Implementation Guide for fælleskommunal informationsmodel
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Implementation Guide for fælleskommunal informationsmodel - Local Development build (v0.7.0). See the Directory of published versions

Resource Profile: CarePlan

Official URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/KLCommonCareSocialCarePlan Version: 0.7.0
Draft as of 2023-07-06 Computable Name: KLCommonCareSocialCarePlan

Overall CarePlan for Danish municipalities, for individual plans regarding social care, and health act §140 and §119

Scope and usage

KLCommonCareSocialCarePlan is used to document a collection of PlannedInterventions, which have a common goal or focus.

CarePlan.category specifies the different types of CarePlans and has the following valid values: Rehabilitation following the health act §140, health promotion and prevention following the health act §119, and social intervention (social indsats) as described by FFB and VUM. The latter is well-described. §140 and §119 as healthcare processes are not thorughly described by FSIII yet, but there is a recognized need, to see them as processes rather than stand-alone interventions. Consequently, attributes are designes as specified by FFB.

The CarePlan.goal have two slices because it is used to describe both the mandatory purpose of the CarePlan (indsatsformål) and any number of connected intevention goals (FFB indsatsmål). An overall description of the intended intervention activities should be provided in CarePlan.description, which have a MUST SUPPORT flag. This means that even though it is not mandatory, it is highly recommended.

CarePlan.careTeam refers to the CareTeam ressource and is used to describe both the organisation that delivers the interventions described in the care plan (CarePlan.careTeam:CareTeam.participant.member), and the type of delivery (FFB tilbud) (CarePlan.careTeam:CareTeam.category).

The target group (Målgruppe) for FFB is specified in the Goal.adressess attribute. Note that the primary and secondary target groups are distinguished using a ConditionRank extension. The primary target group should have rank 1, all others do not have a required rank. FFB requires a primary target group only. The target group is expressed using a FocusCondition profile. Note that only FocusConditions, where the code is actually a target group is relevant here.

CarePlan.intent, CarePlan.status and CarePlan.subject are mandatory in the FHIR CarePlan resource. It is important that the intent is set to “order”, when the interventions 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.

The relevantHistory extension points to earlier significant versions of the CarePlan. Using the relevantHistory extension is recommended if changes to carePlans over time is of relevance for the use case.

CarePlan.activity.outcomeReference is used to represent assesments. Typically Assessment of needs, assessment of citizen resources, and assesment of citizen perspective is relevant, but others may be included. When it comes to of needs (støttebehovsvurdering), it may be used to represent both the initial assesment of needs, and the assesment made when terminating the CarePlan. To make explicite which activity is performed, set activity.detail.code.coding to the appropriate code e.g. effe55c7-572c-4a99-8fb4-2a9dda2f6572 “Støttebehovsvurdering”.

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 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 specificerer hvilke af FHIR-profilens atributter, der skal bruges til specifikation af indholdet.

