevillingen er sket). The status should, as a minimum distinguish between draft, active, revoked and completed plans. Note that the meaning of active is “ready to be acted upon”, so it does not signify that the first activities have occured. CarePlan.activity.detail.status is also mandatory, and has the values not-started, scheduled, in-progress, on-hold, completed, cancelled, stopped, unknown, entered-in-error. The detail-status should at least distinguish between not-started, in-progress and stopped, but all the statuses are relevant in a municipality context. In-progress means that the first activity has occured.

The CarePlan.author, is the organisation with is responsible for the autorisation (myndighed), whereas CarePlan.activity.detail.performer is the organisation that carries out the intervention (leverandør). They might be the same.

CarePlan:extension.FollowUpEncounter makes it possible to explicitely state when follow up on the intervention should occur. This attribute is never used for FFB and is not mandatory for FSIII.

CarePlan.basedOn makes it possible to link any number of PlannedIntervention to a KLCommonCareSocialCarePlan. This is what makes it possible in a FFB context to link interventions (ydelser) to a CarePlan (social indsats).

CarePlan.activity.detail.reasonReference holds the link between conditions and interventions which are mandatory is FSIII. This is not used for FFB.

CarePlan.activity.detail.goal holds the connection between an intervention and its goals. It is used for intervention-goals, and target meassures (målemetoder) in FSIII.

CarePlan:extension.relevantHistory makes it possible to track earlierssignificant versions of the PlannedIntervention.

CarePlan:extension.municipalityCaseNumber is a relation to the municipality case (Sag). The officialCaseIdentifier uses an official http-adress and uuid to relate to a municipality case (Rammearkitektur: Sag.ID). The municipalitySpecificCaseIdentifier uses a municipality specific ID as a value, and a relates to the organization that owns this caseIdentifier(Rammearkitektur Sag.Sagsnummer og Sag.ejer Sagsaktør).

Conversions between Danish information model and FHIR-profile

Nedenstående tabel oversætter mellem de attributter der er defineret i den fælleskommunale informationsmodel (FKI), definerer kort den enkelte attribut på dansk og specificere hvilke af FHIR-profilens atributter der skal bruges til specifikation af indholdet

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from CarePlan

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
basedOn		0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
status		1..1	code	[DK] indsatsstatus
intent		1..1	code	[DK] indsatshensigt
subject		1..1	Reference(Citizen)	[DK] indsatssubjekt
period
start		0..1	dateTime	[DK] indsatsbevillingstid
end		0..1	dateTime	[DK] indsatsafslutningstid
created		1..1	dateTime	[DK] indsatsoprettelsestid
author		0..1	Reference(Organization)	[DK] indsatsansvarlig
activity		1..1	BackboneElement	Action to occur as part of plan
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
detail
code
Slices for coding		0..*	Coding	[DK] indsatsskode Slice: Unordered, Open by value:system
coding:FFBintervention		0..1	Coding	Code defined by a terminology system Binding: KLYdelserFFB (required)
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.22
coding:FSIIIlevel2		0..1	Coding	Code defined by a terminology system Binding: KLIndsatserFSIII (required)
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.21
coding:FSIIIlevel3		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonproprietary
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:KLECode		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: https://data.gov.dk/id/classification/KLE
reasonReference		0..*	Reference(Condition)	[DK] indsatsbegrundelse
goal		0..*	Reference(Goal)	[DK] indsatsmål
status		1..1	code	[DK] indsatsAktivitetsstatus
performer		0..*	Reference(Organization)	[DK] indsatsleverandør
description		0..1	string	[DK] handlingsanvisning
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
CarePlan.activity.detail.code.coding:FFBintervention	required	KLInterventionsFFB
CarePlan.activity.detail.code.coding:FSIIIlevel2	required	KLInterventionsFSIII

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
status	?!Σ	1..1	code	[DK] indsatsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] indsatshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.
subject	Σ	1..1	Reference(Citizen)	[DK] indsatssubjekt
created	Σ	1..1	dateTime	[DK] indsatsoprettelsestid
author	Σ	0..1	Reference(Organization)	[DK] indsatsansvarlig
activity	C	1..1	BackboneElement	Action to occur as part of plan
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
CarePlan.status	required	RequestStatus
CarePlan.intent	required	CarePlanIntent

