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        CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
        2.0.0 - Release 2 US

        This page is part of the NHSN Digital Quality Measures (dQM) Content Package Implementation Guide (v2.0.0: Release) based on FHIR (HL7? FHIR? Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

        Resource Profile: AcuteCareHospitalDailyEventEncounter - Detailed Descriptions

        Page standards status: Trial-use Maturity Level: 2

        Definitions for the ach-daily-encounter resource profile.

        Guidance on how to interpret the contents of this table can be foundhere

        0. Encounter
        Definition

        -


        An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

        Short icon Changed:(NHSN-MS) An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient during the NHSN ACH Daily reporting period. This resource is required for the ACH Daily Measure and must be referenced in all Individual MeasureReport resources for this measure.An interaction during which services are provided to the patient
        Comments

        -

        Control icon Changed:10..*
        Is Modifier false
        Must Support icon Changed:true
        Summary false
        Alternate Names Visit
        Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        encounter-ach-daily-initial-population: Encounter: (class must be from ACH Daily encounter class) or (type from 'Encounter Inpatient' or 'Observation Services') or (Encounter location type from 'Inpatient, Emergency, and Observation Locations') (class.memberOf('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-class') or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307')).exists() or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143')).exists() or where(location.location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()))
        encounter-location-type-initial-population: Encounter: references at least one Location where type is from 'Inpatient, Emergency, and Observation Locations' (location.where(location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists() or location.where(location.resolve().partOf.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists())
        2. Encounter.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        Short icon Changed:(NHSN-MS) Logical id of this artifactLogical id of this artifact
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control 10..1
        Type idstring
        Is Modifier false
        Must Support icon Added:true
        Summary true
        4. Encounter.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        Short A set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control 0..1
        Type uri
        Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. Encounter.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summary false
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Names extensions, user content
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. Encounter.identifier
        Definition

        Identifier(s) by which this encounter is known.

        Short icon Changed:(NHSN-MS)(USCDI) Identifier(s) by which this encounter is knownIdentifier(s) by which this encounter is known
        Note This is a business identifier, not a resource identifier (see discussion)
        Control 10..*
        Type Identifier
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. Encounter.identifier.use
        Definition

        The purpose of this identifier.

        Short icon Changed:(NHSN-MS) usual | official | temp | secondary | old (If known)usual | official | temp | secondary | old (If known)
        Comments

        Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

        Control 0..1
        Binding The codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
        (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

        Identifies the purpose for this identifier, if known .

        Type code
        Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Requirements

        Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Encounter.identifier.type
        Definition

        A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

        Short icon Changed:(NHSN-MS) Description of identifierDescription of identifier
        Comments

        This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

        Control 0..1
        Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

        A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary true
        Requirements

        Allows users to make use of identifiers when the identifier system is not known.

        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. Encounter.identifier.system
        Definition

        Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

        Short icon Changed:(NHSN-MS)(USCDI) The namespace for the identifier valueThe namespace for the identifier value
        Comments

        Identifier.system is always case sensitive.

        Control 10..1
        Type uri
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Requirements

        There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

        Example General: http://www.acme.com/identifiers/patient
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Encounter.identifier.value
        Definition

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

        Short icon Changed:(NHSN-MS)(USCDI) The value that is uniqueThe value that is unique
        Comments

        If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

        Control 10..1
        Type string
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Example General: 123456
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. Encounter.identifier.period
        Definition

        Time period during which identifier is/was valid for use.

        Short icon Changed:(NHSN-MS) Time period when id is/was valid for useTime period when id is/was valid for use
        Control 0..1
        Type Period
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Encounter.status
        Definition

        triaged | in-progress | finished | onleave | entered-in-error.


        planned | arrived | triaged | in-progress | onleave | finished | cancelled +.

        Short icon Changed:(NHSN-MS) triaged | in-progress | finished | onleave | entered-in-errorplanned | arrived | triaged | in-progress | onleave | finished | cancelled +
        Comments

        Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).

        Control 1..1
        Binding The codes SHALL be taken from ACH Daily Encounter Status ValueSethttp://hl7.org/fhir/ValueSet/encounter-status|4.0.1
        (required to http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-status)
        Type code
        Is Modifier true because 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
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Encounter.class
        Definition

        Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.

        Short icon Changed:(NHSN-MS)(USCDI) Classification of patient encounterClassification of patient encounter
        Control 1..1
        Binding Unless not suitable, these codes SHALL be taken from ActEncounterCode (3.0.0)http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
        (extensible to http://terminology.hl7.org/ValueSet/v3-ActEncounterCode|3.0.0)

        Classification of the encounter.

        Type Coding
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Encounter.classHistory
        Definition

        The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.

        Short icon Changed:(NHSN-MS) List of past encounter classesList of past encounter classes
        Control 0..*
        Type BackboneElement
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Encounter.classHistory.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        28. Encounter.classHistory.class
        Definition

        inpatient | outpatient | ambulatory | emergency +.

        Short icon Changed:(NHSN-MS) inpatient | outpatient | ambulatory | emergency +inpatient | outpatient | ambulatory | emergency +
        Control 1..1
        Binding Unless not suitable, these codes SHALL be taken from ActEncounterCode (3.0.0)http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
        (extensible to http://terminology.hl7.org/ValueSet/v3-ActEncounterCode|3.0.0)

        Classification of the encounter.

        Type Coding
        Is Modifier false
        Must Support icon Added:true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Encounter.classHistory.period
        Definition

        The time that the episode was in the specified class.

