Name Flags Card. Type Description & Constraints Condition 0..* JP_Condition 患者の傷病記録 id S 0..1 string このリソースのID text S 0..1 Narrative このリソースの概要 status S 1..1 code generated | extensions | additional | empty Fixed Value: generated div S 1..1 xhtml このリソースの概要 Slices for extension S 0..* Extension Extension Slice: Unordered, Open by value:url StructureDefinition-JP-REZEPT-ExtensionConditionOutcome.html S 0..* Coding 転帰区分コード URL: https://igs.healthdataworks.net/jp-rezept-medical/StructureDefinition-JP-REZEPT-ExtensionConditionOutcome.html Binding: 転帰区分コード (required) JP-REZEPT-ExtensionConditionMajorDisease.html S 0..* boolean 主病名があるかどうかのフラグ URL: https://igs.healthdataworks.net/jp-rezept-medical/StructureDefinition/JP-REZEPT-ExtensionConditionMajorDisease.html StructureDefinition-JP-REZEPT-ExtensionConditionNumberOfComorbidities.html S 0..* integer 併存傷病名数 URL: https://igs.healthdataworks.net/jp-rezept-medical/StructureDefinition-JP-REZEPT-ExtensionConditionNumberOfComorbidities.html clinicalStatus S 0..1 CodeableConcept 臨床的状態のステータス coding S 0..* Coding 臨床的状態のステータス system S 0..1 uri 臨床的状態のステータスのURI code S 0..1 code 臨床的状態のステータスのコード値 display S 0..1 string 臨床的状態のステータスの名称 verificationStatus S 0..1 CodeableConcept 臨床的状態に対する検証状況 coding S 0..* Coding 臨床的状態に対する検証状況 system S 0..1 uri 臨床的状態に対する検証状況のURI code S 0..1 code 臨床的状態に対する検証状況 display S 0..1 string 臨床的状態に対する検証状況の名称 code S 1..1 CodeableConcept 傷病名コード Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by value:system coding:code S 0..* Coding 傷病名コード system S 0..1 uri 傷病名コードのURI code S 0..1 code 傷病名コード Binding: 傷病名コード (required) display S 0..1 string 傷病名 coding:icd10 S 0..* Coding Code defined by a terminology system system S 0..1 uri ICD10コードのURI code S 0..1 code ICD10コード Binding: ICD10コード (required) display S 0..1 string 傷病名 bodySite S 0..* CodeableConcept 部位(歯式) Binding: 歯式コード (required) coding S 0..* Coding 部位 code S 0..1 code 部位コード display S 0..1 string 部位の名称 subject S 1..1 Reference(Patient | Group) 患者の参照 reference S 0..1 string 患者の参照 encounter S 0..1 Reference(Encounter) 受診の参照 reference S 0..1 string 受診の参照 onset[x] S 0..1 dateTime 発症日 recordedDate S 0..1 dateTime 最初の記載日 note S 0..* Annotation 追加情報 text S 1..1 markdown 追加情報 Documentation for this format
実装ガイド作成：小山内 尚、西山 喜樹、能崎 克行
患者の傷病記録、診断内容、またはその他の状況や問題点、または臨床の概念事項を示します。
レセプトの診療年月における患者の傷病記録です。 診療年月が変わった際には同一患者の同じ傷病であっても別の情報となります。
Most systems will expect a clinicalStatus to be valued for problem-list-items that are managed over time, but might not need a clinicalStatus for point in time encounter-diagnosis.
Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
exists(f:clinicalStatus) or exists(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(category[@value='problem-list-item']))
If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
not(exists(*[starts-with(local-name(.), 'abatement')])) or exists(f:clinicalStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-clinical' and f:code/@value=('resolved', 'remission', 'inactive')])
Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
not(exists(f:verificationStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-ver-status' and f:code/@value='entered-in-error'])) or not(exists(f:clinicalStatus))
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
< 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
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).
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
generated | extensions | additional | empty
このリソースの概要がリソースのコンテンツから⽣成されたことを⽰す。
The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained style attributes
not(descendant-or-self::*[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'sub', 'sup', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))]) and not(descendant-or-self::*/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))])
The narrative SHALL have some non-whitespace content
descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src]
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.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
主病名があるかどうかのフラグです。
歯科レセプトの傷病名部位レコード(HS)の場合のみ設定します。
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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
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. 実行者または他のシステムによってこの条件に割り当てられたビジネス識別子。リソースが更新され、サーバーからサーバーに伝送されるときにも変化しない。
This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). 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. これはビジネス識別子であり、リソース識別子ではない。全インスタンスを通して識別子は単一インスタンスを指し示すことがベストである。しかし、異なるリソースタイプの複数のリソースインスタンスに同じ識別子を割り当てることも稀にはある。例えば、重複するPatientリソースインスタンスとPersonリソースインスタンスは同じソーシャルセキュリティー番号を共有することなどである。
Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.