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	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. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this plan
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
replaces	Σ	0..*	Reference(CarePlan)	CarePlan replaced by this CarePlan
partOf	Σ	0..*	Reference(CarePlan)	Part of referenced CarePlan
status	?!Σ	1..1	code	[DK] indsatsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] indsatshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.
category	Σ	0..*	CodeableConcept	Type of 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	Σ	0..1	string	Human-friendly name for the care plan
description	Σ	0..1	string	Summary of nature of plan
subject	Σ	1..1	Reference(Citizen)	[DK] indsatssubjekt
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
period	Σ	0..1	Period	Time period plan covers
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	[DK] indsatsbevillingstid
end	ΣC	0..1	dateTime	[DK] indsatsafslutningstid
created	Σ	1..1	dateTime	[DK] indsatsoprettelsestid
author	Σ	0..1	Reference(Organization)	[DK] indsatsansvarlig
contributor		0..*	Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam)	Who provided the content of the care plan
careTeam		0..*	Reference(CareTeam)	Who's involved in plan?
addresses	Σ	0..*	Reference(Condition)	Health issues this plan addresses
supportingInfo		0..*	Reference(Resource)	Information considered as part of plan
goal		0..*	Reference(Goal)	Desired outcome of plan
activity	C	1..1	BackboneElement	Action to occur as part of plan
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
outcomeCodeableConcept		0..*	CodeableConcept	Results of the activity Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
progress		0..*	Annotation	Comments about the activity status/progress
reference	C	0..1	Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)	Activity details defined in specific resource
detail	C	0..1	BackboneElement	In-line definition of activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	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.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	[DK] indsatsskode Slice: Unordered, Open by value:system
coding:FFBintervention	Σ	0..1	Coding	Code defined by a terminology system Binding: KLYdelserFFB (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.22
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:FSIIIlevel2	Σ	0..1	Coding	Code defined by a terminology system Binding: KLIndsatserFSIII (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.21
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:FSIIIlevel3	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonproprietary
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:KLECode	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: https://data.gov.dk/id/classification/KLE
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
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)	[DK] indsatsbegrundelse
goal		0..*	Reference(Goal)	[DK] indsatsmål
status	?!	1..1	code	[DK] indsatsAktivitetsstatus 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(Organization)	[DK] indsatsleverandør
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		0..1	SimpleQuantity	How to consume/day?
quantity		0..1	SimpleQuantity	How much to administer/supply/consume
description		0..1	string	[DK] handlingsanvisning
note		0..*	Annotation	Comments about the plan
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
CarePlan.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
CarePlan.status	required	RequestStatus
CarePlan.intent	required	CarePlanIntent
CarePlan.category	example	CarePlanCategory
CarePlan.activity.outcomeCodeableConcept	example	CarePlanActivityOutcome
CarePlan.activity.detail.kind	required	CarePlanActivityKind
CarePlan.activity.detail.code	example	ProcedureCodes(SNOMEDCT)
CarePlan.activity.detail.code.coding:FFBintervention	required	KLInterventionsFFB
CarePlan.activity.detail.code.coding:FSIIIlevel2	required	KLInterventionsFSIII
CarePlan.activity.detail.reasonCode	example	SNOMEDCTClinicalFindings
CarePlan.activity.detail.status	required	CarePlanActivityStatus
CarePlan.activity.detail.product[x]	example	SNOMEDCTMedicationCodes

Differential View

This structure is derived from CarePlan

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
basedOn		0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
status		1..1	code	[DK] indsatsstatus
intent		1..1	code	[DK] indsatshensigt
subject		1..1	Reference(Citizen)	[DK] indsatssubjekt
period
start		0..1	dateTime	[DK] indsatsbevillingstid
end		0..1	dateTime	[DK] indsatsafslutningstid
created		1..1	dateTime	[DK] indsatsoprettelsestid
author		0..1	Reference(Organization)	[DK] indsatsansvarlig
activity		1..1	BackboneElement	Action to occur as part of plan
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
detail
code
Slices for coding		0..*	Coding	[DK] indsatsskode Slice: Unordered, Open by value:system
coding:FFBintervention		0..1	Coding	Code defined by a terminology system Binding: KLYdelserFFB (required)
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.22
coding:FSIIIlevel2		0..1	Coding	Code defined by a terminology system Binding: KLIndsatserFSIII (required)
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.21
coding:FSIIIlevel3		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonproprietary
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:KLECode		0..1	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system Required Pattern: https://data.gov.dk/id/classification/KLE
reasonReference		0..*	Reference(Condition)	[DK] indsatsbegrundelse
goal		0..*	Reference(Goal)	[DK] indsatsmål
status		1..1	code	[DK] indsatsAktivitetsstatus
performer		0..*	Reference(Organization)	[DK] indsatsleverandør
description		0..1	string	[DK] handlingsanvisning
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
CarePlan.activity.detail.code.coding:FFBintervention	required	KLInterventionsFFB
CarePlan.activity.detail.code.coding:FSIIIlevel2	required	KLInterventionsFSIII

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
status	?!Σ	1..1	code	[DK] indsatsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] indsatshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.
subject	Σ	1..1	Reference(Citizen)	[DK] indsatssubjekt
created	Σ	1..1	dateTime	[DK] indsatsoprettelsestid
author	Σ	0..1	Reference(Organization)	[DK] indsatsansvarlig
activity	C	1..1	BackboneElement	Action to occur as part of plan
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
CarePlan.status	required	RequestStatus
CarePlan.intent	required	CarePlanIntent