        Short icon Changed:(NHSN-MS) The time that the episode was in the specified classThe time that the episode was in the specified class
        Control 1..1
        Type Period
        Is Modifier false
        Must Support icon Added:true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Encounter.type
        Definition

        Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).

        Short icon Changed:(NHSN-MS)(USCDI) Specific type of encounterSpecific type of encounter
        Comments

        Since there are many ways to further classify encounters, this element is 0..*.

        Control 10..*
        Binding Unless not suitable, these codes SHALL be taken from For example codes, see USCoreEncounterType (6.1.0)http://hl7.org/fhir/ValueSet/encounter-type|4.0.1
        (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-encounter-type|6.1.0)

        Valueset to describe the Encounter Type


        The type of encounter.

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Encounter.subject
        Definition

        The patient or group present at the encounter.

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) The patient or group present at the encounterThe patient or group present at the encounter
        Comments

        While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).

        Control 10..1
        Type Reference(Cross-Measure Patient Profile, Patient, Group)bundled
        Is Modifier false
        Must Support true
        Summary true
        Alternate Names patient
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Encounter.subject.reference
        Definition

        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

        Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
        Comments

        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

        Control 10..1
        This element is affected by the following invariants: ref-1
        Type string
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Encounter.participant
        Definition

        The list of people responsible for providing the service.

        Short icon Changed:(QI-Core)(USCDI) List of participants involved in the encounterList of participants involved in the encounter
        Control 0..*
        Type BackboneElement
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Encounter.participant.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        42. Encounter.participant.type
        Definition

        Role of participant in encounter.

        Short icon Changed:(USCDI) Role of participant in encounterRole of participant in encounter
        Comments

        The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.

        Control 0..*
        Binding Unless not suitable, these codes SHALL be taken from ParticipantTypehttp://hl7.org/fhir/ValueSet/encounter-participant-type|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/encounter-participant-type)

        Role of participant in encounter.

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Encounter.participant.period
        Definition

        The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.

        Short icon Changed:(USCDI) Period of time during the encounter that the participant participatedPeriod of time during the encounter that the participant participated
        Control 0..1
        Type Period
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Encounter.participant.individual
        Definition

        Persons involved in the encounter other than the patient.

        Short icon Changed:(QI-Core)(USCDI) Persons involved in the encounter other than the patientPersons involved in the encounter other than the patient
        Comments

        Should include QICore-RelatedPerson as a possible participant, but USCore-Encounter only allows USCore-Practitioner.

        Control 0..1
        Type Reference(QICore Practitioner, QICore PractitionerRole, QICore RelatedPerson, Practitioner, PractitionerRole, RelatedPerson)
        Is Modifier false
        Must Support true
        Must Support Types No must-support rules about the choice of types/profiles
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Encounter.period
        Definition

        The start and end time of the encounter.

        Short icon Changed:(NHSN-MS)(USCDI) The start and end time of the encounterThe start and end time of the encounter
        Comments

        If not (yet) known, the end of the Period may be omitted.

        Control 10..1
        Type Period
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Encounter.reasonCode
        Definition

        Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.

        Short icon Changed:(NHSN-MS)(USCDI) Coded reason the encounter takes placeCoded reason the encounter takes place
        Comments

        For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

        Control 0..*
        Binding The codes SHOULD be taken from EncounterReasonCodeshttp://hl7.org/fhir/ValueSet/encounter-reason|4.0.1
        (preferred to http://hl7.org/fhir/ValueSet/encounter-reason)

        Reason why the encounter takes place.

        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary true
        Alternate Names Indication, Admission diagnosis
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. Encounter.reasonReference
        Definition

        Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.

        Short icon Changed:(QI-Core)(USCDI) Reason the encounter takes place (reference)Reason the encounter takes place (reference)
        Comments

        For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

        Control 0..*
        Type Reference(QICore Condition Problems Health Concerns, QICore Condition Encounter Diagnosis, QICore Procedure, QICore Simple Observation, QICore ImmunizationRecommendation, Condition, Procedure, Observation, ImmunizationRecommendation)
        Is Modifier false
        Must Support icon Added:true
        Must Support Types No must-support rules about the choice of types/profiles
        Summary true
        Alternate Names Indication, Admission diagnosis
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. Encounter.hospitalization
        Definition

        Details about the admission to a healthcare service.

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Details about the admission to a healthcare serviceDetails about the admission to a healthcare service
        Comments

        An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included.

        The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.

        Control 0..1
        Type BackboneElement
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Encounter.hospitalization.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        58. Encounter.hospitalization.admitSource
        Definition

        From where patient was admitted (physician referral, transfer).

        Short icon Changed:(NHSN-MS) From where patient was admitted (physician referral, transfer)From where patient was admitted (physician referral, transfer)
        Control 0..1
        Binding Unless not suitable, these codes SHALL be taken from The codes SHOULD be taken from AdmitSourcehttp://hl7.org/fhir/ValueSet/encounter-admit-source|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/encounter-admit-source)
        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Encounter.hospitalization.reAdmission
        Definition

        Whether this hospitalization is a readmission and why if known.

        Short icon Changed:(NHSN-MS) The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmissionThe type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
        Control 0..1
        Binding The codes SHOULD be taken from For example codes, see Hl7VSReAdmissionIndicator (3.0.0)http://terminology.hl7.org/ValueSet/v2-0092
        (preferred to http://terminology.hl7.org/ValueSet/v2-0092|3.0.0)
        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Encounter.hospitalization.dischargeDisposition
        Definition

        Category or kind of location after discharge.

