Advance Care Planning (PZP)
1.0.0 - release

This page is part of the Advance Care Planning (PZP) (v1.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: ACP Request to Inform Relatives - Detailed Descriptions

Draft as of 2026-08-11

Definitions for the ACP-InformRelativesRequest resource profile

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

0. CommunicationRequest
Definition

A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

ShortA request for information to be sent to a receiver
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
cr-date-required: The date of the CommunicationRequest is expected to be captured either in the resource itself or in the Encounter in which the CommunicationRequest originated. (authoredOn.exists() or encounter.exists())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. CommunicationRequest.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. CommunicationRequest.modifierExtension
Definition

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

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

ShortExtensions that cannot be ignored
Comments

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

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

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

Alternate Namesextensions, user content
Invariantsele-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())
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())
6. CommunicationRequest.status
Definition

The status of the proposal or order.

Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
Control1..1
BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

The status of the communication request.

Typecode
Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. CommunicationRequest.category
Definition

The type of message to be sent such as alert, notification, reminder, instruction, etc.

ShortMessage category
Comments

The category.text element may be used to provide additional context for human readers next to the pattern category coding, for example: 'Request for patient to inform relatives about treatment agreements'.


There may be multiple axes of categorization and one communication request may serve multiple purposes.

Control10..*
BindingFor example codes, see CommunicationCategoryhttp://hl7.org/fhir/ValueSet/communication-category|4.0.1
(example to http://hl7.org/fhir/ValueSet/communication-category|4.0.1)

Codes for general categories of communications such as alerts, instruction, etc.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Obligations
    ObligationsActor
    SHALL:populate-if-knownACP Actor Provider
    SHALL:no-errorACP Actor Consulter
    Summaryfalse
    Pattern Value{
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "223449006"
      }]
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. CommunicationRequest.doNotPerform
    Definition

    If true indicates that the CommunicationRequest is asking for the specified action to not occur.

    ShortTrue if request is prohibiting action
    Comments

    The attributes provided with the request qualify what is not to be done.

    Control0..1
    Typeboolean
    Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Alternate Namesprohibited
    Meaning if MissingIf do not perform is not specified, the request is a positive request e.g. "do perform"
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. CommunicationRequest.subject
    Definition

    The patient or group that is the focus of this communication request.

    ShortFocus of message
    Control10..1
    TypeReference(ACP Patient, Patient, Group)
    Is Modifierfalse
    Must Supporttrue
    Obligations
      ObligationsActor
      SHALL:populate-if-knownACP Actor Provider
      SHALL:no-errorACP Actor Consulter
      Summaryfalse
      Alternate Namespatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. CommunicationRequest.encounter
      Definition

      The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.

      ShortEncounter created as part of
      Comments

      This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

      Control0..1
      TypeReference(ACP Encounter, Encounter)
      Is Modifierfalse
      Must Supporttrue
      Obligations
        ObligationsActor
        SHALL:populate-if-knownACP Actor Provider
        SHALL:no-errorACP Actor Consulter
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. CommunicationRequest.authoredOn
        Definition

        For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.

        ShortWhen request transitioned to being actionable
        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Obligations
          ObligationsActor
          SHALL:populate-if-knownACP Actor Provider
          SHALL:no-errorACP Actor Consulter
          Summarytrue
          Alternate NamescreatedOn
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. CommunicationRequest.requester
          Definition

          The device, individual, or organization who initiated the request and has responsibility for its activation.

          ShortWho/what is requesting service
          Control10..1
          TypeReference(ACP HealthProfessional PractitionerRole, ACP HealthProfessional Practitioner, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
          Is Modifierfalse
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Obligations
            ObligationsActor
            SHALL:populate-if-knownACP Actor Provider
            SHALL:no-errorACP Actor Consulter
            Summarytrue
            Alternate Namesauthor
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. CommunicationRequest.sender
            Definition

            The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

            ShortMessage sender
            Control10..1
            TypeReference(ACP Patient, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, HealthcareService)
            Is Modifierfalse
            Must Supporttrue
            Obligations
              ObligationsActor
              SHALL:populate-if-knownACP Actor Provider
              SHALL:no-errorACP Actor Consulter
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. CommunicationRequest.reasonCode
              Definition

              Describes why the request is being made in coded or textual form.

