CarePlan - FHIR v5.0.0 (original) (raw)

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

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• Examples
• Detailed Descriptions
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• Extensions
• R4 Conversions

9.5 Resource CarePlan - Content

Patient Care Work Group	Maturity Level: 2	Trial Use	Security Category: Patient	Compartments: Encounter, Patient

Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

9.5.1 Scope and Usage

CarePlan is one of the request resources in the FHIR workflow specification.

Care Plans are used in many areas of healthcare with a variety of scopes. They can be as simple as a general practitioner keeping track of when their patient is next due for a tetanus immunization through to a detailed plan for an oncology patient covering diet, chemotherapy, radiation, lab work and counseling with detailed timing relationships, pre-conditions and goals. They may be used in veterinary care or clinical research to describe the care of a herd or other collection of animals. In public health, they may describe education or immunization campaigns.

This resource takes an intermediate approach to complexity. It captures basic details about who is involved and what actions are intended without dealing in discrete data about dependencies and timing relationships. These can be supported where necessary using the extension mechanism.

The scope of care plans may vary widely. Examples include:

• Multi-disciplinary cross-organizational care plans; e.g. An oncology plan including the oncologist, home nursing staff, pharmacy and others
• Plans to manage specific disease/condition(s) (e.g. nutritional plan for a patient post bowel resection, neurological plan post head injury, prenatal plan, postpartum plan, grief management plan, etc.)
• Decision support generated plans following specific practice guidelines (e.g. stroke care plan, diabetes plan, falls prevention, etc.)
• Self-maintained patient or care-giver authored plans identifying their goals and an integrated understanding of actions to be taken. This does not include the legal Advance Directives, which should be represented with either the Consent resource with Consent.category = Advance Directive or with a specific request resource with intent = directive. Informal advance directives could be represented as a Goal, such as "I want to die at home."

This resource can be used to represent both proposed plans (for example, recommendations from a decision support engine or returned as part of a consult report) as well as active plans. The nature of the plan is communicated by the status. Some systems may need to filter CarePlans to ensure that only appropriate plans are exposed via a given user interface.

9.5.2 Boundaries and Relationships

CarePlan activities can be defined using references to the various "request" resources. These references could be to resources with a status of "planned" or to an active order. It is possible for planned activities to exist (e.g. appointments) without needing a CarePlan at all. CarePlans are used when there's a need to group activities, goals and/or participants together to provide some degree of context.

CarePlans can be tied to specific Conditions, however they can also be condition-independent and instead focused on a particular type of care (e.g. psychological, nutritional) or the care delivered by a particular practitioner or group of practitioners.

An ImmunizationRecommendation can be interpreted as a narrow type of CarePlan dealing only with immunization events. Where such information could appear in either resource, the immunization-specific resource is preferred.

CarePlans represent a specific plan instance for a particular patient or group. It is not intended to be used to define generic plans or protocols that are independent of a specific individual or group. CarePlan represents a specific intent, not a general definition. Protocols and order sets are supported through PlanDefinition.

9.5.3 References to this Resource

• Implements: Request
• Resource References: Appointment, AuditEvent, itself, DeviceDispense, DiagnosticReport... Show 16 more, DocumentReference, Encounter, GuidanceResponse, ImagingSelection, ImagingStudy, Immunization, MedicationAdministration, MedicationDispense, MedicationRequest, NutritionIntake, NutritionOrder, Observation, Procedure, Provenance, QuestionnaireResponse and ServiceRequest
• Extension References: AllergyIntolerance Careplan