        Short icon Changed:(NHSN-MS)(USCDI) Category or kind of location after dischargeCategory or kind of location after discharge
        Control 0..1
        Binding Unless not suitable, these codes SHALL be taken from For example codes, see DischargeDispositionhttp://hl7.org/fhir/ValueSet/encounter-discharge-disposition|4.0.1
        (extensible to http://hl7.org/fhir/ValueSet/encounter-discharge-disposition)
        Type CodeableConcept
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. Encounter.location
        Definition

        List of locations where the patient has been during this encounter.

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) List of locations where the patient has been. Used in part to discern whether the patient is Inpatient, Emergency and or Observation status.List of locations where the patient has been
        Comments

        Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".

        Control 10..*
        Type BackboneElement
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        66. Encounter.location.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        Short Extensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summary true
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Names extensions, user content, modifiers
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        68. Encounter.location.location
        Definition

        The location where the encounter takes place.

        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Location the encounter takes placeLocation the encounter takes place
        Control 1..1
        Type Reference(QICore Location, Location)bundled
        Is Modifier false
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. Encounter.location.location.reference
        Definition

        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

        Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URLLiteral reference, Relative, internal or absolute URL
        Comments

        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

        Control 10..1
        This element is affected by the following invariants: ref-1
        Type string
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. Encounter.location.status
        Definition

        The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.

        Short icon Changed:(NHSN-MS) planned | active | reserved | completedplanned | active | reserved | completed
        Comments

        When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.

        Control 0..1
        Binding The codes SHALL be taken from EncounterLocationStatushttp://hl7.org/fhir/ValueSet/encounter-location-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.1)

        The status of the location.

        Type code
        Is Modifier false
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Must Support true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. Encounter.location.period
        Definition

        Time period during which the patient was present at the location.

        Short icon Changed:(NHSN-MS)(QI-Core) Time period during which the patient was present at the locationTime period during which the patient was present at the location
        Control 10..1
        Type Period
        Is Modifier false
        Must Support icon Added:true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. Encounter.serviceProvider
        Definition

        The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.

        Short icon Changed:(QI-Core)(USCDI) The organization (facility) responsible for this encounterThe organization (facility) responsible for this encounter
        Control 0..1
        Type Reference(QICore Organization, Organization)
        Is Modifier false
        Must Support icon Added:true
        Summary false
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

        Guidance on how to interpret the contents of this table can be foundhere

        0. Encounter
        Short icon Added:(NHSN-MS) An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient during the NHSN ACH Daily reporting period. This resource is required for the ACH Daily Measure and must be referenced in all Individual MeasureReport resources for this measure.
        Control icon Added:1..?
        Must Support icon Added:true
        Invariants encounter-ach-daily-initial-population: Encounter: (class must be from ACH Daily encounter class) or (type from 'Encounter Inpatient' or 'Observation Services') or (Encounter location type from 'Inpatient, Emergency, and Observation Locations') (class.memberOf('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-class') or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307')).exists() or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143')).exists() or where(location.location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()))
        encounter-location-type-initial-population: Encounter: references at least one Location where type is from 'Inpatient, Emergency, and Observation Locations' (location.where(location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists() or location.where(location.resolve().partOf.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists())
        2. Encounter.id
        Short icon Added:(NHSN-MS) Logical id of this artifact
        Control 1..?
        Must Support icon Added:true
        4. Encounter.meta
        6. Encounter.meta.extension:link-received-date-extension
        Slice Name link-received-date-extension
        Control 0..1
        Type Extension(Received Date) (Extension Type: dateTime)
        8. Encounter.identifier
        Short icon Added:(NHSN-MS)(USCDI) Identifier(s) by which this encounter is known
        Note This is a business identifier, not a resource identifier (see discussion)
        Control 1..?
        10. Encounter.identifier.use
        Short icon Added:(NHSN-MS) usual | official | temp | secondary | old (If known)
        Must Support true
        12. Encounter.identifier.type
        Short icon Added:(NHSN-MS) Description of identifier
        Must Support true
        icon Added: 14. Encounter.identifier.system
        Short (NHSN-MS)(USCDI) The namespace for the identifier value
        icon Added: 16. Encounter.identifier.value
        Short (NHSN-MS)(USCDI) The value that is unique
        18. Encounter.identifier.period
        Short icon Added:(NHSN-MS) Time period when id is/was valid for use
        Must Support true
        20. Encounter.status
        Definition

        triaged | in-progress | finished | onleave | entered-in-error.