FKI-attribut Definition FHIR
indsatsforløbKategori Klasse der udtrykker, hvilken slags indsatsforløb der er tale om. CarePlan.category.coding
indsatsforløbFormål Den overordnede intention med indsatsen. CarePlan.goal
indsatsforløbBeskrivelse Beskrivelse af indsatsforløbets indhold. CarePlan.description
indsatsforløbOprettelsestid Det tidspunkt hvor indsatsforløbsdokumentationen først blev oprettet. CarePlan.created
indsatsforløbBevillingstid Det tidspunkt hvor indsatsforløbet blev bevilliget. CarePlan.period.start
indsatsforløbAfslutningstid Det tidspunkt hvor indsatsforløbet blev afsluttet, eller planlægges afsluttet. CarePlan.period.end
indsatsforløbsubjekt Den borger som er genstand for indsatsforløbet. CarePlan.subject
indsatsforløbansvarlig Den organisation som er ansvarlig for bevilling og opfølgning på indsatsforløbet. CarePlan.author
indsatsforløbsleverandør Den organisation, der er ansvarlig for udførelsen af indsatsforløbet. CarePlan.careTeam:CareTeam.participant.member
indsatsforløbmålgruppe Forkustilstand der udtrykker den FFB målgruppe, der er knyttet til en social indsats. (Målgruppen udtrykkes vha profilen FocusCondition) CarePlan.adresses
indsatsforløbmålgruppeRang Heltal der udtrykker, hvordan målgruppen er prioriteret, så der kan skelnes mellem primær målgruppe og øvrige målgrupper. CarePlan.adresses:extension.conditionRank
indsatsforløbtilbud Klasse der udtrykker hvilken type tilbud (i FFB forstand), der skal varetage leveringen af ydelser. CarePlan.careTeam:CareTeam.category
indsatsforløbhensigt Indikerer niveauet af autorisation og hvor langt i planlægningen indsatsforløbet er. CarePlan.intent
indsatsforløbstatus Indikerer om der bliver handlet på der planlagte indsatsforløb, eller om dokumentationen repræsentere en fremtidig intention eller er historisk. CarePlan.status
indsatsforløbændringshistorie Tidligere versioner af Indsatsforløbet, hvor der er sket klinisk relevante ændringer. CarePlan:extension.relevantHistory
indsatsforløbsmål Mål for indsatsforløbet. CarePlan.Goal
indsatsforløbVurderinger Vurderinger foretaget ifm. formulering af og opfølgning på indsatsforløbet. CarePlan.activity.outcomeReference (activity.detail.code.coding)
indsatsforløbDokumenteretISag Kommunalt sagsnummer på den sag, som indsatsforløbet vedrører. Enten officielt uuid eller kommune-specifikt nummer CarePlan:extension.municipalityCaseNumber

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CarePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... municipalityCaseNumber 0..1(Complex)[DK] anledningDokumenteretISag
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/MunicipalityCaseNumber
... intent 1..1code[DK] indsatsforløbhensigt
... category 1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... coding 0..*Coding[DK] indsatsforløbKategori
... description S0..1string[DK] indsatsforløbBeskrivelse
... subject 1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... period
.... start 0..1dateTime[DK] indsatsforløbBevillingstid
.... end 0..1dateTime[DK] indsatsforløbAfslutningstid
... created 1..1dateTime[DK] indsatsforløbOprettelsestid
... author 0..1Reference(Organization)[DK] indsatsforløbansvarlig
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses 0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity 0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
..... detail
...... code
....... coding 0..*Coding[DK] vurderinger
.... activity:carePlanEvaluation 0..*BackboneElementAction to occur as part of plan
..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.
..... detail
...... code 1..1CodeableConceptDetail type of activity
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonCareSocialCodes
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: 95ec4535-8fe8-4296-867c-35de421794cf

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
CarePlan.categoryextensibleKLCarePlanCategoryCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1code[DK] indsatsforløbstatus
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!Σ1..1code[DK] indsatsforløbhensigt
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.

... category Σ1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... coding Σ0..*Coding[DK] indsatsforløbKategori
... description SΣ0..1string[DK] indsatsforløbBeskrivelse
... subject Σ1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... created Σ1..1dateTime[DK] indsatsforløbOprettelsestid
... author Σ0..1Reference(Organization)[DK] indsatsforløbansvarlig
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses Σ0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity C0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
.... activity:carePlanEvaluation C0..*BackboneElementAction to occur as part of plan
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CarePlan.statusrequiredRequestStatus
CarePlan.intentrequiredCarePlanIntent
CarePlan.categoryextensibleKLCarePlanCategoryCodes
NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... municipalityCaseNumber 0..1(Complex)[DK] anledningDokumenteretISag
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/MunicipalityCaseNumber
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal Ids for this plan
... instantiatesCanonical Σ0..*canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan)Fulfills CarePlan
... replaces Σ0..*Reference(CarePlan)CarePlan replaced by this CarePlan
... partOf Σ0..*Reference(CarePlan)Part of referenced CarePlan
... status ?!Σ1..1code[DK] indsatsforløbstatus
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!Σ1..1code[DK] indsatsforløbhensigt
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.

