Advance Care Planning (PZP) STU3
1.0.0 - release

Advance Care Planning (PZP) STU3 - Downloaded Version 1.0.0 See the Directory of published versions

## Resource Profile: ACP Medical Policy Goal - Detailed Descriptions

Draft as of 2026-08-11

Definitions for the ACP-MedicalPolicyGoal resource profile

- Key Elements Table
- Differential Table
- Snapshot Table

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

0. Goal
Definition | Describes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc.
Short | Describes the intended objective(s) for a patient, group or organization
Comments | Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
Control | 0..*
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (`contained.text.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 (`contained.where(('#'+id in %resource.descendants().reference).not()).empty()`) dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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 (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
2. Goal.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.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. Goal.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. Usually modifier elements provide negation or qualification. In order 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.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
6. Goal.status
Definition | Indicates whether the goal has been reached and is still considered relevant.
Short | proposed | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from GoalStatus http://hl7.org/fhir/ValueSet/goal-status|3.0.2 (required to `http://hl7.org/fhir/ValueSet/goal-status|3.0.2` ) Indicates whether the goal has been met and is still being targeted
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows measuring outcome and whether goal needs to be further tracked.
8. Goal.category
Definition | Indicates a category the goal falls within.
Short | E.g. Treatment, dietary, behavioral, etc.
Control | 10..*
Binding | For example codes, see GoalCategory http://hl7.org/fhir/ValueSet/goal-category|3.0.2 (example to `http://hl7.org/fhir/ValueSet/goal-category|3.0.2` ) Codes for grouping and sorting goals
Type | CodeableConcept
Summary | true
Requirements | Allows goals to be filtered and sorted.
Pattern Value | `{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "713603004" }] }`
10. Goal.description
Definition | Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding".
Short | Code or text describing goal
Comments | If no code is available, use CodeableConcept.text.
Control | 1..1
Binding | The codes SHALL be taken from For example codes, see ACPMedicalPolicyGoalVS (1.0.0)http://hl7.org/fhir/ValueSet/clinical-findings|3.0.2 (required to `https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalPolicyGoalVS|1.0.0` )
Type | CodeableConcept
Summary | true
Requirements | Without a description of what's trying to be achieved, element has no purpose.
12. Goal.subject
Definition | Identifies the patient, group or organization for whom the goal is being established.
Short | Who this goal is intended for
Control | 0..1
Type | Reference(ACP Patient, Patient, Group, Organization)
Summary | true
Requirements | Subject is optional to support annonymized reporting.
14. Goal.start[x]
Definition | The date or event after which the goal should begin being pursued.
Short | When goal pursuit begins
Control | 0..1
Binding | For example codes, see GoalStartEvent http://hl7.org/fhir/ValueSet/goal-start-event|3.0.2 (example to `http://hl7.org/fhir/ValueSet/goal-start-event|3.0.2` ) Codes describing events that can trigger the initiation of a goal
Type | Choice of: date, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.
Slicing | This element introduces a set of slices on `Goal.start[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
16. Goal.start[x]:startDate
Slice Name | startDate
Definition | The date or event after which the goal should begin being pursued.
Short | When goal pursuit begins
Control | 0..1
Type | date, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.

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

0. Goal
2. Goal.category
Control | 1..?
Pattern Value | `{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "713603004" }] }`
4. Goal.description
Binding | The codes SHALL be taken from ACPMedicalPolicyGoalVS (1.0.0) (required to `https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalPolicyGoalVS|1.0.0` )
6. Goal.subject
Type | Reference(ACP Patient)
8. Goal.start[x]
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Slicing | This element introduces a set of slices on `Goal.start[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
10. Goal.start[x]:startDate
Slice Name | startDate
Type | date
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
12. Goal.note
14. Goal.note.text