        Short icon Changed:(NHSN-MS) triaged | in-progress | finished | onleave | entered-in-error
        Binding The codes SHALL be taken from ACH Daily Encounter Status ValueSet
        (required to http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-status)
        icon Added: 22. Encounter.class
        Short (NHSN-MS)(USCDI) Classification of patient encounter
        24. Encounter.classHistory
        Short icon Added:(NHSN-MS) List of past encounter classes
        Must Support true
        icon Added: 26. Encounter.classHistory.class
        Short (NHSN-MS) inpatient | outpatient | ambulatory | emergency +
        Must Support true
        icon Added: 28. Encounter.classHistory.period
        Short (NHSN-MS) The time that the episode was in the specified class
        Must Support true
        icon Added: 30. Encounter.type
        Short (NHSN-MS)(USCDI) Specific type of encounter
        icon Added: 32. Encounter.subject
        Short (NHSN-MS)(QI-Core)(USCDI) The patient or group present at the encounter
        Type Reference(Cross-Measure Patient Profile)bundled
        34. Encounter.subject.reference
        Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
        Control 1..?
        Must Support true
        36. Encounter.period
        Short icon Added:(NHSN-MS)(USCDI) The start and end time of the encounter
        Control 1..?
        icon Added: 38. Encounter.reasonCode
        Short (NHSN-MS)(USCDI) Coded reason the encounter takes place
        icon Added: 40. Encounter.hospitalization
        Short (NHSN-MS)(QI-Core)(USCDI) Details about the admission to a healthcare service
        42. Encounter.hospitalization.admitSource
        Short (NHSN-MS) From where patient was admitted (physician referral, transfer)
        Binding Unless not suitable, these codes SHALL be taken from AdmitSource
        (extensible to http://hl7.org/fhir/ValueSet/encounter-admit-source)
        Must Support true
        44. Encounter.hospitalization.reAdmission
        Short (NHSN-MS) The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
        Binding The codes SHOULD be taken from Hl7VSReAdmissionIndicator (3.0.0)
        (preferred to http://terminology.hl7.org/ValueSet/v2-0092|3.0.0)
        Must Support true
        46. Encounter.hospitalization.dischargeDisposition
        Short (NHSN-MS)(USCDI) Category or kind of location after discharge
        Binding Unless not suitable, these codes SHALL be taken from DischargeDisposition
        (extensible to http://hl7.org/fhir/ValueSet/encounter-discharge-disposition)
        48. Encounter.location
        Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) List of locations where the patient has been. Used in part to discern whether the patient is Inpatient, Emergency and or Observation status.
        Control 1..?
        icon Added: 50. Encounter.location.location
        Short (NHSN-MS)(QI-Core)(USCDI) Location the encounter takes place
        Type Reference(QICore Location)bundled
        52. Encounter.location.location.reference
        Short (NHSN-MS) Literal reference, Relative, internal or absolute URL
        Control 1..?
        Must Support true
        54. Encounter.location.status
        Short icon Added:(NHSN-MS) planned | active | reserved | completed
        Must Support true
        56. Encounter.location.period
        Short icon Added:(NHSN-MS)(QI-Core) Time period during which the patient was present at the location
        Control 1..?
        Must Support icon Added:true
        icon Removed:--. Encounter.location.location.reference
        Control 1..?
        Must Support true
        icon Removed:--. Encounter.subject.reference
        Control 1..?
        Must Support true
        icon Removed:--. Encounter.hospitalization.admitSource
        Must Support true
        icon Removed:--. Encounter.hospitalization.reAdmission
        Binding The codes SHOULD be taken from hl7VS-re-admissionIndicator
        (preferred to http://terminology.hl7.org/ValueSet/v2-0092)
        Must Support true
        icon Removed:--. Encounter.hospitalization.dischargeDisposition
        Binding The codes SHALL be taken from DischargeDisposition
        (required to http://hl7.org/fhir/ValueSet/encounter-discharge-disposition)

        Guidance on how to interpret the contents of this table can be foundhere

        0. Encounter
        Definition

        icon Changed:

        -

        Short icon Changed:(NHSN-MS) An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient during the NHSN ACH Daily reporting period. This resource is required for the ACH Daily Measure and must be referenced in all Individual MeasureReport resources for this measure.
        Comments

        icon Added:

        -

        Control icon Changed:1..*
        Is Modifier false
        Must Support icon Changed:true
        Summary false
        Alternate Names Visit
        Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        encounter-ach-daily-initial-population: Encounter: (class must be from ACH Daily encounter class) or (type from 'Encounter Inpatient' or 'Observation Services') or (Encounter location type from 'Inpatient, Emergency, and Observation Locations') (class.memberOf('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-class') or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307')).exists() or type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143')).exists() or where(location.location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()))
        encounter-location-type-initial-population: Encounter: references at least one Location where type is from 'Inpatient, Emergency, and Observation Locations' (location.where(location.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists() or location.where(location.resolve().partOf.resolve().type.where(coding.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265')).exists()).exists())
        2. Encounter.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        Short icon Changed:(NHSN-MS) Logical id of this artifact
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control 1..1
        Type id
        Is Modifier false
        Must Support icon Added:true
        Summary true
        4. Encounter.meta
        Definition

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        Short Metadata about the resource
        Control 0..1
        Type Meta
        Is Modifier false
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. Encounter.meta.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        Short Unique id for inter-element referencing
        Control 0..1
        Type string
        Is Modifier false
        XML Format In the XML format, this property is represented as an attribute.
        Summary false
        8. Encounter.meta.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        Short Additional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 0..*
        Type Extension
        Is Modifier false
        Summary false
        Alternate Names extensions, user content
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        Slicing This element introduces a set of slices on Encounter.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 10. Encounter.meta.extension:link-received-date-extension
          Slice Name link-received-date-extension
          Definition

          This extension stores the date and time a Resource was received by the processing system (e.g., NHSNLink).

          Short Received Date
          Control 0..1
          Type Extension(Received Date) (Extension Type: dateTime)
          Is Modifier false
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          12. Encounter.meta.versionId
          Definition

          The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

          Short Version specific identifier
          Comments

          The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

          Control 0..1
          Type id
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          14. Encounter.meta.lastUpdated
          Definition

          When the resource last changed - e.g. when the version changed.

          Short When the resource version last changed
          Comments

          This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

          Control 0..1
          Type instant
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. Encounter.meta.source
          Definition

          A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

          Short Identifies where the resource comes from
          Comments

          In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

          This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

          Control 0..1
          Type uri
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. Encounter.meta.profile
          Definition

          A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

          Short Profiles this resource claims to conform to
          Comments

          It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

          Control 0..*
          Type canonical(StructureDefinition)
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. Encounter.meta.security
          Definition

          Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

          Short Security Labels applied to this resource
          Comments

          The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

          Control 0..*
          Binding Unless not suitable, these codes SHALL be taken from All Security Labels
          (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

          Security Labels from the Healthcare Privacy and Security Classification System.