9.5.4Resource Content

• Structure
• UML
• XML
• JSON
• Turtle
• R4 Diff
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
CarePlan	TU	DomainResource	Healthcare plan for patient or groupElements defined in Ancestors: id, meta, implicitRules, language, [text](domainresource.html#DomainResource "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, extension, modifierExtension
identifier	Σ	0..*	Identifier	External Ids for this plan
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | Questionnaire	Measure	ActivityDefinition	OperationDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest	RequestOrchestration	NutritionOrder)	Fulfills plan, proposal or order
replaces	Σ	0..*	Reference(CarePlan)	CarePlan replaced by this CarePlan
partOf	Σ	0..*	Reference(CarePlan)	Part of referenced CarePlan
status	?!Σ	1..1	code	draft | active	on-hold	revoked	completed	entered-in-error	unknownBinding: RequestStatus (Required)
intent	?!Σ	1..1	code	proposal | plan	order	option	directiveBinding: Care Plan Intent (Required)
[category](careplan-definitions.html#CarePlan.category "CarePlan.category : Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")	Σ	0..*	CodeableConcept	Type of planBinding: Care Plan Category (Example)
title	Σ	0..1	string	Human-friendly name for the care plan
description	Σ	0..1	string	Summary of nature of plan
subject	Σ	1..1	Reference(Patient | Group)	Who the care plan is for
encounter	Σ	0..1	Reference(Encounter)	The Encounter during which this CarePlan was created
period	Σ	0..1	Period	Time period plan covers
created	Σ	0..1	dateTime	Date record was first recorded
custodian	Σ	0..1	Reference(Patient | Practitioner	PractitionerRole	Device	RelatedPerson	Organization	CareTeam)	Who is the designated responsible party
contributor	0..*	Reference(Patient | Practitioner	PractitionerRole	Device	RelatedPerson	Organization	CareTeam)	Who provided the content of the care plan
careTeam	0..*	Reference(CareTeam)	Who's involved in plan?
addresses	Σ	0..*	CodeableReference(Condition)	Health issues this plan addressesBinding: SNOMED CT Clinical Findings (Example)
supportingInfo	0..*	Reference(Any)	Information considered as part of plan
goal	0..*	Reference(Goal)	Desired outcome of plan
activity	0..*	BackboneElement	Action to occur or has occurred as part of plan
[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "CarePlan.activity.performedActivity : Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")	0..*	CodeableReference(Any)	Results of the activity (concept, or Appointment, Encounter, Procedure, etc.)Binding: Care Plan Activity Performed (Example)
progress	0..*	Annotation	Comments about the activity status/progress
plannedActivityReference	0..1	Reference(Appointment | CommunicationRequest	DeviceRequest	MedicationRequest	NutritionOrder	Task	ServiceRequest	VisionPrescription	RequestOrchestration	ImmunizationRecommendation	SupplyRequest)	Activity that is intended to be part of the care plan
note	0..*	Annotation	Comments about the plan
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

CarePlan (DomainResource)Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlaninstantiatesCanonical : canonical [0..*] « PlanDefinition| Questionnaire|Measure|ActivityDefinition|OperationDefinition »The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlaninstantiatesUri : uri [0..*]A higher-level request resource (i.e. a plan, proposal or order) that is fulfilled in whole or in part by this care planbasedOn : Reference [0..*] « CarePlan|ServiceRequest| RequestOrchestration|NutritionOrder »Completed or terminated care plan whose function is taken by this new care planreplaces : Reference [0..*] « CarePlan »A larger care plan of which this particular care plan is a component or steppartOf : Reference [0..*] « CarePlan »Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)RequestStatus! »Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain (this element modifies the meaning of other elements)intent : code [1..1] « null (Strength=Required)CarePlanIntent! »Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etccategory : CodeableConcept [0..*] « null (Strength=Example)CarePlanCategory?? »Human-friendly name for the care plantitle : string [0..1]A description of the scope and nature of the plandescription : string [0..1]Identifies the patient or group whose intended care is described by the plansubject : Reference [1..1] « Patient|Group »The Encounter during which this CarePlan was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »Indicates when the plan did (or is intended to) come into effect and endperiod : Period [0..1]Represents when this particular CarePlan record was created in the system, which is often a system-generated datecreated : dateTime [0..1]When populated, the custodian is responsible for the care plan. The care plan is attributed to the custodiancustodian : Reference [0..1] « Patient|Practitioner|PractitionerRole| Device|RelatedPerson|Organization|CareTeam »Identifies the individual(s), organization or device who provided the contents of the care plancontributor : Reference [0..*] « Patient|Practitioner| PractitionerRole|Device|RelatedPerson|Organization|CareTeam »Identifies all people and organizations who are expected to be involved in the care envisioned by this plancareTeam : Reference [0..*] « CareTeam »Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this planaddresses : CodeableReference [0..*] « Condition; null (Strength=Example) SNOMEDCTClinicalFindings?? »Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etcsupportingInfo : Reference [0..*] « Any »Describes the intended objective(s) of carrying out the care plangoal : Reference [0..*] « Goal »General notes about the care plan not covered elsewherenote : Annotation [0..*]ActivityIdentifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource)performedActivity : CodeableReference [0..*] « Any; null (Strength=Example) CarePlanActivityPerformed?? »Notes about the adherence/status/progress of the activityprogress : Annotation [0..*]The details of the proposed activity represented in a specific resourceplannedActivityReference : Reference [0..1] « Appointment| CommunicationRequest|DeviceRequest|MedicationRequest| NutritionOrder|Task|ServiceRequest|VisionPrescription| RequestOrchestration|ImmunizationRecommendation|SupplyRequest »Identifies an action that has occurred or is a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring that has occurred, education etcactivity[0..*]

