#### Meldung (Notification)

https://demis.rki.de/fhir/StructureDefinition/Notification

Die Meldung ist ein abstraktes Profil und referenziert die Betroffene Person, den Melder und die Untersuchungsergebnisse. Spezifische Arten von Meldungen werden in abgeleiteten Profilen definiert.

Bildung und Anwendung des Identifiers der Meldung (Meldungs-Id) [Auszug aus den Grundlagen des Meldungs-Lifecyclemanagements]:

- Eine Meldung (M) enthält meldepflichtige Informationen zu einem konkreten Fall (z.B. Erregernachweis CVDP für Person ABC durch Labor XYZ). Meldungen werden grundsätzlich eingebettet in Meldevorgängen (s.o.) transportiert. Eine logisch zusammengehörige Meldung (z.B. Initialmeldung + Ergänzungsmeldung, Initialmeldung + Korrekturmeldung) kann sich dabei über mehrere Meldevorgänge verteilen: Aus fachlicher Sicht wäre dann die Ergänzungsmeldung sozusagen eine neue Version der Initialmeldung.

- Meldungen werden innerhalb des DEMIS-Informationsmodells als profilierte FHIR-Composition-Ressourcen (vgl. z.B. Erregernachweismeldung) abgebildet. Meldungen können eindeutig über die sogenannte Meldungs-Id (NotificationId) identifiziert werden, welche durch den Melder nach einem definierten Schema (s.u.) generiert werden muss. Ergänzungsmeldungen, Korrekturmeldungen usw. müssen jeweils die Meldungs-Id (NotificationId) der Initialmeldung tragen, um eine Zusammenführung der Inhalte in den verarbeitenden Fachverfahren im Gesundheitsamt zu ermöglichen. Dabei muss jedoch berücksichtigt werden, dass Meldungen verschiedener Melder (Primärlabor, Sekundärlabor) niemals die gleiche Meldungs-Id (NotificationId) tragen dürfen, auch wenn sie sich auf den gleichen Fall beziehen. Ähnlich wie die Meldevorgangs-Id wird auch die Meldungs-Id als Bestandteil der PDF-Quittung an den Melder zurück geliefert.

  Repräsentation der Meldungs-Id (NotificationId) als Composition.identifier:

      <Composition xmlns="http://hl7.org/fhir">
      ...
      <identifier>
          <system value="https://demis.rki.de/fhir/NamingSystem/NotificationId"/>
          <value value="c13cd356-f147-5901-859d-31e6b2772465"/>
      </identifier>
      ...
      </Composition>

  Hinweis: Sämtliche durch ein Primärlabor gesendeten Ergänzungs- und/oder Korrekturmeldungen zu einem Fall tragen grundsätzlich dieselbe Meldungs-Id (NotifciationId) wie die Initialmeldung. Sie wird in allen Fällen über das Element Composition.identifier dargestellt. Gesonderte Regelungen gelten für den Fall, dass ein Sekundärlabor sich auf die Meldung des jeweiligen Primärlabors beziehen und diese ggf. ergänzen möchte (vgl. "Verweis auf Meldungen anderer Melder").

  Bildungsvorschrift für die Meldungs-Id

  - Als `system` MUSS https://demis.rki.de/fhir/NamingSystem/NotificationId verwendet werden.

  - Der `value` MUSS eine durch das System des Melders generierte UUID sein, die gemäß einer der beiden im Folgenden beschriebenen Varianten gebildet wird:

    - Variante 1 - Bildung einer Random-UUID (v4) gemäß RFC4122: Sendende Systeme KÖNNEN für die Darstellung der Meldungs-Id (NotificationId) für jeden Fall/Auftrag Random-UUIDs (v4) gemäß RFC4122 in eigener Verantwortung bilden. Um sicherzustellen, dass Ergänzungs- und Korrekturmeldungen zum entsprechenden Fall/Auftrag dieselbe Meldungs-Id (NotificationId) tragen, MÜSSEN die entsprechende Systeme intern sicherstellen, dass die generierte Id dauerhaft mit dem Fall/Auftrag assoziiert bleibt. Dies macht u.U. komplexere Anpassungen an den jeweiligen Systemen bzw. deren Datenmodell erforderlich.