          Type Coding
          Is Modifier false
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Encounter.meta.tag
          Definition

          Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

          Short Tags applied to this resource
          Comments

          The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

          Control 0..*
          Binding For example codes, see CommonTags
          (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

          Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

          Type Coding
          Is Modifier false
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          24. Encounter.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          Short A set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

          Control 0..1
          Type uri
          Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. Encounter.language
          Definition

          The base language in which the resource is written.

          Short Language of the resource content
          Comments

          Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

          Control 0..1
          Binding The codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional Bindings Purpose
          AllLanguages Max Binding
          Type code
          Is Modifier false
          Primitive Value This primitive element may be present, or absent, or replaced by an extension
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          28. Encounter.text
          Definition

          A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

          Short Text summary of the resource, for human interpretation
          Comments

          Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

          Control 0..1
          Type Narrative
          Is Modifier false
          Summary false
          Alternate Names narrative, html, xhtml, display
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. Encounter.contained
          Definition

          These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

          Short Contained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

          Control 0..*
          Type Resource
          Is Modifier false
          Summary false
          Alternate Names inline resources, anonymous resources, contained resources
          32. Encounter.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          Short Additional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control 0..*
          Type Extension
          Is Modifier false
          Summary false
          Alternate Names extensions, user content
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          34. Encounter.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          Short Extensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control 0..*
          Type Extension
          Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Summary false
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Names extensions, user content
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          36. Encounter.identifier
          Definition

          Identifier(s) by which this encounter is known.

          Short icon Changed:(NHSN-MS)(USCDI) Identifier(s) by which this encounter is known
          Note This is a business identifier, not a resource identifier (see discussion)
          Control 1..*
          Type Identifier
          Is Modifier false
          Must Support true
          Summary true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Encounter.identifier.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          Short Unique id for inter-element referencing
          Control 0..1
          Type string
          Is Modifier false
          XML Format In the XML format, this property is represented as an attribute.
          Summary false
          40. Encounter.identifier.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          Short Additional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control 0..*
          Type Extension
          Is Modifier false
          Summary false
          Alternate Names extensions, user content
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          Slicing This element introduces a set of slices on Encounter.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 42. Encounter.identifier.use
            Definition

            The purpose of this identifier.

            Short icon Changed:(NHSN-MS) usual | official | temp | secondary | old (If known)
            Comments

            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

            Control 0..1
            Binding The codes SHALL be taken from IdentifierUse
            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

            Identifies the purpose for this identifier, if known .

            Type code
            Is Modifier true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. Encounter.identifier.type
            Definition

            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

            Short icon Changed:(NHSN-MS) Description of identifier
            Comments

            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

            Control 0..1
            Binding Unless not suitable, these codes SHALL be taken from Identifier Type Codes
            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Requirements

            Allows users to make use of identifiers when the identifier system is not known.

            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. Encounter.identifier.system
            Definition

            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

            Short icon Changed:(NHSN-MS)(USCDI) The namespace for the identifier value
            Comments

            Identifier.system is always case sensitive.

            Control 1..1
            Type uri
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Requirements

            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

            Example General: http://www.acme.com/identifiers/patient
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. Encounter.identifier.value
            Definition

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

            Short icon Changed:(NHSN-MS)(USCDI) The value that is unique
            Comments

            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

            Control 1..1
            Type string
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Example General: 123456
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. Encounter.identifier.period
            Definition

            Time period during which identifier is/was valid for use.

            Short icon Changed:(NHSN-MS) Time period when id is/was valid for use
            Control 0..1
            Type Period
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            52. Encounter.identifier.assigner
            Definition

            Organization that issued/manages the identifier.

            Short Organization that issued id (may be just text)
            Comments

            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

            Control 0..1
            Type Reference(Organization)
            Is Modifier false
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            54. Encounter.status
            Definition

            triaged | in-progress | finished | onleave | entered-in-error.

            Short icon Changed:(NHSN-MS) triaged | in-progress | finished | onleave | entered-in-error
            Comments

            Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).

            Control 1..1
            Binding The codes SHALL be taken from ACH Daily Encounter Status ValueSet
            (required to http://www.cy118119.com/nhsn/fhirportal/dqm/ig/ValueSet/ach-daily-encounter-status)
            Type code
            Is Modifier true because 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
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            56. Encounter.statusHistory
            Definition

            The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.

            Short List of past encounter statuses
            Comments

            The current status is always found in the current version of the resource, not the status history.

            Control 0..*
            Type BackboneElement
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            58. Encounter.statusHistory.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            Short Unique id for inter-element referencing
            Control 0..1
            Type string
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            60. Encounter.statusHistory.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            Short Additional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            62. Encounter.statusHistory.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            Short Extensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summary true
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Names extensions, user content, modifiers
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            64. Encounter.statusHistory.status
            Definition

            planned | arrived | triaged | in-progress | onleave | finished | cancelled +.

            Short planned | arrived | triaged | in-progress | onleave | finished | cancelled +
            Control 1..1
            Binding The codes SHALL be taken from EncounterStatus
            (required to http://hl7.org/fhir/ValueSet/encounter-status|4.0.1)

            Current state of the encounter.

            Type code
            Is Modifier false
            Primitive Value This primitive element may be present, or absent, or replaced by an extension
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. Encounter.statusHistory.period
            Definition

            The time that the episode was in the specified status.

            Short The time that the episode was in the specified status
            Control 1..1
            Type Period
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Encounter.class
            Definition

            Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.