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

0. Goal
Definition | Describes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc.
Short | Describes the intended objective(s) for a patient, group or organization
Comments | Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
Control | 0..*
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (`contained.text.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 (`contained.where(('#'+id in %resource.descendants().reference).not()).empty()`)
2. Goal.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Control | 0..1
Type | id
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
4. Goal.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Summary | true
6. Goal.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.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
Control | 0..1
Type | uri
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
8. Goal.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | Unless not suitable, these codes SHALL be taken from Common Languages (extensible to `http://hl7.org/fhir/ValueSet/languages|3.0.2` ) A human language.
Additional Bindings | Purpose
All Languages | Max Binding
Type | code
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
10. Goal.text
Definition | A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
Control | 0..1 This element is affected by the following invariants: dom-1
Type | Narrative
Alternate Names | narrative, html, xhtml, display
12. Goal.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Control | 0..*
Type | Resource
Alternate Names | inline resources, anonymous resources, contained resources
14. Goal.extension
Definition | May be used to represent additional information that is not part of the basic definition of the resource. In order 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.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
16. Goal.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. Usually modifier elements provide negation or qualification. In order 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.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Alternate Names | extensions, user content
18. Goal.identifier
Definition | This records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).
Short | External Ids for this goal
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Requirements | Need to allow connection to a wider workflow.
20. Goal.status
Definition | Indicates whether the goal has been reached and is still considered relevant.
Short | proposed | accepted | planned | in-progress | on-target | ahead-of-target | behind-target | sustaining | achieved | on-hold | cancelled | entered-in-error | rejected
Comments | This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from GoalStatus (required to `http://hl7.org/fhir/ValueSet/goal-status|3.0.2` ) Indicates whether the goal has been met and is still being targeted
Type | code
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows measuring outcome and whether goal needs to be further tracked.
22. Goal.category
Definition | Indicates a category the goal falls within.
Short | E.g. Treatment, dietary, behavioral, etc.
Control | 1..*
Binding | For example codes, see GoalCategory (example to `http://hl7.org/fhir/ValueSet/goal-category|3.0.2` ) Codes for grouping and sorting goals
Type | CodeableConcept
Summary | true
Requirements | Allows goals to be filtered and sorted.
Pattern Value | `{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "713603004" }] }`
24. Goal.priority
Definition | Identifies the mutually agreed level of importance associated with reaching/sustaining the goal.
Short | high-priority | medium-priority | low-priority
Comments | Extensions are available to track priorities as established by each participant (i.e. Priority from the patient's perspective, different practitioners' perspectives, family member's perspectives) The ordinal extension on Coding can be used to convey a numerically comparable ranking to priority. (Keep in mind that different coding systems may use a "low value=important".
Control | 0..1
Binding | The codes SHOULD be taken from GoalPriority (preferred to `http://hl7.org/fhir/ValueSet/goal-priority|3.0.2` ) The level of importance associated with a goal
Type | CodeableConcept
Summary | true
Requirements | Used for sorting and presenting goals.
26. Goal.description
Definition | Human-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding".
Short | Code or text describing goal
Comments | If no code is available, use CodeableConcept.text.
Control | 1..1
Binding | The codes SHALL be taken from ACPMedicalPolicyGoalVS (1.0.0) (required to `https://api.iknl.nl/docs/pzp/stu3/ValueSet/ACP-MedicalPolicyGoalVS|1.0.0` )
Type | CodeableConcept
Summary | true
Requirements | Without a description of what's trying to be achieved, element has no purpose.
28. Goal.subject
Definition | Identifies the patient, group or organization for whom the goal is being established.
Short | Who this goal is intended for
Control | 0..1
Type | Reference(ACP Patient)
Summary | true
Requirements | Subject is optional to support annonymized reporting.
30. Goal.start[x]
Definition | The date or event after which the goal should begin being pursued.
Short | When goal pursuit begins
Control | 0..1
Binding | For example codes, see GoalStartEvent (example to `http://hl7.org/fhir/ValueSet/goal-start-event|3.0.2` ) Codes describing events that can trigger the initiation of a goal
Type | Choice of: date, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.
Slicing | This element introduces a set of slices on `Goal.start[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
32. Goal.start[x]:startDate
Slice Name | startDate
Definition | The date or event after which the goal should begin being pursued.
Short | When goal pursuit begins
Control | 0..1
Type | date
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery.