XML Template

<CarePlan xmlns="" title="undefined" rel="noopener noreferrer">http://hl7.org/fhir"> <identifier> <instantiatesCanonical> <instantiatesUri value="[uri]"/> <basedOn> <replaces> <partOf> <status value="[code]"/> <intent value="[code]"/> <[**category**](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")> <title value="[string]"/> <description value="[string]"/> <subject> <encounter> <period> <created value="[dateTime]"/> <custodian> <contributor> <careTeam> <addresses> <supportingInfo> <goal> <activity> <[**performedActivity**](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")> <progress> <plannedActivityReference> <note>

JSON Template

{ "resourceType" : "CarePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Ids for this plan "instantiatesCanonical" : ["<canonical(PlanDefinition|Questionnaire|Measure|ActivityDefinition|OperationDefinition)>"], // Instantiates FHIR protocol or definition "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition "basedOn" : [{ Reference(CarePlan|NutritionOrder|RequestOrchestration| ServiceRequest) }], // Fulfills plan, proposal or order "replaces" : [{ Reference(CarePlan) }], // CarePlan replaced by this CarePlan "partOf" : [{ Reference(CarePlan) }], // Part of referenced CarePlan "status" : "<code>", // R! draft | active | on-hold | revoked | completed | entered-in-error | unknown "intent" : "<code>", // R! proposal | plan | order | option | directive "[category](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")" : [{ CodeableConcept }], // Type of plan "title" : "<string>", // Human-friendly name for the care plan "description" : "<string>", // Summary of nature of plan "subject" : { Reference(Group|Patient) }, // R! Who the care plan is for "encounter" : { Reference(Encounter) }, // The Encounter during which this CarePlan was created "period" : { Period }, // Time period plan covers "created" : "<dateTime>", // Date record was first recorded "custodian" : { Reference(CareTeam|Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }, // Who is the designated responsible party "contributor" : [{ Reference(CareTeam|Device|Organization|Patient| Practitioner|PractitionerRole|RelatedPerson) }], // Who provided the content of the care plan "careTeam" : [{ Reference(CareTeam) }], // Who's involved in plan? "addresses" : [{ CodeableReference(Condition) }], // Health issues this plan addresses "supportingInfo" : [{ Reference(Any) }], // Information considered as part of plan "goal" : [{ Reference(Goal) }], // Desired outcome of plan "activity" : [{ // Action to occur or has occurred as part of plan "[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")" : [{ CodeableReference(Any) }], // Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) "progress" : [{ Annotation }], // Comments about the activity status/progress "plannedActivityReference" : { Reference(Appointment|CommunicationRequest| DeviceRequest|ImmunizationRecommendation|MedicationRequest|NutritionOrder| RequestOrchestration|ServiceRequest|SupplyRequest|Task|VisionPrescription) } // Activity that is intended to be part of the care plan }], "note" : [{ Annotation }] // Comments about the plan }

Turtle Template

@prefix fhir: http://hl7.org/fhir/ .