            Short icon Changed:(NHSN-MS)(USCDI) Classification of patient encounter
            Control 1..1
            Binding Unless not suitable, these codes SHALL be taken from ActEncounterCode (3.0.0)
            (extensible to http://terminology.hl7.org/ValueSet/v3-ActEncounterCode|3.0.0)

            Classification of the encounter.

            Type Coding
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            70. Encounter.classHistory
            Definition

            The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.

            Short icon Changed:(NHSN-MS) List of past encounter classes
            Control 0..*
            Type BackboneElement
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            72. Encounter.classHistory.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            Short Unique id for inter-element referencing
            Control 0..1
            Type string
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            74. Encounter.classHistory.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            Short Additional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            76. Encounter.classHistory.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            Short Extensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..*
            Type Extension
            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summary true
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Names extensions, user content, modifiers
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            78. Encounter.classHistory.class
            Definition

            inpatient | outpatient | ambulatory | emergency +.

            Short icon Changed:(NHSN-MS) inpatient | outpatient | ambulatory | emergency +
            Control 1..1
            Binding Unless not suitable, these codes SHALL be taken from ActEncounterCode (3.0.0)
            (extensible to http://terminology.hl7.org/ValueSet/v3-ActEncounterCode|3.0.0)

            Classification of the encounter.

            Type Coding
            Is Modifier false
            Must Support icon Added:true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            80. Encounter.classHistory.period
            Definition

            The time that the episode was in the specified class.

            Short icon Changed:(NHSN-MS) The time that the episode was in the specified class
            Control 1..1
            Type Period
            Is Modifier false
            Must Support icon Added:true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            82. Encounter.type
            Definition

            Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).

            Short icon Changed:(NHSN-MS)(USCDI) Specific type of encounter
            Comments

            Since there are many ways to further classify encounters, this element is 0..*.

            Control 1..*
            Binding Unless not suitable, these codes SHALL be taken from USCoreEncounterType (6.1.0)
            (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-encounter-type|6.1.0)

            Valueset to describe the Encounter Type

            Type CodeableConcept
            Is Modifier false
            Must Support true
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            84. Encounter.serviceType
            Definition

            Broad categorization of the service that is to be provided (e.g. cardiology).

            Short Specific type of service
            Control 0..1
            Binding For example codes, see ServiceType
            (example to http://hl7.org/fhir/ValueSet/service-type)

            Broad categorization of the service that is to be provided.

            Type CodeableConcept
            Is Modifier false
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            86. Encounter.priority
            Definition

            Indicates the urgency of the encounter.

            Short Indicates the urgency of the encounter
            Control 0..1
            Binding For example codes, see ActPriority (3.0.0)
            (example to http://terminology.hl7.org/ValueSet/v3-ActPriority|3.0.0)

            Indicates the urgency of the encounter.

            Type CodeableConcept
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            88. Encounter.subject
            Definition

            The patient or group present at the encounter.

            Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) The patient or group present at the encounter
            Comments

            While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).

            Control 1..1
            Type Reference(Cross-Measure Patient Profile)bundled
            Is Modifier false
            Must Support true
            Summary true
            Alternate Names patient
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. Encounter.subject.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            Short Unique id for inter-element referencing
            Control 0..1
            Type string
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            92. Encounter.subject.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            Short Additional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            Slicing This element introduces a set of slices on Encounter.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 94. Encounter.subject.reference
              Definition

              A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

              Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URL
              Comments

              Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

              Control 1..1
              This element is affected by the following invariants: ref-1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Must Support true
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              96. Encounter.subject.type
              Definition

              The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

              The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

              Short Type the reference refers to (e.g. "Patient")
              Comments

              This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

              Control 0..1
              Binding Unless not suitable, these codes SHALL be taken from ResourceType
              (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

              Aa resource (or, for logical models, the URI of the logical model).

              Type uri
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              98. Encounter.subject.identifier
              Definition

              An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

              Short Logical reference, when literal reference is not known
              Comments

              When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

              When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

              Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

              Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

              Note This is a business identifier, not a resource identifier (see discussion)
              Control 0..1
              Type Identifier
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              100. Encounter.subject.display
              Definition

              Plain text narrative that identifies the resource in addition to the resource reference.

              Short Text alternative for the resource
              Comments

              This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

              Control 0..1
              Type string
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. Encounter.episodeOfCare
              Definition

              Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).

              Short Episode(s) of care that this encounter should be recorded against
              Control 0..*
              Type Reference(EpisodeOfCare)
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. Encounter.basedOn
              Definition

              The request this encounter satisfies (e.g. incoming referral or procedure request).

              Short The ServiceRequest that initiated this encounter
              Control 0..*
              Type Reference(ServiceRequest)
              Is Modifier false
              Summary false
              Alternate Names incomingReferral
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              106. Encounter.participant
              Definition

              The list of people responsible for providing the service.

              Short icon Changed:(QI-Core)(USCDI) List of participants involved in the encounter
              Control 0..*
              Type BackboneElement
              Is Modifier false
              Must Support true
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              108. Encounter.participant.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              110. Encounter.participant.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              Short Additional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              112. Encounter.participant.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              Short Extensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summary true
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Names extensions, user content, modifiers
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              114. Encounter.participant.type
              Definition

              Role of participant in encounter.

              Short icon Changed:(USCDI) Role of participant in encounter
              Comments

              The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.

              Control 0..*
              Binding Unless not suitable, these codes SHALL be taken from ParticipantType
              (extensible to http://hl7.org/fhir/ValueSet/encounter-participant-type)

              Role of participant in encounter.

              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. Encounter.participant.period
              Definition

              The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.

