DK MedCom Document
1.0.1 - release
DK MedCom Document
1.0.1 - release
This page is part of the DK MedCom Document (v1.0.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
| Official URL: http://medcomfhir.dk/ig/document/StructureDefinition/medcom-document-composition | Version: 1.0.1 | |||
| Active as of 2025-05-12 | Computable Name: MedComDocumentComposition | |||
The profile of the MedCom Document Composition containing the minimum allowed content.
The MedComDocumentComposition profile defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle. The Composition resource organizes clinical and administrative content into sections, each of which contains a narrative, and references other resources for supporting data.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
  Composition |
0..* | Composition | A set of resources composed into a single coherent clinical statement with clinical attestation dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |||||
  meta |
Σ | 0..1 | Meta | Metadata about the resource ele-1: All FHIR elements must have a @value or children | ||||
   profile |
SΣ | 1..1 | canonical(StructureDefinition) | Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children | ||||
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children | ||||
| language |
S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
ele-1: All FHIR elements must have a @value or children | ||||
| text |
S | 0..1 | Narrative | Text summary of the resource, for human interpretation ele-1: All FHIR elements must have a @value or children | ||||
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | ||||
| status |
?!SΣ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. ele-1: All FHIR elements must have a @value or children Required Pattern: final | ||||
| type |
SΣ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: FHIRDocumentTypeCodes (preferred): Type of a composition. ele-1: All FHIR elements must have a @value or children | ||||
 subject |
SΣ | 1..1 | Reference(MedComDocumentPatient) {b} | Who and/or what the composition is about ele-1: All FHIR elements must have a @value or children | ||||
| date |
SΣ | 1..1 | dateTime | Composition editing time ele-1: All FHIR elements must have a @value or children | ||||
 Slices for author |
Σ | 1..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) {b} | Who and/or what authored the composition Slice: Unordered, Closed by type:$this.resolve() ele-1: All FHIR elements must have a @value or children | ||||
  author:institution |
SΣ | 1..1 | Reference(MedComDocumentOrganization) | The organization who authored the document ele-1: All FHIR elements must have a @value or children | ||||
 author:person |
SΣ | 0..1 | Reference(MedComDocumentPractitioner) | The person who authored the document ele-1: All FHIR elements must have a @value or children | ||||
| title |
SΣ | 1..1 | string | Human Readable name/title ele-1: All FHIR elements must have a @value or children | ||||
| confidentiality |
SΣ | 1..1 | code | As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition. ele-1: All FHIR elements must have a @value or children | ||||
| attester |
S | 0..1 | BackboneElement | Attests to accuracy of composition ele-1: All FHIR elements must have a @value or children | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | ||||
| mode |
S | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children | ||||
| party |
S | 0..1 | Reference(MedComDocumentPractitioner) {b} | Who attested the composition ele-1: All FHIR elements must have a @value or children | ||||
| event |
SΣ | 0..1 | BackboneElement | The clinical service(s) being documented ele-1: All FHIR elements must have a @value or children | ||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | ||||
| code |
SΣ | 0..1 | CodeableConcept | Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. ele-1: All FHIR elements must have a @value or children | ||||
| period |
Σ | 0..1 | Period | The period covered by the documentation ele-1: All FHIR elements must have a @value or children | ||||
| start |
SΣC | 0..1 | dateTime | Starting time with inclusive boundary ele-1: All FHIR elements must have a @value or children | ||||
| end |
SΣC | 0..1 | dateTime | End time with inclusive boundary, if not ongoing ele-1: All FHIR elements must have a @value or children | ||||
| detail |
SΣ | 0..* | Reference(Resource) | The event(s) being documented ele-1: All FHIR elements must have a @value or children | ||||
 section |
SC | 1..* | BackboneElement | Composition is broken into sections cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children | ||||
 modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both | ||||
| text |
SC | 0..1 | Narrative | Text summary of the section, for human interpretation ele-1: All FHIR elements must have a @value or children | ||||
| entry |
SC | 0..* | Reference(Resource) | A reference to data that supports this section ele-1: All FHIR elements must have a @value or children | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet / Code | URI | |||
| Composition.language | preferred | CommonLanguageshttp://hl7.org/fhir/ValueSet/languagesfrom the FHIR Standard
| ||||
| Composition.status | required | Pattern: finalhttp://hl7.org/fhir/ValueSet/composition-status|4.0.1from the FHIR Standard | ||||
| Composition.type | preferred | FHIRDocumentTypeCodeshttp://hl7.org/fhir/ValueSet/doc-typecodesfrom the FHIR Standard | ||||
| Composition.confidentiality | required | v3.ConfidentialityClassificationhttp://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification|2014-03-26from the FHIR Standard | ||||
| Composition.attester.mode | required | CompositionAttestationModehttp://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1from the FHIR Standard | ||||
| Composition.event.code | example | ActCodehttp://terminology.hl7.org/ValueSet/v3-ActCode |
| Id | Grade | Path(s) | Details | Requirements |
| cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists() | |
| cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty() | |
| dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | Composition | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | Composition | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Other representations of profile: CSV, Excel, Schematron