    - Variante 2 - Bildung einer namensbasierten UUID (v5) gemäß RFC4122 (SHA1-basiert): Sendende Systeme KÖNNEN für die Darstellung der Meldungs-Id (NotificationId) für jeden Fall/Auftrag namensbasierte UUIDs (v5) gemäß RFC4122 (SHA1-basiert) in eigener Verantwortung bilden. In diesem Zusammenhang MUSS durch die Implementierung sichergestellt werden, dass die in die UUID-Generierung einfließenden Parameter so gewählt werden, dass sowohl für unterschiedliche Fälle/Aufträge als auch für unterschiedliche Melder niemals dieselben UUIDs generiert werden. Folgendes Verfahren KANN in diesem Zusammenhang zum Einsatz kommen:

      - Für jedes meldende System MUSS einmalig eine individuelle Namespace UUID als Random-UUID (v4) gemäß RFC4122 gebildet werden (z.B. "db5da554-9bb0-4393-9ee3-4866cad38c1e" → Bitte diese Namespace UUID NICHT nutzen. Sie ist lediglich ein Beispiel). Die einmalig generierte Namespace UUID fließt fortan dauerhaft in die Generierung der namensbasierten UUID (v5) gemäß RFC4122 (SHA1-basiert) ein und stellt damit sicher, dass andere meldende Systeme keine identischen UUIDs bilden werden.

      - Für jedes meldende System MÜSSEN neben der Namespace UUID weitere Eingabeparameter definiert werden, die sicherstellen, dass die generierte UUID in Bezug auf den Fall/Auftrag DAUERHAFT eindeutig bleibt. Dies kann beispielsweise eine sinnvolle Konkatenierung der DEMIS Labor ID, der Jahreszahl und einer melderspezifischen Proben-/Auftragsnummer sein (z.B. "LAB12345_2021-007023"). Bei der Auswahl der jeweiligen Parameter sind insbesondere Situationen geschickt zu adressieren, in denen sich verwendete Parameter wiederholen könnten (z.B. Auftragsnummern beginnen jedes Jahr bei '00000').

      - Bildung der namensbasierte UUIDs (v5) gemäß RFC4122 (SHA1-basiert) unter Nutzung der Namespace UUID und der übrigen Eingabeparameter:

        - UUIDv5.nameUUIDFromNsAndString("db5da554-9bb0-4393-9ee3-4866cad38c1e", "LAB12345_2021-007023") → c13cd356-f147-5901-859d-31e6b2772465

      Die zweite Variante hat den Vorteil, dass das meldende System die generierte UUID nicht dauerhaft mit dem Fall/Auftrag assoziieren muss, da aus den bereits verwalteten Angaben zu einem Fall/Auftrag dieselbe Meldungs-Id jederzeit neu berechnet werden kann.

  Wichtig: Die Gewährleistung der Eindeutigkeit der Meldungs-Id (NotificationId) für einen konkreten Fall/Auftrag ist ESSENTIELL wichtig für die empfangenden Gesundheitsämter, da insbesondere über diesen Mechanismus eine (teil)automatisierte Zusammenführung von Initial-, Ergänzungs- und Korrekturmeldungen leicht ermöglicht werden kann. Werden dieselben Meldungs-Ids (NotificationIds) jedoch für unterschiedliche Fälle/Aufträge verwendet, kann es u.U. zu größeren Verwerfungen in den Fachverfahren der Gesundheitsämtern kommen, da potentiell nicht zusammengehörige Meldungen einander zugeordnet werden. Bitte halten Sie sich daher zwingend an die formulierten Anforderungen!

  Verweis auf Meldungen anderer Melder

  Es existieren Szenarien (s.u.), in denen verschiedene Melder (z.B. Primärlabor + Sekundärlabor), Meldungen an DEMIS versenden, die sich für alle Akteure erkennbar auf den selben Fall beziehen. Um eine automatisierte Zuordenbarkeit dieser Meldungen bei den empfangenden Gesundheitsämtern sicherstellen zu können, ist es möglich, innerhalb einer Meldung M2 auf eine Meldung M1 eines anderen Melders zu verweisen. Verweise auf Meldungen anderer Melder, die sich auf den selben Fall beziehen MÜSSEN dabei im `Composition.relatesTo` Element der jeweiligen Ressource entsprechend des im Folgenden dargestellten Schemas eingebettet werden. Der verwendete Identifier ist dabei die Meldungs-Id (NotificationId) der Meldung auf welche verwiesen wird.

