References

• HL7 Europe Hospital Discharge Report
• International Patient Summary
• LOINC Consultation note - recommended C-CDA R1.1 sections

Introduction

The consultation note forms the basis of IM1 Consultation Writeback and GP Connect Send Document. It is also related to the EMIS consultation screen sections and PRSB section headings.

Overview

As composition is not for data capture, we need an archetype to form the high framework for the consulation-note.

The current model is shown below. Historically this is related to SOAP Note and also Nursing Process (ADPIE) which are also included for documentation purposes.

Informatics Model

The consultation note consists of three main structures:

• composition which forms the main body of the consultation
• archetype/template, which are a templated set of questions that can be used during a consultation. It will often be referred to as a form, and it is primarily a data capture method. Examples include
  • vital signs
  • daily physical activity
• resource entities, which are the data structures persisted in the clinical repository. The most common resource will be:
  • Observation

Both archetype/template and entities are data capture related and will often relate to a data entry screen within an application. Compositions provide a high-level structure to the consultation, but they are generally assembled from both archetype/templates and resource entities; it is a data aggregate.

Many questions within the archetype / template will be the same and also overlap with directly captured entities. I.e., in remote patient monitoring (virtual wards) a patient's weight, pulse rate and blood pressure can be captured from device data. These data items also exist in vital signs.

Where a template/archetype question may have multiple uses, it is persisted as a resource entity.

These questions will be SNOMED or LOINC coded.

Composition & FHIR Document

The basic structure of a composition is shown above and detailed below, in its aggregated form which is typically how it is exchanged, it is known as a FHIR Document and a redendered example is shown below:

Examples

• FHIR Document EMIS IM1 Consultation Note 30 Jun 2002
• FHIR Document EMIS IM1 Consultation Note 8 Nov 2024

Comosition.section - Document Section Codes

Each section is coded using Document Section Codes, which can be found Value Set: Document Section Codes.

This is not required to be SNOMED CT coded.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Type of a composition.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:SNOMED	SΣ	0..*	Coding	Code defined by a terminology system Binding: VH Observation Code (required)
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 823651000000106
coding:LOINC	Σ	0..*	Coding	Code defined by a terminology system Binding: LOINCCodes (extensible)
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 11488-4
subject	Σ	1..1	Reference(Patient)	Who and/or what the composition is about
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
identifier	Σ	0..1	NHSNumber	Logical reference, when literal reference is not known
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
Slices for section	SC	1..*	BackboneElement	Sections composing the IPS Slice: Unordered, Open by value:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required)
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
section:ComplaintsAndIssues	SC	0..*	BackboneElement	Complaints and Issues Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Presenting complaints or issues
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61150-9
display		1..1	string	Representation defined by the system Fixed Value: Subjective Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
section:VitalSigns	SC	0..*	BackboneElement	Vital Signs Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Vital Signs
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 8716-3
display		1..1	string	Representation defined by the system Fixed Value: Vital signs
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(Observation)	Observation with category of `vital-signs`
section:Objective	SC	0..*	BackboneElement	Objective Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Examination findings
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61149-1
display		1..1	string	Representation defined by the system Fixed Value: Objective Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(Observation)	Observation with category of `exam`
section:SocialHistory	SC	0..*	BackboneElement	Social History Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Social Context
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 29762-2
display		1..1	string	Representation defined by the system Fixed Value: Social history Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(Observation)	Observation with category of `social-history`
section:Problems	SC	0..*	BackboneElement	Problems Constraints: cmp-1, cmp-2
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Problems
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 57852-6
display		1..1	string	Representation defined by the system Fixed Value: Problem list Narrative - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..*	Coding	Code defined by a terminology system
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(Condition)	A reference to data that supports this section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	preferred	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes From the FHIR Standard
Composition.type.coding:SNOMED	required	VHObservationCode https://fhir.virtually.healthcare/ValueSet/VHObservationCode From this IG
Composition.type.coding:LOINC	extensible	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Composition.section.code	required	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:ComplaintsAndIssues.code	required	Pattern Value: LOINC Code 61150-9("Subjective Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:VitalSigns.code	required	Pattern Value: LOINC Code 8716-3("Vital signs") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:Objective.code	required	Pattern Value: LOINC Code 61149-1("Objective Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:SocialHistory.code	required	Pattern Value: LOINC Code 29762-2("Social history Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:Problems.code	required	Pattern Value: LOINC Code 57852-6("Problem list Narrative - Reported") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:ComplaintsAndIssues, Composition.section:VitalSigns, Composition.section:Objective, Composition.section:SocialHistory, Composition.section:Problems	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:ComplaintsAndIssues, Composition.section:VitalSigns, Composition.section:Objective, Composition.section:SocialHistory, Composition.section:Problems	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	error	Composition	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	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from Composition