... category Σ1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*Coding[DK] indsatsforløbKategori
.... text Σ0..1stringPlain text representation of the concept
... title Σ0..1stringHuman-friendly name for the care plan
... description SΣ0..1string[DK] indsatsforløbBeskrivelse
... subject Σ1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... period Σ0..1PeriodTime period plan covers
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... start ΣC0..1dateTime[DK] indsatsforløbBevillingstid
.... end ΣC0..1dateTime[DK] indsatsforløbAfslutningstid
... created Σ1..1dateTime[DK] indsatsforløbOprettelsestid
... author Σ0..1Reference(Organization)[DK] indsatsforløbansvarlig
... contributor 0..*Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam)Who provided the content of the care plan
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses Σ0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... supportingInfo 0..*Reference(Resource)Information considered as part of plan
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity C0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeCodeableConcept 0..*CodeableConceptResults of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
..... progress 0..*AnnotationComments about the activity status/progress
..... reference C0..1Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)Activity details defined in specific resource
..... detail C0..1BackboneElementIn-line definition of activity
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... kind 0..1codeAppointment | 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..*uriInstantiates external protocol or definition
...... code 0..1CodeableConceptDetail 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..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... coding Σ0..*Coding[DK] vurderinger
....... text Σ0..1stringPlain text representation of the concept
...... reasonCode 0..*CodeableConceptWhy 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..1codenot-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..1CodeableConceptReason for current status
...... doNotPerform ?!0..1booleanIf true, activity is prohibiting action
...... scheduled[x] 0..1When activity is to occur
....... scheduledTimingTiming
....... scheduledPeriodPeriod
....... scheduledStringstring
...... location 0..1Reference(Location)Where it should happen
...... performer 0..*Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device)Who will be responsible?
...... product[x] 0..1What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

....... productCodeableConceptCodeableConcept
....... productReferenceReference(Medication | Substance)
...... dailyAmount 0..1SimpleQuantityHow to consume/day?
...... quantity 0..1SimpleQuantityHow much to administer/supply/consume
...... description 0..1stringExtra info describing activity to perform
.... activity:carePlanEvaluation C0..*BackboneElementAction to occur as part of plan
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeCodeableConcept 0..*CodeableConceptResults of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.
..... progress 0..*AnnotationComments about the activity status/progress
..... reference C0..1Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)Activity details defined in specific resource
..... detail C0..1BackboneElementIn-line definition of activity
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... kind 0..1codeAppointment | 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..*uriInstantiates external protocol or definition
...... code 1..1CodeableConceptDetail 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.


Required Pattern: At least the following
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ id0..1stringUnique id for inter-element referencing
........ extension0..*ExtensionAdditional content defined by implementations
........ system1..1uriIdentity of the terminology system
Fixed Value: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonCareSocialCodes
........ version0..1stringVersion of the system - if relevant
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: 95ec4535-8fe8-4296-867c-35de421794cf
........ display0..1stringRepresentation defined by the system
........ userSelected0..1booleanIf this coding was chosen directly by the user
....... text0..1stringPlain text representation of the concept
...... reasonCode 0..*CodeableConceptWhy 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..1codenot-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..1CodeableConceptReason for current status
...... doNotPerform ?!0..1booleanIf true, activity is prohibiting action
...... scheduled[x] 0..1When activity is to occur
....... scheduledTimingTiming
....... scheduledPeriodPeriod
....... scheduledStringstring
...... location 0..1Reference(Location)Where it should happen
...... performer 0..*Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device)Who will be responsible?
...... product[x] 0..1What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

....... productCodeableConceptCodeableConcept
....... productReferenceReference(Medication | Substance)
...... dailyAmount 0..1SimpleQuantityHow to consume/day?
...... quantity 0..1SimpleQuantityHow much to administer/supply/consume
...... description 0..1stringExtra info describing activity to perform
... note 0..*AnnotationComments about the plan