  Verweise auf Meldungen anderer Melder, die sich auf den selben Fall beziehen:

      <Composition xmlns="http://hl7.org/fhir">
      ...
      <relatesTo>
          <code value="appends"/>
          <targetReference>
          <type value="Composition"/>
          <identifier>
              <system value="https://demis.rki.de/fhir/NamingSystem/NotificationId"/>
              <value value="c13cd356-f147-5901-859d-31e6b2772465"/>
          </identifier>
          </targetReference>
      </relatesTo>
      ...
      </Composition>

  Voraussetzung für die Einbettung des entsprechenden Verweises in die Meldung ist, dass das Primärlabor dem Sekundärlabor die entsprechende Meldungs-Id im Rahmen der Auftragserteilung übermittelt hat. Wie und auf welchem Weg dies erfolgt, liegt außerhalb der Regelungshoheit von DEMIS. Denkbar ist hier beispielsweise die Übermittlung der Meldungs-Id vom Primär- zum Sekundärlabor als Bestandteil des Probenbegleitscheins. Sofern der Datenaustausch zwischen Primär- und Sekundärlabor noch nicht vollständig digitalisiert ist, sollten jedoch Mechanismen vorgesehen werden, die Sicherstellen, dass der entsprechende Identifier nicht "abgetippt" werden muss. Hier bietet sich - sofern papierbasierte Begleitscheine zum Einsatz kommen - u.U. eine Darstellung als QR-Code o.ä. an.

  Wichtig: Unabhängig von der Verwendung des Composition.relatesTo Elements MUSS das meldende Sekundärlabor dennoch eine eigene Meldungs-Id zum jeweiligen Fall/Auftrag erzeugen und in Composition.identifier einbetten.

  Die in diesem Abschnitt getroffenen Aussagen beziehen sich ausschließlich auf die Referenzierung von Meldungen ANDERER Melder. Eine Nutzung von Composition.relatesTo ist für eigene Ergänzungsmeldungen NICHT zielführend, da hier bereits die Zusammenführung der Inhalte über Composition.identifier (s.o.) erfolgt.