[ a fhir:CarePlan; fhir:nodeRole fhir:treeRoot; # if this is the parser root

from Resource: .id, .meta, .implicitRules, and .language

from DomainResource: .text, .contained, .extension, and .modifierExtension

fhir:identifier ( [ Identifier ] ... ) ; # 0..* External Ids for this plan fhir:instantiatesCanonical ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition fhir:instantiatesUri ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition fhir:basedOn ( [ Reference(CarePlan|NutritionOrder|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* Fulfills plan, proposal or order fhir:replaces ( [ Reference(CarePlan) ] ... ) ; # 0..* CarePlan replaced by this CarePlan fhir:partOf ( [ Reference(CarePlan) ] ... ) ; # 0..* Part of referenced CarePlan fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown fhir:intent [ code ] ; # 1..1 proposal | plan | order | option | directive fhir:[category](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.") ( [ CodeableConcept ] ... ) ; # 0..* Type of plan fhir:title [ string ] ; # 0..1 Human-friendly name for the care plan fhir:description [ string ] ; # 0..1 Summary of nature of plan fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who the care plan is for fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this CarePlan was created fhir:period [ Period ] ; # 0..1 Time period plan covers fhir:created [ dateTime ] ; # 0..1 Date record was first recorded fhir:custodian [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who is the designated responsible party fhir:contributor ( [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who provided the content of the care plan fhir:careTeam ( [ Reference(CareTeam) ] ... ) ; # 0..* Who's involved in plan? fhir:addresses ( [ CodeableReference(Condition) ] ... ) ; # 0..* Health issues this plan addresses fhir:supportingInfo ( [ Reference(Any) ] ... ) ; # 0..* Information considered as part of plan fhir:goal ( [ Reference(Goal) ] ... ) ; # 0..* Desired outcome of plan fhir:activity ( [ # 0..* Action to occur or has occurred as part of plan fhir:[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).") ( [ CodeableReference(Any) ] ... ) ; # 0..* Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) fhir:progress ( [ Annotation ] ... ) ; # 0..* Comments about the activity status/progress fhir:plannedActivityReference [ Reference(Appointment|CommunicationRequest|DeviceRequest|ImmunizationRecommendation| MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest| SupplyRequest|Task|VisionPrescription) ] ; # 0..1 Activity that is intended to be part of the care plan ] ... ) ; fhir:note ( [ Annotation ] ... ) ; # 0..* Comments about the plan ]