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
CarePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
CarePlan.statusrequiredRequestStatus
CarePlan.intentrequiredCarePlanIntent
CarePlan.categoryextensibleKLCarePlanCategoryCodes
CarePlan.addresses.typeextensibleResourceType
CarePlan.activity.outcomeCodeableConceptexampleCarePlanActivityOutcome
CarePlan.activity.detail.kindrequiredCarePlanActivityKind
CarePlan.activity.detail.codeexampleProcedureCodes(SNOMEDCT)
CarePlan.activity.detail.reasonCodeexampleSNOMEDCTClinicalFindings
CarePlan.activity.detail.statusrequiredCarePlanActivityStatus
CarePlan.activity.detail.product[x]exampleSNOMEDCTMedicationCodes
CarePlan.activity:carePlanEvaluation.outcomeCodeableConceptexampleCarePlanActivityOutcome
CarePlan.activity:carePlanEvaluation.detail.kindrequiredCarePlanActivityKind
CarePlan.activity:carePlanEvaluation.detail.codeexamplePattern: 95ec4535-8fe8-4296-867c-35de421794cf
CarePlan.activity:carePlanEvaluation.detail.reasonCodeexampleSNOMEDCTClinicalFindings
CarePlan.activity:carePlanEvaluation.detail.statusrequiredCarePlanActivityStatus
CarePlan.activity:carePlanEvaluation.detail.product[x]exampleSNOMEDCTMedicationCodes

Differential View

This structure is derived from CarePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... municipalityCaseNumber 0..1(Complex)[DK] anledningDokumenteretISag
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/MunicipalityCaseNumber
... intent 1..1code[DK] indsatsforløbhensigt
... category 1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... coding 0..*Coding[DK] indsatsforløbKategori
... description S0..1string[DK] indsatsforløbBeskrivelse
... subject 1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... period
.... start 0..1dateTime[DK] indsatsforløbBevillingstid
.... end 0..1dateTime[DK] indsatsforløbAfslutningstid
... created 1..1dateTime[DK] indsatsforløbOprettelsestid
... author 0..1Reference(Organization)[DK] indsatsforløbansvarlig
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses 0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity 0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
..... detail
...... code
....... coding 0..*Coding[DK] vurderinger
.... activity:carePlanEvaluation 0..*BackboneElementAction to occur as part of plan
..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.
..... detail
...... code 1..1CodeableConceptDetail type of activity
Required Pattern: At least the following
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ system1..1uriIdentity of the terminology system
Fixed Value: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonCareSocialCodes
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: 95ec4535-8fe8-4296-867c-35de421794cf

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
CarePlan.categoryextensibleKLCarePlanCategoryCodes

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... status ?!Σ1..1code[DK] indsatsforløbstatus
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!Σ1..1code[DK] indsatsforløbhensigt
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.

... category Σ1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... coding Σ0..*Coding[DK] indsatsforløbKategori
... description SΣ0..1string[DK] indsatsforløbBeskrivelse
... subject Σ1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... created Σ1..1dateTime[DK] indsatsforløbOprettelsestid
... author Σ0..1Reference(Organization)[DK] indsatsforløbansvarlig
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses Σ0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity C0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
.... activity:carePlanEvaluation C0..*BackboneElementAction to occur as part of plan
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet
CarePlan.statusrequiredRequestStatus
CarePlan.intentrequiredCarePlanIntent
CarePlan.categoryextensibleKLCarePlanCategoryCodes

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..*CarePlanHealthcare plan for patient or group
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... relevantHistory 0..*Reference(Provenance)[DK] indsatsforløbændringshistorie
URL: http://hl7.org/fhir/StructureDefinition/request-relevantHistory
... municipalityCaseNumber 0..1(Complex)[DK] anledningDokumenteretISag
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/MunicipalityCaseNumber
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... identifier Σ0..*IdentifierExternal Ids for this plan
... instantiatesCanonical Σ0..*canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition)Instantiates FHIR protocol or definition
... instantiatesUri Σ0..*uriInstantiates external protocol or definition
... basedOn Σ0..*Reference(CarePlan)Fulfills CarePlan
... replaces Σ0..*Reference(CarePlan)CarePlan replaced by this CarePlan
... partOf Σ0..*Reference(CarePlan)Part of referenced CarePlan
... status ?!Σ1..1code[DK] indsatsforløbstatus
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!Σ1..1code[DK] indsatsforløbhensigt
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan.