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. codeとしてhttp://terminology.hl7.org/CodeSystem/condition-clinicalでは Lv0 active: 状態による症状が現在継続している、または状態を裏付ける所見などが存在していることを指す。 Lv1 recurrence: 過去に一回解消した問題が再発していることを指す。 Lv1 relapse: 過去に改善または寛解を得た状態が再度悪化していることを指す。 Lv0 inactive: 状態による症状が現在存在していない、または状態を裏付ける所見などが存在していないことを指す。 Lv1 remission: 状態による症状が現在存在していないが、再発のリスクを有している場合を指す。 Lv1 resolved: 状態による症状が現在存在していおらず、再発のリスクを考慮する必要がない場合を指す。 上記が入力されるが、JP Coreでは保険病名の表現を可能とするため、上記情報に加え下記を表現可能とするか否か検討のひつようがある。別個にclinicaloutcomeを作成する検討の必要性がある。 退院時転帰 1 =資源病名が治癒したと判断される場合 2 =資源病名が軽快したと判断される場合 3 =資源病名が寛解したと判断される場合 4 =資源病名が不変と判断される場合 5 =資源病名が増悪したと判断される場合 6 =資源病名による死亡 7 =資源病名以外による死亡 9 =その他(検査入院含む)
This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
The clinical status of the condition or diagnosis.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
臨床的状態のステータスのコード値
臨床的状態のステータスのコード値です。
active: 状態による症状が現在継続している、または状態を裏付ける所見などが存在していることを指します。 inactive: 状態による症状が現在存在していない、または状態を裏付ける所見などが存在していないことを指します。
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
臨床的状態のステータスの名称です。
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
臨床的状態に対する検証状況です。
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, 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. codeとしてhttp://terminology.hl7.org/CodeSystem/condition-ver-statusを用い、具体的には Lv0 unconfirmed: 該当する状態の存在を確定とは言い切れないことを示す。 Lv1 provisional: 該当する状態の存在は暫定的であることを示す。 Lv1 differential: 該当する状態を鑑別するべき意図で記載されたことを示す。 Lv0 confirmed: 該当する状態は十分な根拠によって確定されたものであることを示す。 Lv0 refuted: 該当する状態は十分な根拠によって除外されたものであることを示す。 Lv0 entered-in-error: 有効でない入力であることを示す。 上記が入力される。
This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
The verification status to support or decline the clinical status of the condition or diagnosis.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
臨床的状態に対する検証状況のURIです。
unconfirmed: 該当する状態の存在を確定とは言い切れないことを示します。 confirmed: 該当する状態は十分な根拠によって確定されたものであることを示します。
臨床的状態に対する検証状況の名称
臨床的状態に対する検証状況の名称です。
problem-list-item | encounter-diagnosis | health-concern
A category assigned to the condition. 本状態のカテゴリ。プロブレムリスト項目、受診時診断、健康問題、など。
The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts. カテゴリー情報は多くの場合、高度にコンテキストに依存しているので、他のコンテキストでは十分にカテゴリーとして区分されていないか、あまり役に立たないように見える場合がある。 【JP-CORE】 encounter diagnosisの概念を残すかどうかについて検討の余地がある。 [案1] codeとしてhttp://terminology.hl7.org/CodeSystem/condition-categoryを参考にするが、保険登録病名として反映可能かどうかの情報を含める。具体的には、 problem-list-item-available-as-claim-diagnosis: 時間的な幅をもってプロブレムリストの一つとして扱われているもののうち、保険病名として反映すべきものを示す。 problem-list-item-unavailable-as-claim-diagnosis: 時間的な幅をもってプロブレムリストの一つとして扱われているもののうち、保険病名として反映すべきでないものを示す。 encounter-diagnosis-available-as-claim-diagnosis: 時間的な幅を持たず瞬間的な判断根拠によって示された状態表現のうち、保険病名として反映すべきものを示す。 encounter-diagnosis: 時間的な幅を持たず瞬間的な判断根拠によって示された状態表現のうち、保険病名として反映すべきでないものを示す。 上記が入力される。 [案2] 保険登録病名として反映可能かどうかの情報のみを示す。具体的には、 available-as-claim-diagnosis: 保険病名として反映すべきものを示す。 unavailable-as-claim-diagnosis: 保険病名として反映すべきでないものを示す。 上記が入力される。 ＊US Coreに倣い、problem-list-item | encounter-diagnosis | health-concernとしている。カーディナリティを1..1としているため、このいずれかが入力されることになるため検討を必要とする。
'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
Subjective severity of condition 状態の主観的な重症度
A subjective assessment of the severity of the condition as evaluated by the clinician. 医師によって評価された本状態の主観的な重症度。
Coding of the severity with a terminology is preferred, where possible. 可能な限り、ターミノロジーを用いて重症度をコーディングすること。 【JP-CORE】 codeとしてhttp://snomed.info/sctに定義された下記が用いられる。 code:24484000 Display:Severe code:6736007 Display:Moderate code:255604002 Display:Mild
A subjective assessment of the severity of the condition as evaluated by the clinician.
Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
傷病名レコードの場合、レセプトの傷病名マスタの値を設定します。
0..1 to account for primarily narrative only resources.
Identification of the condition or diagnosis.
code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
A reference to a code defined by a terminology system.
歯科レセプトのみ歯式の情報があるため部位に設定します。
< 442083009 |Anatomical or acquired body structure|
The identification of the code system that defines the meaning of the symbol in the code.
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. 参照は、実際のFHIRリソースへの参照である必要があり、解決可能（内容に到達可能）である必要がある（アクセス制御、一時的な使用不可などを考慮に入れる）。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。 【JP-CORE】 必須(Cardinality 1...1)とする。
Group is typically used for veterinary or public health use cases.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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". これは通常、イベントが発生したエンカウンターだが、場合によっては病状状態は、エンカウンターが完了する前または後に開始されているる場合がある。それでもエンカウンターのコンテキストに関連付けられる。このレコードは、この特定のレコードが関連付けられているエンカウンターを示す。状態に関する進行中/新しい情報を反映した「新しい」診断の場合には、それまでに存在していた状態がはじめて「知られた」最初のエンカウンターとは異なる可能性がある。 【JP仕様】 入院外来の区別や所在場所、担当診療科の情報に使用する。付加的な情報であり、1...1には制約しない。
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
レセプトでは傷病の発症日はわからないが、傷病の診療開始日がわかるため、診療開始日を発症日とみなします。
.effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
When in resolution/remission 治癒（解決）または寛解した時期
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate. 状態が解決した、または寛解した日付または推定日。これは、「寛解」または「治癒（解決）」のどちらかを使うには意味が重すぎることから「軽快」と呼ばれる-状態は実際には治癒していないが、軽快にすることはできる。
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. 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. 多くの場合、解決と寛解の間に明確な区別はない。年齢は一般的に、患者が状態が緩和した年齢を報告するケースで使用される。軽快要素がない場合、状態が解決したか、寛解に入ったかは不明である。アプリケーションとユーザーは通常、状態がまだ有効であると想定する必要があ。 abatementStringが存在する場合、それは状態が軽快されることを意味する。
.effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
レセプトでは診療年月と診療行為の日付を記載日とみなします。
Individual who recorded the record and takes responsibility for its content. 本記録を記録し、その内容に責任を負う個人。
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. 参照は、実際のFHIRリソースへの参照である必要があり、解決可能（内容に到達可能）である必要がある（アクセス制御、一時的な使用不可などを考慮に入れる）。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。 【JP-CORE】 FHIR規定仕様においてCardinalityで0を許容しているのは記載内容の責任者と記録者が異なるケースを想定していると考えられるが、現状の診療で一般的に行われるカルテ記載形式を考慮し、Cardinality 1...1を検討するべきとも考えれるため、基本的には本要素には値を設定する。
Person who asserts this condition この状態があるというした人
Individual who is making the condition statement. 本状態があるという事実を作成した個人。
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. 参照は、実際のFHIRリソースへの参照である必要があり、解決可能（内容に到達可能）である必要がある（アクセス制御、一時的な使用不可などを考慮に入れる）。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。 【JP-CORE】 通常の診療では判断した個人と記載した個人は同一であるケースが一般的であり、既存の情報の転記などの際に、記載者と状態の存在を判断した個人が異なる場合に記入が必要となると考えられる。
Stage/grade, usually assessed formally ステージやグレードで、普通は正式に評価されたもの。
Clinical stage or grade of a condition. May include formal severity assessments. 病状の臨床病期またはグレード。正式な重症度評価が含まれる場合がある。
exists(f:summary) or exists(f:assessment)
./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
Codes describing condition stages (e.g. Cancer stages).
Reference to a formal record of the evidence on which the staging assessment is based.
The kind of staging, such as pathological or clinical staging.
Codes describing the kind of condition staging (e.g. clinical or pathological).
./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]
Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition. 状態を確認または反駁した証拠など、状態の検証ステータスの基礎となる裏付けとなる証拠/兆候。
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both. エビデンスは、コード化された症状/症状の単純なリスト、または観察または正式な評価への参照、あるいはその両方である可能性がある。 【仕様例】 codeとしてhttp://snomed.info/sctに定義された 404684003 (Clinical finding)が用いられる。 例 code:1735007 Display:Thrill
.outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
A manifestation or symptom that led to the recording of this condition.
Codes that describe the manifestation or symptoms of a condition.
Links to other relevant information, including pathology reports.
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. *Annotations SHOULD NOT* be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). 構造化された注釈（アノテーション）を持たないシステムの場合、作成者や時間なしで単一の注釈を簡単に伝達できる。情報を変更する可能性があるため、この要素をナラティブに含める必要がある場合がある。 *注釈は、計算機処理れきる「変更」情報を伝達するために使用されるべきではない*。 （ユーザーの行動を強制することはほとんど不可能であるため、これはSHOULDである）。
.inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.