Changes from both R4 and R4B

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
CarePlan	TU	DomainResource	Healthcare plan for patient or groupElements defined in Ancestors: id, meta, implicitRules, language, [text](domainresource.html#DomainResource "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, extension, modifierExtension
identifier	Σ	0..*	Identifier	External Ids for this plan
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | Questionnaire	Measure	ActivityDefinition	OperationDefinition)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest	RequestOrchestration	NutritionOrder)	Fulfills plan, proposal or order
replaces	Σ	0..*	Reference(CarePlan)	CarePlan replaced by this CarePlan
partOf	Σ	0..*	Reference(CarePlan)	Part of referenced CarePlan
status	?!Σ	1..1	code	draft | active	on-hold	revoked	completed	entered-in-error	unknownBinding: RequestStatus (Required)
intent	?!Σ	1..1	code	proposal | plan	order	option	directiveBinding: Care Plan Intent (Required)
[category](careplan-definitions.html#CarePlan.category "CarePlan.category : Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")	Σ	0..*	CodeableConcept	Type of planBinding: Care Plan Category (Example)
title	Σ	0..1	string	Human-friendly name for the care plan
description	Σ	0..1	string	Summary of nature of plan
subject	Σ	1..1	Reference(Patient | Group)	Who the care plan is for
encounter	Σ	0..1	Reference(Encounter)	The Encounter during which this CarePlan was created
period	Σ	0..1	Period	Time period plan covers
created	Σ	0..1	dateTime	Date record was first recorded
custodian	Σ	0..1	Reference(Patient | Practitioner	PractitionerRole	Device	RelatedPerson	Organization	CareTeam)	Who is the designated responsible party
contributor	0..*	Reference(Patient | Practitioner	PractitionerRole	Device	RelatedPerson	Organization	CareTeam)	Who provided the content of the care plan
careTeam	0..*	Reference(CareTeam)	Who's involved in plan?
addresses	Σ	0..*	CodeableReference(Condition)	Health issues this plan addressesBinding: SNOMED CT Clinical Findings (Example)
supportingInfo	0..*	Reference(Any)	Information considered as part of plan
goal	0..*	Reference(Goal)	Desired outcome of plan
activity	0..*	BackboneElement	Action to occur or has occurred as part of plan
[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "CarePlan.activity.performedActivity : Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")	0..*	CodeableReference(Any)	Results of the activity (concept, or Appointment, Encounter, Procedure, etc.)Binding: Care Plan Activity Performed (Example)
progress	0..*	Annotation	Comments about the activity status/progress
plannedActivityReference	0..1	Reference(Appointment | CommunicationRequest	DeviceRequest	MedicationRequest	NutritionOrder	Task	ServiceRequest	VisionPrescription	RequestOrchestration	ImmunizationRecommendation	SupplyRequest)	Activity that is intended to be part of the care plan
note	0..*	Annotation	Comments about the plan
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

CarePlan (DomainResource)Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to serveridentifier : Identifier [0..*]The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlaninstantiatesCanonical : canonical [0..*] « PlanDefinition| Questionnaire|Measure|ActivityDefinition|OperationDefinition »The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlaninstantiatesUri : uri [0..*]A higher-level request resource (i.e. a plan, proposal or order) that is fulfilled in whole or in part by this care planbasedOn : Reference [0..*] « CarePlan|ServiceRequest| RequestOrchestration|NutritionOrder »Completed or terminated care plan whose function is taken by this new care planreplaces : Reference [0..*] « CarePlan »A larger care plan of which this particular care plan is a component or steppartOf : Reference [0..*] « CarePlan »Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)RequestStatus! »Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain (this element modifies the meaning of other elements)intent : code [1..1] « null (Strength=Required)CarePlanIntent! »Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etccategory : CodeableConcept [0..*] « null (Strength=Example)CarePlanCategory?? »Human-friendly name for the care plantitle : string [0..1]A description of the scope and nature of the plandescription : string [0..1]Identifies the patient or group whose intended care is described by the plansubject : Reference [1..1] « Patient|Group »The Encounter during which this CarePlan was created or to which the creation of this record is tightly associatedencounter : Reference [0..1] « Encounter »Indicates when the plan did (or is intended to) come into effect and endperiod : Period [0..1]Represents when this particular CarePlan record was created in the system, which is often a system-generated datecreated : dateTime [0..1]When populated, the custodian is responsible for the care plan. The care plan is attributed to the custodiancustodian : Reference [0..1] « Patient|Practitioner|PractitionerRole| Device|RelatedPerson|Organization|CareTeam »Identifies the individual(s), organization or device who provided the contents of the care plancontributor : Reference [0..*] « Patient|Practitioner| PractitionerRole|Device|RelatedPerson|Organization|CareTeam »Identifies all people and organizations who are expected to be involved in the care envisioned by this plancareTeam : Reference [0..*] « CareTeam »Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this planaddresses : CodeableReference [0..*] « Condition; null (Strength=Example) SNOMEDCTClinicalFindings?? »Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etcsupportingInfo : Reference [0..*] « Any »Describes the intended objective(s) of carrying out the care plangoal : Reference [0..*] « Goal »General notes about the care plan not covered elsewherenote : Annotation [0..*]ActivityIdentifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource)performedActivity : CodeableReference [0..*] « Any; null (Strength=Example) CarePlanActivityPerformed?? »Notes about the adherence/status/progress of the activityprogress : Annotation [0..*]The details of the proposed activity represented in a specific resourceplannedActivityReference : Reference [0..1] « Appointment| CommunicationRequest|DeviceRequest|MedicationRequest| NutritionOrder|Task|ServiceRequest|VisionPrescription| RequestOrchestration|ImmunizationRecommendation|SupplyRequest »Identifies an action that has occurred or is a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring that has occurred, education etcactivity[0..*]