... category Σ1..1CodeableConceptType of plan
Binding: KLIndsatsforløbTypekoder (extensible)
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*Coding[DK] indsatsforløbKategori
.... text Σ0..1stringPlain text representation of the concept
... title Σ0..1stringHuman-friendly name for the care plan
... description SΣ0..1string[DK] indsatsforløbBeskrivelse
... subject Σ1..1Reference(Citizen)[DK] indsatsforløbsubjekt
... encounter Σ0..1Reference(Encounter)Encounter created as part of
... period Σ0..1PeriodTime period plan covers
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... start ΣC0..1dateTime[DK] indsatsforløbBevillingstid
.... end ΣC0..1dateTime[DK] indsatsforløbAfslutningstid
... created Σ1..1dateTime[DK] indsatsforløbOprettelsestid
... author Σ0..1Reference(Organization)[DK] indsatsforløbansvarlig
... contributor 0..*Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam)Who provided the content of the care plan
... careTeam 0..*Reference(ServicePerformer)[DK] indsatsforløbsleverandør og indsatsforløbtilbud
... addresses Σ0..*Reference(FocusCondition)[DK] indsatsforløbmålgruppe
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... conditionRank 0..1positiveInt[DK] indsatsforløbsmålgruppeRang
URL: http://kl.dk/fhir/common/caresocial/StructureDefinition/ConditionRank
.... reference ΣC0..1stringLiteral reference, Relative, internal or absolute URL
.... type Σ0..1uriType the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).

.... identifier Σ0..1IdentifierLogical reference, when literal reference is not known
.... display Σ0..1stringText alternative for the resource
... supportingInfo 0..*Reference(Resource)Information considered as part of plan
... Slices for goal 1..*Reference(Goal)Desired outcome of plan
Slice: Unordered, Open by value:resolve().category
.... goal:fpurpose 1..1Reference(Goal - Purpose)[DK] indsatsforløbFormål
.... goal:ffbgoal 0..*Reference(Goal - FFB Intervention)[DK] indsatsforløbsmål
... Slices for activity C0..*BackboneElementAction to occur as part of plan
Slice: Unordered, Open by value:detail.code
.... activity:All Slices Content/Rules for all slices
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeCodeableConcept 0..*CodeableConceptResults of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


..... outcomeReference 0..*Reference(Resource)[DK] vurderinger
..... progress 0..*AnnotationComments about the activity status/progress
..... reference C0..1Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)Activity details defined in specific resource
..... detail C0..1BackboneElementIn-line definition of activity
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... kind 0..1codeAppointment | 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..*uriInstantiates external protocol or definition
...... code 0..1CodeableConceptDetail 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..1stringUnique id for inter-element referencing
....... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... coding Σ0..*Coding[DK] vurderinger
....... text Σ0..1stringPlain text representation of the concept
...... reasonCode 0..*CodeableConceptWhy 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..1codenot-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..1CodeableConceptReason for current status
...... doNotPerform ?!0..1booleanIf true, activity is prohibiting action
...... scheduled[x] 0..1When activity is to occur
....... scheduledTimingTiming
....... scheduledPeriodPeriod
....... scheduledStringstring
...... location 0..1Reference(Location)Where it should happen
...... performer 0..*Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device)Who will be responsible?
...... product[x] 0..1What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