34. Goal.target
Definition | Indicates what should be done by when.
Short | Target outcome for the goal
Control | 0..1 This element is affected by the following invariants: gol-1
Type | BackboneElement
Requirements | Allows the progress of the goal to be monitored against an observation or due date.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() | (children().count() > id.count())`) gol-1: Goal.target.measure is required if Goal.target.detail is populated (`(detail.exists() and measure.exists()) or detail.exists().not()`)
36. Goal.target.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
38. Goal.target.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
40. Goal.target.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because No Modifier Reason provideed in previous versions of FHIR
Summary | true
Alternate Names | extensions, user content, modifiers
42. Goal.target.measure
Definition | The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
Short | The parameter whose value is being tracked
Control | 0..1 This element is affected by the following invariants: gol-1
Binding | For example codes, see LOINC Codes (example to `http://hl7.org/fhir/ValueSet/observation-codes|3.0.2` ) Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
Type | CodeableConcept
Summary | true
44. Goal.target.detail[x]
Definition | The target value of the focus to be achieved to signify the fulfillment of the goal, e.g. 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value.
Short | The target value to be achieved
Control | 0..1 This element is affected by the following invariants: gol-1
Binding | Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
Type | Choice of: Quantity, Range, CodeableConcept
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Summary | true
46. Goal.target.due[x]
Definition | Indicates either the date or the duration after start by which the goal should be met.
Short | Reach goal on or before
Control | 0..1
Type | Choice of: date, Duration
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Identifies when the goal should be evaluated.
48. Goal.statusDate
Definition | Identifies when the current status. I.e. When initially created, when achieved, when cancelled, etc.
Short | When goal status took effect
Comments | To see the date for past statuses, query history.
Control | 0..1
Type | date
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
50. Goal.statusReason
Definition | Captures the reason for the current status.
Short | Reason for current status
Comments | This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others.
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
52. Goal.expressedBy
Definition | Indicates whose goal this is - patient goal, practitioner goal, etc.
Short | Who's responsible for creating Goal?
Comments | This is the individual reponsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.).
Control | 0..1
Type | Reference(Patient, Practitioner, RelatedPerson)
Summary | true
54. Goal.addresses
Definition | The identified conditions and other health record elements that are intended to be addressed by the goal.
Short | Issues addressed by this goal
Control | 0..*
Type | Reference(Condition, Observation, MedicationStatement, NutritionOrder, ProcedureRequest, RiskAssessment)
Requirements | Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable.
56. Goal.note
Definition | Any comments related to the goal.
Short | Comments about the goal
Comments | May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
Control | 0..*
Type | Annotation
Requirements | There's a need to capture information about the goal that doesn't actually describe the goal.
58. Goal.note.id
Definition | unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
XML Format | In the XML format, this property is represented as an attribute.
60. Goal.note.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. In order 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.
Short | Additional Content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Alternate Names | extensions, user content
Slicing | This element introduces a set of slices on `Goal.note.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
62. Goal.note.author[x]
Definition | The individual responsible for making the annotation.
Short | Individual responsible for the annotation
Control | 0..1
Type | Choice of: Reference(Practitioner, Patient, RelatedPerson), string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
64. Goal.note.time
Definition | Indicates when this particular annotation was made.
Short | When the annotation was made
Control | 0..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
66. Goal.note.text
Definition | The text of the annotation.
Short | The annotation - text content
Control | 1..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
68. Goal.outcomeCode
Definition | Identifies the change (or lack of change) at the point when the status of the goal is assessed.
Short | What result was achieved regarding the goal?
Comments | Note that this should not duplicate the goal status.
Control | 0..*
Binding | For example codes, see SNOMED CT Clinical Findings (example to `http://hl7.org/fhir/ValueSet/clinical-findings|3.0.2` ) The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months"
Type | CodeableConcept
Requirements | Outcome tracking is a key aspect of care planning.
70. Goal.outcomeReference
Definition | Details of what's changed (or not changed).
Short | Observation that resulted from goal
Comments | The goal outcome is independent of the outcome of the related activities. For example, if the Goal is to achieve a target body weight of 150 lb and a care plan activity is defined to diet, then the care plan’s activity outcome could be calories consumed whereas goal outcome is an observation for the actual body weight measured.
Control | 0..*
Type | Reference(Observation)
Requirements | Outcome tracking is a key aspect of care planning.