Generated Narrative: StructureDefinition ch-orf-consent Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Consent 0..* Consent CH ORF Consent Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url extension:consentCode S 0..1 Coding CH ORF Consent Code URL: http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-consentcode Binding: Consent Status (required) extension:consentNote S 0..1 string CH ORF Consent Note URL: http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-consentnote status 1..1 code draft | proposed | active | rejected | inactive | entered-in-error Required Pattern: active scope 1..1 CodeableConcept Which of the four areas this resource covers (extensible) Required Pattern: At least the following coding 1..* Coding Code defined by a terminology system Fixed Value: (complex) system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/consentscope code 1..1 code Symbol in syntax defined by the system Fixed Value: patient-privacy category 1..* CodeableConcept Classification of the consent statement - for indexing/retrieval Required Pattern: At least the following coding 1..* Coding Code defined by a terminology system Fixed Value: (complex) system 1..1 uri Identity of the terminology system Fixed Value: http://loinc.org code 1..1 code Symbol in syntax defined by the system Fixed Value: 59284-0 policyRule 0..1 CodeableConcept Element required due to rule 'ppc-1'. Because it is not applicable in the context of CH ORF, a data absent reason is given. extension 1..* Extension Extension Slices for extension Content/Rules for all slices extension:data-absent-reason 1..1 (Complex) unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason value[x] 1..1 code Value of extension Required Pattern: not-applicable <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format
Profile to specify if the patient gave an informed consent to this order; in particulars for spitex and transfer to retirement home etc.
A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.
Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.
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
exists(f:policy) or exists(f:policyRule)
IF Scope=privacy, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='patient-privacy'])))
IF Scope=research, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='research').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='research'])))
patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='adr'])))
IF Scope=treatment, there must be a patient
patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()
exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='treatment'])))
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.
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).
Text summary of the resource, for human interpretation
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifier for this record (external references)
Unique identifier for this copy of the Consent Statement.
This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.
draft | proposed | active | rejected | inactive | entered-in-error
Indicates the current state of this consent.
This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the Consent as not currently valid.
The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Which of the four areas this resource covers (extensible)
A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.
Allows changes to codes based on scope selection
The four anticipated uses for the Consent Resource.
Classification of the consent statement - for indexing/retrieval
A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
A classification of the type of consents found in a consent statement.
The patient/healthcare consumer to whom this consent applies.
Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.
When this Consent was created or indexed
When this Consent was issued / created / indexed.
This is not the time of the original consent, but the time that this statement was made or derived.
Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.
Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.
The organization that manages the consent, and the framework within which it is executed.
The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Field 19 Informational Material Supplied Indicator
The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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.
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
Entity or Organization having regulatory jurisdiction or accountability for enforcing policies pertaining to Consent Directives.
This element is for discoverability / documentation and does not modify or qualify the policy rules.
Element required due to rule 'ppc-1'. Because it is not applicable in the context of CH ORF, a data absent reason is given.
A reference to the specific base computable regulation or policy.
If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.
Might be a unique identifier of a policy set in XACML, or other rules engine.
Extensions are always sliced by (at least) url
unknown | asked | temp | notasked | masked | unsupported | astext | error
Provides a reason why the expected value or elements in the element that is extended are missing.
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](http://hl7.org/fhir/R5/extensibility.html) for a list).
A reference to a code defined by a terminology system.
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
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
Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.
Who verified the instruction (Patient, Relative or other Authorized Person).
Constraints to the base Consent.policyRule
An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.
Action to take - permit or deny - when the rule conditions are met. Not permitted in root rule, required in all nested rules.
How a rule statement is applied, such as adding additional consent or removing consent.
Who|what controlled by this rule (or group, by role)
Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').
There is no specific actor associated with the exception
How the individual is involved in the resources content that is described in the exception.
How an actor is involved in the consent considerations.
Resource for the actor (or group, by role)
The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').
Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.
Security Labels that define affected resources
A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.
If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.
Security Labels from the Healthcare Privacy and Security Classification System.
Context of activities covered by this rule
The context of the activities a user is taking - why the user is accessing the data - that are controlled by this rule.
When the purpose of use tag is on the data, access request purpose of use shall not conflict.
What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.
The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.
Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.
The class (type) of information a consent rule covers.
e.g. LOINC or SNOMED CT code, etc. in the content
If this code is found in an instance, then the rule applies.
Typical use of this is a Document code with class = CDA.
If this code is found in an instance, then the exception applies.
Timeframe for data controlled by this rule
Clinical or Operational Relevant period of time that bounds the data controlled by this rule.
This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.
The resources controlled by this rule if specific resources are referenced.
instance | related | dependents | authoredby
How the resource reference is interpreted when testing consent restrictions.
How a resource reference is interpreted when testing consent restrictions.
A reference to a specific resource that defines which resources are covered by this consent.
Rules which provide exceptions to the base rule or subrules.