Notification (Composition) | C |  | Composition | There are no (further) constraints on this element Element id
    Composition
Short description A set of resources composed into a single coherent clinical statement with clinical attestation Definition A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.). Comments While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical. Data type Composition Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6: A resource should have narrative for robust management `text.`div`.exists()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()] cda: ClinicalDocument fhirdocumentreference: when described by DocumentReference
id | Σ | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.id
Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. 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. Data type string
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element id
    Composition.meta
Short description Metadata about the resource 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. Data type Meta Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element id
    Composition.implicitRules
Short description A set of rules under which this content was created 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. 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. Data type uri Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language |  | 0..1 | code Binding | There are no (further) constraints on this element Element id
    Composition.language
Short description Language of the resource content Definition The base language in which the resource is written. 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). Data type code Binding A human language. CommonLanguages (preferred) Binding extensions
maxValueSet | AllLanguages
Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text |  | 0..1 | Narrative | There are no (further) constraints on this element Element id
    Composition.text
Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display 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. 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. Data type Narrative Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained |  | 0..* | Resource | There are no (further) constraints on this element Element id
    Composition.contained
Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources 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. 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.modifierExtension
Short description Extensions that cannot be ignored Alternate names extensions, user content 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). 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element id
    Composition.identifier
Short description Version-independent identifier for the Composition Definition A version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time. Comments Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate. Data type Identifier Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: Document.id / Document.setId cda: .setId fhirdocumentreference: DocumentReference.masterIdentifier
status | S Σ ?! | 1..1 | code Binding | Element id
    Composition.status
Short description Status der Meldungsinhalte Definition Der Status gibt, ob die Meldungsinhalte verbindlich oder vorläufig sind. Oder ob es sich um eine Korrektur-bzw. Ergänzungsmeldung handelt. Requirements Need to be able to mark interim, amended, or withdrawn compositions or documents. Comments Der Status ist szenarienspezifisch folgendermaßen zu belegen: final - wenn keine weiteren Untersuchungen notwendig sind und der Meldetatbestand erfüllt ist preliminary - wenn ein Bestätigungstest notwendig ist amended - wenn die Meldung korrigiert oder um einen weiteren Erregernachweis ergänzt wird Data type code Binding The workflow/clinical status of the composition. CompositionStatus (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete" cda: n/a fhirdocumentreference: DocumentReference.status
type | S Σ | 1..1 | CodeableConcept Binding | Element id
    Composition.type
Short description Typ der Composition Definition Typ der Composition Requirements Key metadata element describing the composition, used in searching/filtering. Comments For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding. Data type CodeableConcept Binding Type of a composition. FHIRDocumentTypeCodes (preferred) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.code w5: FiveWs.class rim: ./code cda: .code fhirdocumentreference: DocumentReference.type
category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element id
    Composition.category
Short description Categorization of Composition Definition A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type. Requirements Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents. Comments This is a metadata field from XDS/MHD. Data type CodeableConcept Binding High-level kind of a clinical document at a macro level. DocumentClassValueSet (example) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.subject w5: FiveWs.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code cda: n/a fhirdocumentreference: DocumenttReference.category
subject | Σ C | 0..1 | Reference(Resource) | There are no (further) constraints on this element Element id
    Composition.subject
Short description Who and/or what the composition is about Definition Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure). Requirements Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about. Comments For clinical documents, this is usually the patient. Data type Reference(Resource) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.subject[x] rim: .participation[typeCode="SBJ"].role[typeCode="PAT"] cda: .recordTarget fhirdocumentreference: DocumentReference.subject w5: FiveWs.subject
encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element id
    Composition.encounter
Short description Context of the Composition Definition Describes the clinical encounter or type of care this documentation is associated with. Requirements Provides context for the composition and supports searching. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Encounter) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.context w5: FiveWs.context rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct]) cda: .componentOf.encompassingEncounter fhirdocumentreference: DocumentReference.context.encounter
date | S Σ | 1..1 | dateTime | Element id
    Composition.date
Short description Zeitpunkt der Erstellung/Bearbeitung der aktuellen Version der Meldung Definition Zeitpunkt der Erstellung/Bearbeitung der aktuellen Version der Meldung Requirements dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging. Comments The Last Modified Date on the composition may be after the date of the document was attested without being changed. Data type dateTime Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.occurrence[x] w5: FiveWs.done[x] rim: .effectiveTime[type="TS"] cda: .effectiveTime fhirdocumentreference: DocumentReference.content.attachment.date, DocumentReference.created
author | S Σ C | 1..1 | Reference(NotifierRole) | Element id
    Composition.author
Short description Verweis auf die Melder-Rolle. Definition Verweis auf die Melder-Rolle. Über die Melder-Rolle kann eine Person oder eine Organisation als Melder referenziert werden. Requirements Identifies who is responsible for the content. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(NotifierRole) Allowed aggregation:bundled Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.performer w5: FiveWs.author rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"] cda: .author.assignedAuthor fhirdocumentreference: DocumentReference.agent
id |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.author.id
Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.author.extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
reference | S Σ C | 1..1 | string | There are no (further) constraints on this element Element id
    Composition.author.reference
Short description Literal reference, Relative, internal or absolute URL 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. 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. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1, ref-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type | Σ | 0..1 | uri Binding | There are no (further) constraints on this element Element id