              ShortWhy is communication needed?
              Comments

              Textual reasons can be captured using reasonCode.text.

              Control10..*
              BindingFor example codes, see ActReason (3.0.0)http://terminology.hl7.org/ValueSet/v3-ActReason
              (example to http://terminology.hl7.org/ValueSet/v3-ActReason|3.0.0)

              Codes for describing reasons for the occurrence of a communication.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Obligations
                ObligationsActor
                SHALL:populate-if-knownACP Actor Provider
                SHALL:no-errorACP Actor Consulter
                Summarytrue
                Pattern Value{
                  "coding" : [{
                    "system" : "http://snomed.info/sct",
                    "code" : "713603004"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

                0. CommunicationRequest
                Invariantscr-date-required: The date of the CommunicationRequest is expected to be captured either in the resource itself or in the Encounter in which the CommunicationRequest originated. (authoredOn.exists() or encounter.exists())
                2. CommunicationRequest.category
                Comments

                The category.text element may be used to provide additional context for human readers next to the pattern category coding, for example: 'Request for patient to inform relatives about treatment agreements'.

                Control1..?
                Must Supporttrue
                Obligations
                  ObligationsActor
                  SHALL:populate-if-knownACP Actor Provider
                  SHALL:no-errorACP Actor Consulter
                  Pattern Value{
                    "coding" : [{
                      "system" : "http://snomed.info/sct",
                      "code" : "223449006"
                    }]
                  }
                  4. CommunicationRequest.subject
                  Control1..?
                  TypeReference(ACP Patient)
                  Must Supporttrue
                  Obligations
                    ObligationsActor
                    SHALL:populate-if-knownACP Actor Provider
                    SHALL:no-errorACP Actor Consulter
                    6. CommunicationRequest.encounter
                    TypeReference(ACP Encounter)
                    Must Supporttrue
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownACP Actor Provider
                      SHALL:no-errorACP Actor Consulter
                      8. CommunicationRequest.authoredOn
                      Must Supporttrue
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownACP Actor Provider
                        SHALL:no-errorACP Actor Consulter
                        10. CommunicationRequest.requester
                        Control1..?
                        TypeReference(ACP HealthProfessional PractitionerRole, ACP HealthProfessional Practitioner)
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownACP Actor Provider
                          SHALL:no-errorACP Actor Consulter
                          12. CommunicationRequest.sender
                          Control1..?
                          TypeReference(ACP Patient)
                          Must Supporttrue
                          Obligations
                            ObligationsActor
                            SHALL:populate-if-knownACP Actor Provider
                            SHALL:no-errorACP Actor Consulter
                            14. CommunicationRequest.reasonCode
                            Control1..?
                            Must Supporttrue
                            Obligations
                              ObligationsActor
                              SHALL:populate-if-knownACP Actor Provider
                              SHALL:no-errorACP Actor Consulter
                              Pattern Value{
                                "coding" : [{
                                  "system" : "http://snomed.info/sct",
                                  "code" : "713603004"
                                }]
                              }

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

                              0. CommunicationRequest
                              Definition

                              A request to convey information; e.g. the CDS system proposes that an alert be sent to a responsible provider, the CDS system proposes that the public health agency be notified about a reportable condition.

