For representation of SDOH conditions.

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths (e.g., to arrive at SDOH Conditions) are also possible.

One specific use for this profile is to represent a Health Concern that is either; 1) directly asserted based on the patient’s answer to a specific question from an SDOH screening questionnaire or 2) computed/generated based on the patient’s answers to multiple questions. The questions and answers from the screening questionnaire are also represented using SDC Questionnaire, SDC QuestionnaireResponse and SDOHCC Screening Response Observation.

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

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

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.

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

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

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

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

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.

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.

The base language in which the resource is written.

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).

Optional Extension Element - found in all resources.

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

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).

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.

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.

The clinical status of the condition.

The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

The verification status to support the clinical status of the condition.

verificationStatus is not required. For example, when a patient complains of stress during a provider encounter, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

For SDOH conditions that are autogenerated based on a questionnaire response, the Condition.asserter is a “Device” AND Condition.Category should be "health-concern". In that case, Condition.verificationStatus should be "unconfirmed" and should be changed to “confirmed” only after review and concurrence by the provider and patient.

A category assigned to the condition.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

For a condition that is autogenerated based only on an individual's responses to an SDOH questionnaire, category should be "health-concern".

An SDOH category assigned to the condition.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

Codes for high-level SDOH categories.

Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to a condition. It is recommended that SDOH category codes be used to facilitate searching for SDOH conditions.

Identification of the condition, problem or diagnosis.

Valueset to describe the actual problem experienced by the patient

Code is required and must be selected from the bound value set.

The anatomical location where this condition manifests itself.

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Codes describing anatomical locations. May include laterality.

Indicates the patient who the condition record is associated with.

US Core Condition Profile restricts subject to patient.

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

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. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

Estimated or actual dateTime or Period the condition began.

For SDOH conditions that have their onset over an extended (or fuzzy) period (e.g., the past month), Condition.onset may use a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min).

The estimated or actual dateTime or Period that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution".

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

For SDOH Conditions that have a fuzzy abatement period, a lower precision representation (e.g., month/year or year) may be used. However, for SDOH Conditions that end at a specific point in time (e.g., food insecurity may abate upon acquiring a new job or gaining eligibility to a food program) a higher precision representation (e.g., year/month/date) may also be used.

The individual or device making the condition statement.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

For a condition that is autogenerated based on the patient directly answering a specific question from an SDOH screening questionnaire, the Condition.asserter should be the patient. For a condition that is autogenerated based on a computation that uses the patient’s answers to multiple questions, Condition.asserter should reference “Device” (using the using AsserterDevice extension) to specify the device used to compute the condition.

Clinical stage or grade of a condition. May include formal severity assessments.

Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

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).

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.

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.

Links to other relevant information, including pathology reports.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Additionally, see Comment for Condition.evidence.code.

Links to other relevant information.

When a condition is based on one or more SDOH observations that were generated from questionnaire responses, Condition.evidence.detail should reference instances that comply with the SDOHCC Observation Screening Response or SDC Questionnaire Response. However, references to other instance types are also possible.

For representation of SDOH conditions.

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths (e.g., to arrive at SDOH Conditions) are also possible.

One specific use for this profile is to represent a Health Concern that is either; 1) directly asserted based on the patient’s answer to a specific question from an SDOH screening questionnaire or 2) computed/generated based on the patient’s answers to multiple questions. The questions and answers from the screening questionnaire are also represented using SDC Questionnaire, SDC QuestionnaireResponse and SDOHCC Screening Response Observation.

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

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

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.

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

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.

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.

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

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

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

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

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

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

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

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

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

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

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

Security Labels from the Healthcare Privacy and Security Classification System.

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

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

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

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.

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.

The base language in which the resource is written.

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).

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.

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.

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.

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.

An Extension

Optional Extension Element - found in all resources.

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

An Extension

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

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).

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.

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.

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

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.

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

The clinical status of the condition.

The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

The verification status to support the clinical status of the condition.

verificationStatus is not required. For example, when a patient complains of stress during a provider encounter, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

For SDOH conditions that are autogenerated based on a questionnaire response, the Condition.asserter is a “Device” AND Condition.Category should be "health-concern". In that case, Condition.verificationStatus should be "unconfirmed" and should be changed to “confirmed” only after review and concurrence by the provider and patient.

A category assigned to the condition.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

For a condition that is autogenerated based only on an individual's responses to an SDOH questionnaire, category should be "health-concern".

An SDOH category assigned to the condition.

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

Codes for high-level SDOH categories.

Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to a condition. It is recommended that SDOH category codes be used to facilitate searching for SDOH conditions.

A subjective assessment of the severity of the condition as evaluated by the clinician.

Coding of the severity with a terminology is preferred, where possible.

A subjective assessment of the severity of the condition as evaluated by the clinician.

Identification of the condition, problem or diagnosis.

Valueset to describe the actual problem experienced by the patient

Code is required and must be selected from the bound value set.

The anatomical location where this condition manifests itself.

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Codes describing anatomical locations. May include laterality.

Indicates the patient who the condition record is associated with.

US Core Condition Profile restricts subject to patient.

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

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. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

Estimated or actual dateTime or Period the condition began.

For SDOH conditions that have their onset over an extended (or fuzzy) period (e.g., the past month), Condition.onset may use a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min).

The estimated or actual dateTime or Period that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution".

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

For SDOH Conditions that have a fuzzy abatement period, a lower precision representation (e.g., month/year or year) may be used. However, for SDOH Conditions that end at a specific point in time (e.g., food insecurity may abate upon acquiring a new job or gaining eligibility to a food program) a higher precision representation (e.g., year/month/date) may also be used.

The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

Individual who recorded the record and takes responsibility for its content.

The individual or device making the condition statement.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

For a condition that is autogenerated based on the patient directly answering a specific question from an SDOH screening questionnaire, the Condition.asserter should be the patient. For a condition that is autogenerated based on a computation that uses the patient’s answers to multiple questions, Condition.asserter should reference “Device” (using the using AsserterDevice extension) to specify the device used to compute the condition.

Clinical stage or grade of a condition. May include formal severity assessments.

Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

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

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.

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.

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).

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.

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.

A manifestation or symptom that led to the recording of this condition.

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Information represented by Condition.evidence.code may overlap significantly with information represented by Condition.evidence.detail. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar infomation could be provided by either Condition.evidence.code or Condition.evidence.detail, it is recommended that Condition.evidence.detail should be used as supporting evidence for the condition.

Codes that describe the manifestation or symptoms of a condition.

Links to other relevant information, including pathology reports.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Additionally, see Comment for Condition.evidence.code.

Links to other relevant information.

When a condition is based on one or more SDOH observations that were generated from questionnaire responses, Condition.evidence.detail should reference instances that comply with the SDOHCC Observation Screening Response or SDC Questionnaire Response. However, references to other instance types are also possible.

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.