              Short icon Changed:(USCDI) Period of time during the encounter that the participant participated
              Control 0..1
              Type Period
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Encounter.participant.individual
              Definition

              Persons involved in the encounter other than the patient.

              Short icon Changed:(QI-Core)(USCDI) Persons involved in the encounter other than the patient
              Comments

              icon Added:

              Should include QICore-RelatedPerson as a possible participant, but USCore-Encounter only allows USCore-Practitioner.

              Control 0..1
              Type Reference(QICore Practitioner, QICore PractitionerRole, QICore RelatedPerson)
              Is Modifier false
              Must Support true
              Must Support Types No must-support rules about the choice of types/profiles
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              120. Encounter.appointment
              Definition

              The appointment that scheduled this encounter.

              Short The appointment that scheduled this encounter
              Control 0..*
              Type Reference(Appointment)
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              122. Encounter.period
              Definition

              The start and end time of the encounter.

              Short icon Changed:(NHSN-MS)(USCDI) The start and end time of the encounter
              Comments

              If not (yet) known, the end of the Period may be omitted.

              Control 1..1
              Type Period
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              124. Encounter.length
              Definition

              Quantity of time the encounter lasted. This excludes the time during leaves of absence.

              Short Quantity of time the encounter lasted (less time absent)
              Comments

              May differ from the time the Encounter.period lasted because of leave of absence.

              Control 0..1
              Type Duration
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              126. Encounter.reasonCode
              Definition

              Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.

              Short icon Changed:(NHSN-MS)(USCDI) Coded reason the encounter takes place
              Comments

              For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

              Control 0..*
              Binding The codes SHOULD be taken from EncounterReasonCodes
              (preferred to http://hl7.org/fhir/ValueSet/encounter-reason)

              Reason why the encounter takes place.

              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary true
              Alternate Names Indication, Admission diagnosis
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              128. Encounter.reasonReference
              Definition

              Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.

              Short icon Changed:(QI-Core)(USCDI) Reason the encounter takes place (reference)
              Comments

              For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

              Control 0..*
              Type Reference(QICore Condition Problems Health Concerns, QICore Condition Encounter Diagnosis, QICore Procedure, QICore Simple Observation, QICore ImmunizationRecommendation)
              Is Modifier false
              Must Support icon Added:true
              Must Support Types No must-support rules about the choice of types/profiles
              Summary true
              Alternate Names Indication, Admission diagnosis
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              130. Encounter.diagnosis
              Definition

              The list of diagnosis relevant to this encounter.

              Short The list of diagnosis relevant to this encounter
              Control 0..*
              Type BackboneElement
              Is Modifier false
              Summary true
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              132. Encounter.diagnosis.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              134. Encounter.diagnosis.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              Short Additional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              136. Encounter.diagnosis.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              Short Extensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summary true
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Names extensions, user content, modifiers
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              138. Encounter.diagnosis.condition
              Definition

              Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.

              Short The diagnosis or procedure relevant to the encounter
              Comments

              For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).

              Control 1..1
              Type Reference(Condition, Procedure)
              Is Modifier false
              Summary true
              Alternate Names Admission diagnosis, discharge diagnosis, indication
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              140. Encounter.diagnosis.use
              Definition

              Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).

              Short Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
              Control 0..1
              Binding The codes SHOULD be taken from DiagnosisRole
              (preferred to http://hl7.org/fhir/ValueSet/diagnosis-role)

              The type of diagnosis this condition represents.

              Type CodeableConcept
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              142. Encounter.diagnosis.rank
              Definition

              Ranking of the diagnosis (for each role type).

              Short Ranking of the diagnosis (for each role type)
              Control 0..1
              Type positiveInt
              Is Modifier false
              Primitive Value This primitive element may be present, or absent, or replaced by an extension
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              144. Encounter.account
              Definition

              The set of accounts that may be used for billing for this Encounter.

              Short The set of accounts that may be used for billing for this Encounter
              Comments

              The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.

              Control 0..*
              Type Reference(Account)
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              146. Encounter.hospitalization
              Definition

              Details about the admission to a healthcare service.

              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Details about the admission to a healthcare service
              Comments

              An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included.

              The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.

              Control 0..1
              Type BackboneElement
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              148. Encounter.hospitalization.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              150. Encounter.hospitalization.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              Short Additional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              152. Encounter.hospitalization.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              Short Extensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summary true
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Names extensions, user content, modifiers
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              154. Encounter.hospitalization.preAdmissionIdentifier
              Definition

              Pre-admission identifier.

              Short Pre-admission identifier
              Control 0..1
              Type Identifier
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              156. Encounter.hospitalization.origin
              Definition

              The location/organization from which the patient came before admission.

              Short The location/organization from which the patient came before admission
              Control 0..1
              Type Reference(QICore Location)
              Is Modifier false
              Must Support icon Added:false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              158. Encounter.hospitalization.admitSource
              Definition

              From where patient was admitted (physician referral, transfer).

              Short icon Changed:(NHSN-MS) From where patient was admitted (physician referral, transfer)
              Control 0..1
              Binding Unless not suitable, these codes SHALL be taken from AdmitSource
              (extensible to http://hl7.org/fhir/ValueSet/encounter-admit-source)
              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              160. Encounter.hospitalization.reAdmission
              Definition

              Whether this hospitalization is a readmission and why if known.

              Short icon Changed:(NHSN-MS) The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
              Control 0..1
              Binding The codes SHOULD be taken from Hl7VSReAdmissionIndicator (3.0.0)
              (preferred to http://terminology.hl7.org/ValueSet/v2-0092|3.0.0)
              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              162. Encounter.hospitalization.dietPreference
              Definition

              Diet preferences reported by the patient.