                              ShortA request for information to be sent to a receiver
                              Control0..*
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                              dom-6: A resource should have narrative for robust management (text.`div`.exists())
                              cr-date-required: The date of the CommunicationRequest is expected to be captured either in the resource itself or in the Encounter in which the CommunicationRequest originated. (authoredOn.exists() or encounter.exists())
                              2. CommunicationRequest.id
                              Definition

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

                              ShortLogical id of this artifact
                              Comments

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

                              Control0..1
                              Typeid
                              Is Modifierfalse
                              Summarytrue
                              4. CommunicationRequest.meta
                              Definition

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

                              ShortMetadata about the resource
                              Control0..1
                              TypeMeta
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              6. CommunicationRequest.implicitRules
                              Definition

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

                              ShortA set of rules under which this content was created
                              Comments

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

                              Control0..1
                              Typeuri
                              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              8. CommunicationRequest.language
                              Definition

                              The base language in which the resource is written.

                              ShortLanguage of the resource content
                              Comments

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

                              Control0..1
                              BindingThe codes SHOULD be taken from CommonLanguages
                              (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

                              A human language.

                              Additional BindingsPurpose
                              AllLanguagesMax Binding
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              10. CommunicationRequest.text
                              Definition

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

                              ShortText summary of the resource, for human interpretation
                              Comments

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

                              Control0..1
                              TypeNarrative
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesnarrative, html, xhtml, display
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              12. CommunicationRequest.contained
                              Definition

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

                              ShortContained, inline Resources
                              Comments

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

                              Control0..*
                              TypeResource
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesinline resources, anonymous resources, contained resources
                              14. CommunicationRequest.extension
                              Definition

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

                              ShortAdditional content defined by implementations
                              Comments

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

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-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())
                              16. CommunicationRequest.modifierExtension
                              Definition

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

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

                              ShortExtensions that cannot be ignored
                              Comments

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

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                              Summaryfalse
                              Requirements

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

                              Alternate Namesextensions, user content
                              Invariantsele-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())
                              18. CommunicationRequest.identifier
                              Definition

                              Business identifiers assigned to this communication request by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

                              ShortUnique identifier
                              Comments

                              This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..*
                              TypeIdentifier
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows identification of the communication request as it is known by various participating systems and in a way that remains consistent across servers.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              20. CommunicationRequest.basedOn
                              Definition

                              A plan or proposal that is fulfilled in whole or in part by this request.

                              ShortFulfills plan or proposal
                              Control0..*
                              TypeReference(Resource)
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows tracing of authorization for the request and tracking whether proposals/recommendations were acted upon.

                              Alternate Namesfulfills
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              22. CommunicationRequest.replaces
                              Definition

                              Completed or terminated request(s) whose function is taken by this new request.

                              ShortRequest(s) replaced by this request
                              Comments

                              The replacement could be because the initial request was immediately rejected (due to an issue) or because the previous request was completed, but the need for the action described by the request remains ongoing.

                              Control0..*
                              TypeReference(CommunicationRequest)
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows tracing the continuation of a therapy or administrative process instantiated through multiple requests.

                              Alternate Namessupersedes, prior
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              24. CommunicationRequest.groupIdentifier
                              Definition

                              A shared identifier common to all requests that were authorized more or less simultaneously by a single author, representing the identifier of the requisition, prescription or similar form.

                              ShortComposite request this is part of
                              Comments

                              Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

                              Control0..1
                              TypeIdentifier
                              Is Modifierfalse
                              Summarytrue
                              Alternate NamesgrouperId
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              26. CommunicationRequest.status
                              Definition

                              The status of the proposal or order.

                              Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
                              Control1..1
                              BindingThe codes SHALL be taken from RequestStatus
                              (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

                              The status of the communication request.

                              Typecode
                              Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid.
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              28. CommunicationRequest.statusReason
                              Definition

                              Captures the reason for the current state of the CommunicationRequest.

                              ShortReason for current status
                              Comments

                              This is generally only used for "exception" statuses such as "suspended" or "cancelled". The reason why the CommunicationRequest was created at all is captured in reasonCode, not here. [distinct reason codes for different statuses can be enforced using invariants if they are universal bindings].

                              Control0..1
                              Binding

                              Codes identifying the reason for the current state of a request.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Alternate NamesSuspended Reason, Cancelled Reason
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              30. CommunicationRequest.category
                              Definition

                              The type of message to be sent such as alert, notification, reminder, instruction, etc.