    Composition.author.type
Short description Type the reference refers to (e.g. "Patient") 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). 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. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element id
    Composition.author.identifier
Short description Logical reference, when literal reference is not known 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. 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). Data type Identifier Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display | Σ | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.author.display
Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. 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. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
title | S Σ | 1..1 | string | Element id
    Composition.title
Short description Titel der Meldung Definition Titel der Meldung Comments For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: ./title cda: .title fhirdocumentreference: DocumentReference.description, DocumentReference.content.attachment.title
confidentiality | Σ | 0..0 | code Binding | There are no (further) constraints on this element Element id
    Composition.confidentiality
Short description As defined by affinity domain Definition The code specifying the level of confidentiality of the Composition. Comments The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not. Data type code Binding Codes specifying the level of confidentiality of the composition. v3.ConfidentialityClassification (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .confidentialityCode cda: .confidentialityCode fhirdocumentreference: DocumentReference.securityLabel
attester |  | 0..0 | BackboneElement | There are no (further) constraints on this element Element id
    Composition.attester
Short description Attests to accuracy of composition Definition A participant who has attested to the accuracy of the composition/document. Requirements Identifies responsibility for the accuracy of the composition content. Comments Only list each attester once. Data type BackboneElement Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"] cda: .authenticator/.legalAuthenticator fhirdocumentreference: DocumentReference.authenticator
custodian | Σ C | 0..0 | Reference(Organization) | There are no (further) constraints on this element Element id
    Composition.custodian
Short description Organization which maintains the composition Definition Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information. Requirements Identifies where to go to find the current version, where to report issues, etc. Comments This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged. Data type Reference(Organization) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"] cda: .custodian.assignedCustodian fhirdocumentreference: DocumentReference.custodian
relatesTo | S | 0..1 | BackboneElement | Element id
    Composition.relatesTo
Short description Verweis auf eine Meldung Definition Es kann eine Meldung referenziert werden, z.B. eine vorangegangene Meldung eines Primärlabors. Dazu wird die NotificationId der Meldung, auf die verwiesen werden soll, im relatesTo-Identifier angegeben. Comments A document is a version specific composition. Data type BackboneElement Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship cda: .relatedDocument fhirdocumentreference: DocumentReference.relatesTo
id |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.id
Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.relatesTo.extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.relatesTo.modifierExtension
Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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). 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. 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. Data type Extension Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
code | S | 1..1 | code Binding Fixed Value | Element id
    Composition.relatesTo.code
Short description replaces | transforms | signs | appends Definition The type of relationship that this composition has with anther composition or document. Comments If this document appends another document, then the document cannot be fully understood without also accessing the referenced document. Data type code Binding The type of relationship between documents. DocumentRelationshipType (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value
    appends
Mappings rim: n/a rim: .outboundRelationship.typeCode cda: .relatedDocument.typeCode fhirdocumentreference: DocumentReference.relatesTo.code
target[x] | S | 1..1 | Reference(Composition) | Element id
    Composition.relatesTo.target[x]
Short description Target of the relationship Definition The target composition/document of this relationship. Data type Reference(Composition) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .target[classCode="DOC", moodCode="EVN"].id cda: .relatedDocument.id fhirdocumentreference: DocumentReference.relatesTo.target
id |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].id
Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
reference | Σ C | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].reference
Short description Literal reference, Relative, internal or absolute URL 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. 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. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1, ref-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type | S Σ | 1..1 | uri Binding Fixed Value | Element id
    Composition.relatesTo.target[x].type
Short description Type the reference refers to (e.g. "Patient") 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). 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. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value
    Composition
Mappings rim: n/a rim: N/A
identifier | S Σ | 1..1 | Identifier | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier
Short description Logical reference, when literal reference is not known 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. 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). Data type Identifier Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
id |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.id
Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
use | Σ ?! | 0..1 | code Binding | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.use
Short description usual | official | temp | secondary | old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Role.code or implied by context
type | Σ | 0..1 | CodeableConcept Binding | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.type
Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. 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. Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: CX.5 rim: Role.code or implied by context
system | S Σ | 1..1 | uri Fixed Value | Element id
    Composition.relatesTo.target[x].identifier.system
Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. 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. Comments Identifier.system is always case sensitive. Data type uri Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value
    https://demis.rki.de/fhir/NamingSystem/NotificationId
Examples General
    http://www.acme.com/identifiers/patient
Mappings rim: n/a v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
value | S Σ | 1..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.value
Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. 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. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General
    123456
Mappings rim: n/a v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
period | Σ C | 0..1 | Period | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.period
Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
assigner | Σ C | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].identifier.assigner
Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. 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. Data type Reference(Organization) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
display | Σ | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.relatesTo.target[x].display
Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. 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. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
event | Σ | 0..0 | BackboneElement | There are no (further) constraints on this element Element id
    Composition.event
Short description The clinical service(s) being documented Definition The clinical service, such as a colonoscopy or an appendectomy, being documented. Requirements Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event. Comments The event needs to be consistent with the type element, though can provide further information if desired. Data type BackboneElement Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT'] cda: .documentationOf.serviceEvent fhirdocumentreference: DocumentReference.event
section | C | 0..* | BackboneElement | There are no (further) constraints on this element Element id
    Composition.section
Short description Composition is broken into sections Definition The root of the sections that make up the composition. Data type BackboneElement Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` cmp-1: A section must contain at least one of text, entries, or sub-sections `text.exists() or entry.exists() or section.exists()` cmp-2: A section can only have an emptyReason if it is empty `emptyReason.empty() or entry.empty()` Mappings rim: n/a rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct] cda: .component.structuredBody.component.section
id |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.section.id
Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension | C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.section.extension
Short description Additional content defined by implementations Alternate names extensions, user content 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. 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. Data type Extension Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element id
    Composition.section.modifierExtension
Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers 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). 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. 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. Data type Extension Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints 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()` Mappings rim: n/a rim: N/A
title |  | 0..1 | string | There are no (further) constraints on this element Element id
    Composition.section.title
Short description Label for section (e.g. for ToC) Alternate names header, label, caption Definition The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents. Requirements Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized. Comments The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element. Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: ./title cda: .title
code |  | 0..1 | CodeableConcept | There are no (further) constraints on this element Element id
    Composition.section.code
Short description Classification of section (recommended) Definition A code identifying the kind of content contained within the section. This must be consistent with the section title. Requirements Provides computable standardized labels to topics within the document. Comments The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code. Data type CodeableConcept Binding Classification of a section of a composition/document. DocumentSectionCodes (example) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./code cda: .code
author | C | 0..* | Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element id
    Composition.section.author
Short description Who and/or what authored the section Definition Identifies who is responsible for the information in this section, not necessarily who typed it in. Requirements Identifies who is responsible for the content. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"] cda: .author.assignedAuthor
focus | C | 0..1 | Reference(Resource) | There are no (further) constraints on this element Element id
    Composition.section.focus
Short description Who/what the section is about, when it is not about the subject of composition Definition The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources). Comments Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples. Data type Reference(Resource) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) cda: .subject? (CDA did not differentiate between subject and focus)
text | C | 0..1 | Narrative | There are no (further) constraints on this element Element id
    Composition.section.text
Short description Text summary of the section, for human interpretation Definition A human-readable narrative that contains the attested content of the section, 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. Comments Document profiles may define what content should be represented in the narrative to ensure clinical safety. Data type Narrative Conditions The cardinality or value of this element may be affected by these constraints: ele-1, cmp-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: .text cda: .text
mode |  | 0..1 | code Binding | There are no (further) constraints on this element Element id
    Composition.section.mode
Short description working | snapshot | changes Definition How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted. Requirements Sections are used in various ways, and it must be known in what way it is safe to use the entries in them. Comments This element is labeled as a modifier because a change list must not be misunderstood as a complete list. Data type code Binding The processing mode that applies to this section. ListMode (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.class rim: .outBoundRelationship[typeCode=COMP].target[classCode=OBS"].value cda: n/a
orderedBy |  | 0..1 | CodeableConcept Binding | There are no (further) constraints on this element Element id
    Composition.section.orderedBy
Short description Order of section entries Definition Specifies the order applied to the items in the section entries. Requirements Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries. Comments Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order. Data type CodeableConcept Binding What order applies to the items in the entry. ListOrderCodes (preferred) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .outboundRelationship[typeCode=COMP].sequenceNumber > 1 cda: n/a
entry | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element id
    Composition.section.entry
Short description A reference to data that supports this section Definition A reference to the actual resource from which the narrative in the section is derived. Comments If there are no entries in the list, an emptyReason SHOULD be provided. Data type Reference(Resource) Conditions The cardinality or value of this element may be affected by these constraints: ele-1, cmp-2 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ] cda: .entry
emptyReason | C | 0..1 | CodeableConcept Binding | There are no (further) constraints on this element Element id
    Composition.section.emptyReason
Short description Why the section is empty Definition If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason. Requirements Allows capturing things like "none exist" or "not asked" which can be important for most lists. Comments The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases. Data type CodeableConcept Binding If a section is empty, why it is empty. ListEmptyReasons (preferred) Conditions The cardinality or value of this element may be affected by these constraints: ele-1, cmp-2 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: .inboundRelationship[typeCode=SUBJ,code<ListEmptyReason].value[type=CD] cda: n/a
section | C | 0..* | see (section) | There are no (further) constraints on this element Element id
    Composition.section.section
Short description Nested Section Definition A nested sub-section within this section. Comments Nested sections are primarily used to help human readers navigate to particular portions of the document. Conditions The cardinality or value of this element may be affected by these constraints: cmp-1 Mappings rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct] cda: .component.section

Beispiele finden sich in den Projekten, die jeweils einen spezifischen Meldungstyp gemäß Infektionsschutzgesetz abbilden, siehe hierzu DEMIS-Erregernachweismeldung oder DEMIS-Erkrankungsmeldung.