XML Template

<CarePlan xmlns="" title="undefined" rel="noopener noreferrer">http://hl7.org/fhir"> <identifier> <instantiatesCanonical> <instantiatesUri value="[uri]"/> <basedOn> <replaces> <partOf> <status value="[code]"/> <intent value="[code]"/> <[**category**](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")> <title value="[string]"/> <description value="[string]"/> <subject> <encounter> <period> <created value="[dateTime]"/> <custodian> <contributor> <careTeam> <addresses> <supportingInfo> <goal> <activity> <[**performedActivity**](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")> <progress> <plannedActivityReference> <note>

JSON Template

{ "resourceType" : "CarePlan", // from Resource: id, meta, implicitRules, and language // from DomainResource: text, contained, extension, and modifierExtension "identifier" : [{ Identifier }], // External Ids for this plan "instantiatesCanonical" : ["<canonical(PlanDefinition|Questionnaire|Measure|ActivityDefinition|OperationDefinition)>"], // Instantiates FHIR protocol or definition "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition "basedOn" : [{ Reference(CarePlan|NutritionOrder|RequestOrchestration| ServiceRequest) }], // Fulfills plan, proposal or order "replaces" : [{ Reference(CarePlan) }], // CarePlan replaced by this CarePlan "partOf" : [{ Reference(CarePlan) }], // Part of referenced CarePlan "status" : "<code>", // R! draft | active | on-hold | revoked | completed | entered-in-error | unknown "intent" : "<code>", // R! proposal | plan | order | option | directive "[category](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.")" : [{ CodeableConcept }], // Type of plan "title" : "<string>", // Human-friendly name for the care plan "description" : "<string>", // Summary of nature of plan "subject" : { Reference(Group|Patient) }, // R! Who the care plan is for "encounter" : { Reference(Encounter) }, // The Encounter during which this CarePlan was created "period" : { Period }, // Time period plan covers "created" : "<dateTime>", // Date record was first recorded "custodian" : { Reference(CareTeam|Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) }, // Who is the designated responsible party "contributor" : [{ Reference(CareTeam|Device|Organization|Patient| Practitioner|PractitionerRole|RelatedPerson) }], // Who provided the content of the care plan "careTeam" : [{ Reference(CareTeam) }], // Who's involved in plan? "addresses" : [{ CodeableReference(Condition) }], // Health issues this plan addresses "supportingInfo" : [{ Reference(Any) }], // Information considered as part of plan "goal" : [{ Reference(Goal) }], // Desired outcome of plan "activity" : [{ // Action to occur or has occurred as part of plan "[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).")" : [{ CodeableReference(Any) }], // Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) "progress" : [{ Annotation }], // Comments about the activity status/progress "plannedActivityReference" : { Reference(Appointment|CommunicationRequest| DeviceRequest|ImmunizationRecommendation|MedicationRequest|NutritionOrder| RequestOrchestration|ServiceRequest|SupplyRequest|Task|VisionPrescription) } // Activity that is intended to be part of the care plan }], "note" : [{ Annotation }] // Comments about the plan }

Turtle Template

@prefix fhir: http://hl7.org/fhir/ .