                              ShortMessage category
                              Comments

                              The category.text element may be used to provide additional context for human readers next to the pattern category coding, for example: 'Request for patient to inform relatives about treatment agreements'.

                              Control1..*
                              BindingFor example codes, see CommunicationCategory
                              (example to http://hl7.org/fhir/ValueSet/communication-category|4.0.1)

                              Codes for general categories of communications such as alerts, instruction, etc.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Obligations
                                ObligationsActor
                                SHALL:populate-if-knownACP Actor Provider
                                SHALL:no-errorACP Actor Consulter
                                Summaryfalse
                                Pattern Value{
                                  "coding" : [{
                                    "system" : "http://snomed.info/sct",
                                    "code" : "223449006"
                                  }]
                                }
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                32. CommunicationRequest.priority
                                Definition

                                Characterizes how quickly the proposed act must be initiated. Includes concepts such as stat, urgent, routine.

                                Shortroutine | urgent | asap | stat
                                Control0..1
                                BindingThe codes SHALL be taken from RequestPriority
                                (required to http://hl7.org/fhir/ValueSet/request-priority|4.0.1)

                                Codes indicating the relative importance of a communication request.

                                Typecode
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Meaning if MissingIf missing, this task should be performed with normal priority
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                34. CommunicationRequest.doNotPerform
                                Definition

                                If true indicates that the CommunicationRequest is asking for the specified action to not occur.

                                ShortTrue if request is prohibiting action
                                Comments

                                The attributes provided with the request qualify what is not to be done.

                                Control0..1
                                Typeboolean
                                Is Modifiertrue because If true this element negates the specified action. For Example, instead of a request for a communication, it is a request for the communication to not occur.
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Alternate Namesprohibited
                                Meaning if MissingIf do not perform is not specified, the request is a positive request e.g. "do perform"
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                36. CommunicationRequest.medium
                                Definition

                                A channel that was used for this communication (e.g. email, fax).

                                ShortA channel of communication
                                Control0..*
                                BindingFor example codes, see ParticipationMode (3.0.0)
                                (example to http://terminology.hl7.org/ValueSet/v3-ParticipationMode|3.0.0)

                                Codes for communication mediums such as phone, fax, email, in person, etc.

                                TypeCodeableConcept
                                Is Modifierfalse
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                38. CommunicationRequest.subject
                                Definition

                                The patient or group that is the focus of this communication request.

                                ShortFocus of message
                                Control1..1
                                TypeReference(ACP Patient)
                                Is Modifierfalse
                                Must Supporttrue
                                Obligations
                                  ObligationsActor
                                  SHALL:populate-if-knownACP Actor Provider
                                  SHALL:no-errorACP Actor Consulter
                                  Summaryfalse
                                  Alternate Namespatient
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  40. CommunicationRequest.about
                                  Definition

                                  Other resources that pertain to this communication request and to which this communication request should be associated.

                                  ShortResources that pertain to this communication request
                                  Comments

                                  Don't use CommunicationRequest.about element when a more specific element exists, such as basedOn, reasonReference, or replaces.

                                  Control0..*
                                  TypeReference(Resource)
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  42. CommunicationRequest.encounter
                                  Definition

                                  The Encounter during which this CommunicationRequest was created or to which the creation of this record is tightly associated.

                                  ShortEncounter created as part of
                                  Comments

                                  This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                                  Control0..1
                                  TypeReference(ACP Encounter)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Obligations
                                    ObligationsActor
                                    SHALL:populate-if-knownACP Actor Provider
                                    SHALL:no-errorACP Actor Consulter
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    44. CommunicationRequest.payload
                                    Definition

                                    Text, attachment(s), or resource(s) to be communicated to the recipient.