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
type
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:SNOMED	S	0..*	Coding	Code defined by a terminology system Binding: VH Observation Code (required)
system		1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 823651000000106
coding:LOINC		0..*	Coding	Code defined by a terminology system Binding: LOINCCodes (extensible)
system		1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Required Pattern: 11488-4
subject		1..1	Reference(Patient)	Who and/or what the composition is about
reference		1..1	string	Literal reference, Relative, internal or absolute URL
identifier		0..1	NHSNumber	Logical reference, when literal reference is not known
custodian
identifier		0..1	OrganisationCode	Logical reference, when literal reference is not known
Slices for section	S	1..*	BackboneElement	Sections composing the IPS Slice: Unordered, Open by value:code
section:All Slices				Content/Rules for all slices
title		1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required)
coding		1..*	Coding	Code defined by a terminology system
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
text	S	1..1	Narrative	Text summary of the section, for human interpretation
section		0..0
section:ComplaintsAndIssues	S	0..*	BackboneElement	Complaints and Issues
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Presenting complaints or issues
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61150-9
display		1..1	string	Representation defined by the system Fixed Value: Subjective Narrative
section:VitalSigns	S	0..*	BackboneElement	Vital Signs
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Vital Signs
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 8716-3
display		1..1	string	Representation defined by the system Fixed Value: Vital signs
entry		0..*	Reference(Observation)	Observation with category of `vital-signs`
section:Objective	S	0..*	BackboneElement	Objective
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Examination findings
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61149-1
display		1..1	string	Representation defined by the system Fixed Value: Objective Narrative
entry		0..*	Reference(Observation)	Observation with category of `exam`
section:SocialHistory	S	0..*	BackboneElement	Social History
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Social Context
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 29762-2
display		1..1	string	Representation defined by the system Fixed Value: Social history Narrative
entry		0..*	Reference(Observation)	Observation with category of `social-history`
section:Problems	S	0..*	BackboneElement	Problems
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Problems
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 57852-6
display		1..1	string	Representation defined by the system Fixed Value: Problem list Narrative - Reported
entry		0..*	Reference(Condition)	A reference to data that supports this section
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.type.coding:SNOMED	required	VHObservationCode https://fhir.virtually.healthcare/ValueSet/VHObservationCode From this IG
Composition.type.coding:LOINC	extensible	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Composition.section.code	required	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	Composition	A set of resources composed into a single coherent clinical statement with clinical attestation
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Type of a composition.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:SNOMED	SΣ	0..*	Coding	Code defined by a terminology system Binding: VH Observation Code (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 823651000000106
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:LOINC	Σ	0..*	Coding	Code defined by a terminology system Binding: LOINCCodes (extensible)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Required Pattern: 11488-4
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	Σ	1..1	Reference(Patient)	Who and/or what the composition is about
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	NHSNumber	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
encounter	Σ	0..1	Reference(Encounter)	Context of the Composition
date	Σ	1..1	dateTime	Composition editing time
author	Σ	1..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
confidentiality	Σ	0..1	code	As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester		0..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the composition
custodian	Σ	0..1	Reference(Organization)	Organization which maintains the composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	OrganisationCode	Logical reference, when literal reference is not known
display	Σ	0..1	string	Text alternative for the resource
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	Σ	0..1	Period	The period covered by the documentation
detail	Σ	0..*	Reference(Resource)	The event(s) being documented
Slices for section	SC	1..*	BackboneElement	Sections composing the IPS Slice: Unordered, Open by value:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section:ComplaintsAndIssues	SC	0..*	BackboneElement	Complaints and Issues Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Presenting complaints or issues
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61150-9
display		1..1	string	Representation defined by the system Fixed Value: Subjective Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section:VitalSigns	SC	0..*	BackboneElement	Vital Signs Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Vital Signs
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 8716-3
display		1..1	string	Representation defined by the system Fixed Value: Vital signs
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Observation)	Observation with category of `vital-signs`
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section:Objective	SC	0..*	BackboneElement	Objective Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Examination findings
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61149-1
display		1..1	string	Representation defined by the system Fixed Value: Objective Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Observation)	Observation with category of `exam`
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section:SocialHistory	SC	0..*	BackboneElement	Social History Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Social Context
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 29762-2
display		1..1	string	Representation defined by the system Fixed Value: Social history Narrative
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Observation)	Observation with category of `social-history`
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section:Problems	SC	0..*	BackboneElement	Problems Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		1..1	string	Label for section (e.g. for ToC) Required Pattern: Problems
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (required) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 57852-6
display		1..1	string	Representation defined by the system Fixed Value: Problem list Narrative - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Condition)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	preferred	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes From the FHIR Standard
Composition.type.coding:SNOMED	required	VHObservationCode https://fhir.virtually.healthcare/ValueSet/VHObservationCode From this IG
Composition.type.coding:LOINC	extensible	LOINCCodes(a valid code from LOINC) http://hl7.org/fhir/ValueSet/observation-codes From the FHIR Standard
Composition.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
Composition.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Composition.confidentiality	required	v3.ConfidentialityClassification http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26 From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.custodian.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types From the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 From the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	required	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:ComplaintsAndIssues.code	required	Pattern Value: LOINC Code 61150-9("Subjective Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:ComplaintsAndIssues.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:ComplaintsAndIssues.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:ComplaintsAndIssues.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:VitalSigns.code	required	Pattern Value: LOINC Code 8716-3("Vital signs") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:VitalSigns.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:VitalSigns.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:VitalSigns.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:Objective.code	required	Pattern Value: LOINC Code 61149-1("Objective Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:Objective.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:Objective.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:Objective.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:SocialHistory.code	required	Pattern Value: LOINC Code 29762-2("Social history Narrative") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:SocialHistory.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:SocialHistory.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:SocialHistory.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard
Composition.section:Problems.code	required	Pattern Value: LOINC Code 57852-6("Problem list Narrative - Reported") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:Problems.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 From the FHIR Standard
Composition.section:Problems.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order From the FHIR Standard
Composition.section:Problems.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:ComplaintsAndIssues, Composition.section:VitalSigns, Composition.section:Objective, Composition.section:SocialHistory, Composition.section:Problems	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:ComplaintsAndIssues, Composition.section:VitalSigns, Composition.section:Objective, Composition.section:SocialHistory, Composition.section:Problems	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	error	Composition	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	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()