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	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. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
followUpEncounter		0..1	Reference(Encounter)	[DK] indsatsPlanlagtOpfølgning URL: http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
relevantHistory		0..*	Reference(Provenance)	[DK] indsatsændringshistorie URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
municipalityCaseNumber		0..1	(Complex)	[DK] anledningDokumenteretISag URL: http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Ids for this plan
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan)	[DK] indsatsDelAfPlan
replaces	Σ	0..*	Reference(CarePlan)	CarePlan replaced by this CarePlan
partOf	Σ	0..*	Reference(CarePlan)	Part of referenced CarePlan
status	?!Σ	1..1	code	[DK] indsatsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] indsatshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.
category	Σ	0..*	CodeableConcept	Type of 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	Σ	0..1	string	Human-friendly name for the care plan
description	Σ	0..1	string	Summary of nature of plan
subject	Σ	1..1	Reference(Citizen)	[DK] indsatssubjekt
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
period	Σ	0..1	Period	Time period plan covers
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	0..1	dateTime	[DK] indsatsbevillingstid
end	ΣC	0..1	dateTime	[DK] indsatsafslutningstid
created	Σ	1..1	dateTime	[DK] indsatsoprettelsestid
author	Σ	0..1	Reference(Organization)	[DK] indsatsansvarlig
contributor		0..*	Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam)	Who provided the content of the care plan
careTeam		0..*	Reference(CareTeam)	Who's involved in plan?
addresses	Σ	0..*	Reference(Condition)	Health issues this plan addresses
supportingInfo		0..*	Reference(Resource)	Information considered as part of plan
goal		0..*	Reference(Goal)	Desired outcome of plan
activity	C	1..1	BackboneElement	Action to occur as part of plan
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
outcomeCodeableConcept		0..*	CodeableConcept	Results of the activity Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.
outcomeReference		0..*	Reference(Encounter)	[DK] indsatsgennemførtAktivitet
progress		0..*	Annotation	Comments about the activity status/progress
reference	C	0..1	Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)	Activity details defined in specific resource
detail	C	0..1	BackboneElement	In-line definition of activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	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.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	[DK] indsatsskode Slice: Unordered, Open by value:system
coding:FFBintervention	Σ	0..1	Coding	Code defined by a terminology system Binding: KLYdelserFFB (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.22
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:FSIIIlevel2	Σ	0..1	Coding	Code defined by a terminology system Binding: KLIndsatserFSIII (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.208.176.2.21
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:FSIIIlevel3	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonproprietary
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:KLECode	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: https://data.gov.dk/id/classification/KLE
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
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)	[DK] indsatsbegrundelse
goal		0..*	Reference(Goal)	[DK] indsatsmål
status	?!	1..1	code	[DK] indsatsAktivitetsstatus 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(Organization)	[DK] indsatsleverandør
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		0..1	SimpleQuantity	How to consume/day?
quantity		0..1	SimpleQuantity	How much to administer/supply/consume
description		0..1	string	[DK] handlingsanvisning
note		0..*	Annotation	Comments about the plan
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
CarePlan.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
CarePlan.status	required	RequestStatus
CarePlan.intent	required	CarePlanIntent
CarePlan.category	example	CarePlanCategory
CarePlan.activity.outcomeCodeableConcept	example	CarePlanActivityOutcome
CarePlan.activity.detail.kind	required	CarePlanActivityKind
CarePlan.activity.detail.code	example	ProcedureCodes(SNOMEDCT)
CarePlan.activity.detail.code.coding:FFBintervention	required	KLInterventionsFFB
CarePlan.activity.detail.code.coding:FSIIIlevel2	required	KLInterventionsFSIII
CarePlan.activity.detail.reasonCode	example	SNOMEDCTClinicalFindings
CarePlan.activity.detail.status	required	CarePlanActivityStatus
CarePlan.activity.detail.product[x]	example	SNOMEDCTMedicationCodes

This structure is derived from CarePlan

Summary

Mandatory: 2 elements (6 nested mandatory elements)

Structures

This structure refers to these other structures:

• CarePlan (http://fhir.kl.dk/core/StructureDefinition/KLCommonCareSocialCarePlan)
• Citizen (http://fhir.kl.dk/core/StructureDefinition/KLCommonCitizen)
• Organization (http://fhir.kl.dk/core/StructureDefinition/KLCommonOrganization)
• Encounter (http://fhir.kl.dk/core/StructureDefinition/KLCommonCareSocialEncounter)
• Condition (http://fhir.kl.dk/core/StructureDefinition/KLCommonCareSocialCondition)
• Goal (http://fhir.kl.dk/core/StructureDefinition/KLCommonCareSocialGoal)

Extensions

This structure refers to these extensions:

• http://fhir.kl.dk/core/StructureDefinition/FollowUpEncounter
• http://hl7.org/fhir/StructureDefinition/request-relevantHistory
• http://fhir.kl.dk/core/StructureDefinition/MunicipalityCaseNumber

Slices

This structure defines the following Slices:

• The element CarePlan.activity.detail.code.coding is sliced based on the value of value:system