                                    ShortMessage payload
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    46. CommunicationRequest.payload.id
                                    Definition

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

                                    ShortUnique id for inter-element referencing
                                    Control0..1
                                    Typestring
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    48. CommunicationRequest.payload.extension
                                    Definition

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

                                    ShortAdditional content defined by implementations
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifierfalse
                                    Summaryfalse
                                    Alternate Namesextensions, user content
                                    Invariantsele-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())
                                    50. CommunicationRequest.payload.modifierExtension
                                    Definition

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

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

                                    ShortExtensions that cannot be ignored even if unrecognized
                                    Comments

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

                                    Control0..*
                                    TypeExtension
                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                    Summarytrue
                                    Requirements

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

                                    Alternate Namesextensions, user content, modifiers
                                    Invariantsele-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())
                                    52. CommunicationRequest.payload.content[x]
                                    Definition

                                    The communicated content (or for multi-part communications, one portion of the communication).

                                    ShortMessage part content
                                    Control1..1
                                    TypeChoice of: string, Attachment, Reference(Resource)
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    54. CommunicationRequest.occurrence[x]
                                    Definition

                                    The time when this communication is to occur.

                                    ShortWhen scheduled
                                    Control0..1
                                    TypeChoice of: dateTime, Period
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Alternate Namestiming
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    56. CommunicationRequest.authoredOn
                                    Definition

                                    For draft requests, indicates the date of initial creation. For requests with other statuses, indicates the date of activation.

                                    ShortWhen request transitioned to being actionable
                                    Control0..1
                                    TypedateTime
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Obligations
                                      ObligationsActor
                                      SHALL:populate-if-knownACP Actor Provider
                                      SHALL:no-errorACP Actor Consulter
                                      Summarytrue
                                      Alternate NamescreatedOn
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      58. CommunicationRequest.requester
                                      Definition

                                      The device, individual, or organization who initiated the request and has responsibility for its activation.

                                      ShortWho/what is requesting service
                                      Control1..1
                                      TypeReference(ACP HealthProfessional PractitionerRole, ACP HealthProfessional Practitioner)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Must Support TypesNo must-support rules about the choice of types/profiles
                                      Obligations
                                        ObligationsActor
                                        SHALL:populate-if-knownACP Actor Provider
                                        SHALL:no-errorACP Actor Consulter
                                        Summarytrue
                                        Alternate Namesauthor
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        60. CommunicationRequest.recipient
                                        Definition

                                        The entity (e.g. person, organization, clinical information system, device, group, or care team) which is the intended target of the communication.

                                        ShortMessage recipient
                                        Control0..*
                                        TypeReference(Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, Group, CareTeam, HealthcareService)
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        62. CommunicationRequest.sender
                                        Definition

                                        The entity (e.g. person, organization, clinical information system, or device) which is to be the source of the communication.

                                        ShortMessage sender
                                        Control1..1
                                        TypeReference(ACP Patient)
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Obligations
                                          ObligationsActor
                                          SHALL:populate-if-knownACP Actor Provider
                                          SHALL:no-errorACP Actor Consulter
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          64. CommunicationRequest.reasonCode
                                          Definition

                                          Describes why the request is being made in coded or textual form.

                                          ShortWhy is communication needed?
                                          Comments

                                          Textual reasons can be captured using reasonCode.text.

                                          Control1..*
                                          BindingFor example codes, see ActReason (3.0.0)
                                          (example to http://terminology.hl7.org/ValueSet/v3-ActReason|3.0.0)

                                          Codes for describing reasons for the occurrence of a communication.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Obligations
                                            ObligationsActor
                                            SHALL:populate-if-knownACP Actor Provider
                                            SHALL:no-errorACP Actor Consulter
                                            Summarytrue
                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://snomed.info/sct",
                                                "code" : "713603004"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            66. CommunicationRequest.reasonReference
                                            Definition

                                            Indicates another resource whose existence justifies this request.

                                            ShortWhy is communication needed?
                                            Control0..*
                                            TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            68. CommunicationRequest.note
                                            Definition

                                            Comments made about the request by the requester, sender, recipient, subject or other participants.

                                            ShortComments made about communication request
                                            Control0..*
                                            TypeAnnotation
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))