[ a fhir:CarePlan; fhir:nodeRole fhir:treeRoot; # if this is the parser root

from Resource: .id, .meta, .implicitRules, and .language

from DomainResource: .text, .contained, .extension, and .modifierExtension

fhir:identifier ( [ Identifier ] ... ) ; # 0..* External Ids for this plan fhir:instantiatesCanonical ( [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ] ... ) ; # 0..* Instantiates FHIR protocol or definition fhir:instantiatesUri ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition fhir:basedOn ( [ Reference(CarePlan|NutritionOrder|RequestOrchestration|ServiceRequest) ] ... ) ; # 0..* Fulfills plan, proposal or order fhir:replaces ( [ Reference(CarePlan) ] ... ) ; # 0..* CarePlan replaced by this CarePlan fhir:partOf ( [ Reference(CarePlan) ] ... ) ; # 0..* Part of referenced CarePlan fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown fhir:intent [ code ] ; # 1..1 proposal | plan | order | option | directive fhir:[category](careplan-definitions.html#CarePlan.category "Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.") ( [ CodeableConcept ] ... ) ; # 0..* Type of plan fhir:title [ string ] ; # 0..1 Human-friendly name for the care plan fhir:description [ string ] ; # 0..1 Summary of nature of plan fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who the care plan is for fhir:encounter [ Reference(Encounter) ] ; # 0..1 The Encounter during which this CarePlan was created fhir:period [ Period ] ; # 0..1 Time period plan covers fhir:created [ dateTime ] ; # 0..1 Date record was first recorded fhir:custodian [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ; # 0..1 Who is the designated responsible party fhir:contributor ( [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who provided the content of the care plan fhir:careTeam ( [ Reference(CareTeam) ] ... ) ; # 0..* Who's involved in plan? fhir:addresses ( [ CodeableReference(Condition) ] ... ) ; # 0..* Health issues this plan addresses fhir:supportingInfo ( [ Reference(Any) ] ... ) ; # 0..* Information considered as part of plan fhir:goal ( [ Reference(Goal) ] ... ) ; # 0..* Desired outcome of plan fhir:activity ( [ # 0..* Action to occur or has occurred as part of plan fhir:[performedActivity](careplan-definitions.html#CarePlan.activity.performedActivity "Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource).") ( [ CodeableReference(Any) ] ... ) ; # 0..* Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) fhir:progress ( [ Annotation ] ... ) ; # 0..* Comments about the activity status/progress fhir:plannedActivityReference [ Reference(Appointment|CommunicationRequest|DeviceRequest|ImmunizationRecommendation| MedicationRequest|NutritionOrder|RequestOrchestration|ServiceRequest| SupplyRequest|Task|VisionPrescription) ] ; # 0..1 Activity that is intended to be part of the care plan ] ... ) ; fhir:note ( [ Annotation ] ... ) ; # 0..* Comments about the plan ]

Changes from both R4 and R4B

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON,XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

9.5.4.1Terminology Bindings

Path	ValueSet	Type	Documentation
CarePlan.status	RequestStatus	Required	Codes identifying the lifecycle stage of a request.
CarePlan.intent	CarePlanIntent	Required	Codes indicating the degree of authority/intentionality associated with a care plan.
CarePlan.category	CarePlanCategory	Example	Example codes indicating the category a care plan falls within. Note that these are in no way complete and might not even be appropriate for some uses.
CarePlan.addresses	SNOMEDCTClinicalFindings	Example	This value set includes all the "Clinical finding" SNOMED CT codes - concepts where concept is-a 404684003 (Clinical finding (finding)).
CarePlan.activity.performedActivity	CarePlanActivityPerformed	Example	Example codes indicating the care plan activity that was performed. Note that these are in no way complete and might not even be appropriate for some uses.

9.5.4.2 Notes

The Provenance resource can be used for detailed review information, such as when the care plan was last reviewed and by whom.

9.5.5 Open Issues

9.5.6 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.