....... productCodeableConceptCodeableConcept
....... productReferenceReference(Medication | Substance)
...... dailyAmount 0..1SimpleQuantityHow to consume/day?
...... quantity 0..1SimpleQuantityHow much to administer/supply/consume
...... description 0..1stringExtra info describing activity to perform
.... activity:carePlanEvaluation C0..*BackboneElementAction to occur as part of plan
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... outcomeCodeableConcept 0..*CodeableConceptResults of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


..... outcomeReference 0..*Reference(Evaluation)Appointment, Encounter, Procedure, etc.
..... progress 0..*AnnotationComments about the activity status/progress
..... reference C0..1Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup)Activity details defined in specific resource
..... detail C0..1BackboneElementIn-line definition of activity
...... id 0..1stringUnique id for inter-element referencing
...... extension 0..*ExtensionAdditional content defined by implementations
...... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
...... kind 0..1codeAppointment | 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..*uriInstantiates external protocol or definition
...... code 1..1CodeableConceptDetail 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.


Required Pattern: At least the following
....... id0..1stringUnique id for inter-element referencing
....... extension0..*ExtensionAdditional content defined by implementations
....... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
........ id0..1stringUnique id for inter-element referencing
........ extension0..*ExtensionAdditional content defined by implementations
........ system1..1uriIdentity of the terminology system
Fixed Value: http://kl.dk/fhir/common/caresocial/CodeSystem/KLCommonCareSocialCodes
........ version0..1stringVersion of the system - if relevant
........ code1..1codeSymbol in syntax defined by the system
Fixed Value: 95ec4535-8fe8-4296-867c-35de421794cf
........ display0..1stringRepresentation defined by the system
........ userSelected0..1booleanIf this coding was chosen directly by the user
....... text0..1stringPlain text representation of the concept
...... reasonCode 0..*CodeableConceptWhy 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..1codenot-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..1CodeableConceptReason for current status
...... doNotPerform ?!0..1booleanIf true, activity is prohibiting action
...... scheduled[x] 0..1When activity is to occur
....... scheduledTimingTiming
....... scheduledPeriodPeriod
....... scheduledStringstring
...... location 0..1Reference(Location)Where it should happen
...... performer 0..*Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device)Who will be responsible?
...... product[x] 0..1What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

....... productCodeableConceptCodeableConcept
....... productReferenceReference(Medication | Substance)
...... dailyAmount 0..1SimpleQuantityHow to consume/day?
...... quantity 0..1SimpleQuantityHow much to administer/supply/consume
...... description 0..1stringExtra info describing activity to perform
... note 0..*AnnotationComments about the plan

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
CarePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
CarePlan.statusrequiredRequestStatus
CarePlan.intentrequiredCarePlanIntent
CarePlan.categoryextensibleKLCarePlanCategoryCodes
CarePlan.addresses.typeextensibleResourceType
CarePlan.activity.outcomeCodeableConceptexampleCarePlanActivityOutcome
CarePlan.activity.detail.kindrequiredCarePlanActivityKind
CarePlan.activity.detail.codeexampleProcedureCodes(SNOMEDCT)
CarePlan.activity.detail.reasonCodeexampleSNOMEDCTClinicalFindings
CarePlan.activity.detail.statusrequiredCarePlanActivityStatus
CarePlan.activity.detail.product[x]exampleSNOMEDCTMedicationCodes
CarePlan.activity:carePlanEvaluation.outcomeCodeableConceptexampleCarePlanActivityOutcome
CarePlan.activity:carePlanEvaluation.detail.kindrequiredCarePlanActivityKind
CarePlan.activity:carePlanEvaluation.detail.codeexamplePattern: 95ec4535-8fe8-4296-867c-35de421794cf
CarePlan.activity:carePlanEvaluation.detail.reasonCodeexampleSNOMEDCTClinicalFindings
CarePlan.activity:carePlanEvaluation.detail.statusrequiredCarePlanActivityStatus
CarePlan.activity:carePlanEvaluation.detail.product[x]exampleSNOMEDCTMedicationCodes

 

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