              Short Diet preferences reported by the patient
              Comments

              For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).

              Control 0..*
              Binding For example codes, see Diet
              (example to http://hl7.org/fhir/ValueSet/encounter-diet)

              Medical, cultural or ethical food preferences to help with catering requirements.

              Type CodeableConcept
              Is Modifier false
              Summary false
              Requirements

              Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.

              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              164. Encounter.hospitalization.specialCourtesy
              Definition

              Special courtesies (VIP, board member).

              Short Special courtesies (VIP, board member)
              Control 0..*
              Binding The codes SHOULD be taken from SpecialCourtesy
              (preferred to http://hl7.org/fhir/ValueSet/encounter-special-courtesy)

              Special courtesies.

              Type CodeableConcept
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              166. Encounter.hospitalization.specialArrangement
              Definition

              Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.

              Short Wheelchair, translator, stretcher, etc.
              Control 0..*
              Binding The codes SHOULD be taken from SpecialArrangements
              (preferred to http://hl7.org/fhir/ValueSet/encounter-special-arrangements)

              Special arrangements.

              Type CodeableConcept
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              168. Encounter.hospitalization.destination
              Definition

              Location/organization to which the patient is discharged.

              Short Location/organization to which the patient is discharged
              Control 0..1
              Type Reference(QICore Location)
              Is Modifier false
              Must Support icon Added:false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              170. Encounter.hospitalization.dischargeDisposition
              Definition

              Category or kind of location after discharge.

              Short icon Changed:(NHSN-MS)(USCDI) Category or kind of location after discharge
              Control 0..1
              Binding Unless not suitable, these codes SHALL be taken from DischargeDisposition
              (extensible to http://hl7.org/fhir/ValueSet/encounter-discharge-disposition)
              Type CodeableConcept
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              172. Encounter.location
              Definition

              List of locations where the patient has been during this encounter.

              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) List of locations where the patient has been. Used in part to discern whether the patient is Inpatient, Emergency and or Observation status.
              Comments

              Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".

              Control 1..*
              Type BackboneElement
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              174. Encounter.location.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              176. Encounter.location.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              Short Additional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              178. Encounter.location.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              Short Extensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summary true
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Names extensions, user content, modifiers
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              180. Encounter.location.location
              Definition

              The location where the encounter takes place.

              Short icon Changed:(NHSN-MS)(QI-Core)(USCDI) Location the encounter takes place
              Control 1..1
              Type Reference(QICore Location)bundled
              Is Modifier false
              Must Support true
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              182. Encounter.location.location.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              Short Unique id for inter-element referencing
              Control 0..1
              Type string
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              184. Encounter.location.location.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              Short Additional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control 0..*
              Type Extension
              Is Modifier false
              Summary false
              Alternate Names extensions, user content
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              Slicing This element introduces a set of slices on Encounter.location.location.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 186. Encounter.location.location.reference
                Definition

                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                Short icon Changed:(NHSN-MS) Literal reference, Relative, internal or absolute URL
                Comments

                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                Control 1..1
                This element is affected by the following invariants: ref-1
                Type string
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                188. Encounter.location.location.type
                Definition

                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                Short Type the reference refers to (e.g. "Patient")
                Comments

                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                Control 0..1
                Binding Unless not suitable, these codes SHALL be taken from ResourceType
                (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                Aa resource (or, for logical models, the URI of the logical model).

                Type uri
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                190. Encounter.location.location.identifier
                Definition

                An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                Short Logical reference, when literal reference is not known
                Comments

                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                Note This is a business identifier, not a resource identifier (see discussion)
                Control 0..1
                Type Identifier
                Is Modifier false
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                192. Encounter.location.location.display
                Definition

                Plain text narrative that identifies the resource in addition to the resource reference.

                Short Text alternative for the resource
                Comments

                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                Control 0..1
                Type string
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Summary true
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                194. Encounter.location.status
                Definition

                The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.

                Short icon Changed:(NHSN-MS) planned | active | reserved | completed
                Comments

                When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.

                Control 0..1
                Binding The codes SHALL be taken from EncounterLocationStatus
                (required to http://hl7.org/fhir/ValueSet/encounter-location-status|4.0.1)

                The status of the location.

                Type code
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                Must Support true
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                196. Encounter.location.physicalType
                Definition

                This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.

                Short The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
                Comments

                This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query.

                There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.

                Control 0..1
                Binding For example codes, see LocationType
                (example to http://hl7.org/fhir/ValueSet/location-physical-type)

                Physical form of the location.

                Type CodeableConcept
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                198. Encounter.location.period
                Definition

                Time period during which the patient was present at the location.

                Short icon Changed:(NHSN-MS)(QI-Core) Time period during which the patient was present at the location
                Control 1..1
                Type Period
                Is Modifier false
                Must Support icon Added:true
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                200. Encounter.serviceProvider
                Definition

                The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.

                Short icon Changed:(QI-Core)(USCDI) The organization (facility) responsible for this encounter
                Control 0..1
                Type Reference(QICore Organization)
                Is Modifier false
                Must Support icon Added:true
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                202. Encounter.partOf
                Definition

                Another Encounter of which this encounter is a part of (administratively or in time).

                Short Another Encounter this encounter is part of
                Comments

                This is also used for associating a child's encounter back to the mother's encounter.

                Refer to the Notes section in the Patient resource for further details.

                Control 0..1
                Type Reference(QICore Encounter)
                Is Modifier false
                Must Support icon Added:false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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