MCC eCare Plan Implementation Guide
0.1.0 - CI Build
US
MCC eCare Plan Implementation Guide
0.1.0 - CI Build
US
MCC eCare Plan Implementation Guide - Local Development build (v0.1.0). See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CarePlan;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "MCCCarePlan"];
fhir:Resource.meta [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/instance-name" ];
fhir:Extension.valueString [ fhir:value "Multiple Chronic Condition Care Plan Example" ] ], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/instance-description" ];
fhir:Extension.valueMarkdown [ fhir:value "This is an example for the *MCC CarePlan Profile*." ] ];
fhir:Meta.versionId [ fhir:value "3" ];
fhir:Meta.lastUpdated [ fhir:value "2022-04-21T17:36:21.612+00:00"^^xsd:dateTime ];
fhir:Meta.source [ fhir:value "#RnawHckMdX9QjJoN" ];
fhir:Meta.profile [
fhir:value "http://hl7.org/fhir/us/mcc/StructureDefinition/mccCarePlan";
fhir:index 0;
fhir:link <http://hl7.org/fhir/us/mcc/StructureDefinition/mccCarePlan> ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"MCCCarePlan\" Version \"3\" Updated \"2022-04-21 05:36:21+0000\" </p><p style=\"margin-bottom: 0px\">Information Source: #RnawHckMdX9QjJoN!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-mccCarePlan.html\">Multiple Chronic Care Condition Care Plan</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: plan</p><p><b>category</b>: Care Plan <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#734163000; <a href=\"http://hl7.org/fhir/us/core/STU4/CodeSystem-careplan-category.html\">US Core CarePlan Category Extension Codes</a>#assess-plan)</span></p><p><b>subject</b>: <a href=\"Patient-cc-pat-pnoelle.html\">Patient/cc-pat-pnoelle: Patricia Noelle</a> \" NOELLE\"</p><p><b>period</b>: 2018-05-01 --> (ongoing)</p><p><b>created</b>: 2019-01-01</p><p><b>author</b>: <a href=\"PractitionerRole-PractitionerRoleMCC2.html\">PractitionerRole/PractitionerRoleMCC2: Nancy Nurse RN</a></p><p><b>contributor</b>: </p><ul><li><a href=\"PractitionerRole-PractitionerRoleMCC1.html\">PractitionerRole/PractitionerRoleMCC1: Henry Levin VII MD Nephrologist</a></li><li><a href=\"PractitionerRole-PractitionerRoleMCC2.html\">PractitionerRole/PractitionerRoleMCC2: Nancy Nurse RN</a></li><li><a href=\"PractitionerRole-PractitionerRoleMCC3.html\">PractitionerRole/PractitionerRoleMCC3: Peter Primary MD Primary Provider</a></li></ul><p><b>careTeam</b>: <a href=\"CareTeam-MCCCareTeamexample.html\">CareTeam/MCCCareTeamexample: Longitudinal care-coordination focused care team</a> \"US-Core MCC example CareTeam\"</p><p><b>addresses</b>: <a href=\"Condition-ConditionCKD.html\">Condition/ConditionCKD: Chronic Kidney Disease</a></p><p><b>supportingInfo</b>: </p><ul><li><a href=\"Procedure-Dialysis.html\">Procedure/Dialysis: Chronic Pain</a></li><li><a href=\"http://hl7.org/fhir/uv/sdc/QuestionnaireResponse/questionnaireresponse-sdc-profile-example-PHQ9\">http://hl7.org/fhir/uv/sdc/QuestionnaireResponse/questionnaireresponse-sdc-profile-example-PHQ9: Patient health questionnaire 9 item total score: 13 Moderate Depression</a></li><li><a href=\"Observation-bunMCC.html\">Observation/bunMCC: BUN 24 mL/min/{1.73_m2}</a></li></ul><p><b>goal</b>: <a href=\"Goal-WGT-loss.html\">Goal/WGT-loss: Lose weight, decrease chronic pain with less use of pain medication and improved lab results</a></p><blockquote><p><b>activity</b></p><p><b>outcomeReference</b>: <a href=\"Procedure-Dialysis.html\">Procedure/Dialysis: Dialysis</a></p><p><b>progress</b>: Patricia Noelle is measuring her weight daily ( @2019-01-10)</p><p><b>reference</b>: <a href=\"http://example.org/Task/123\">http://example.org/Task/123: Patricia Noelle or cargiver to perform daily weights</a></p></blockquote><blockquote><p><b>activity</b></p><p><b>outcomeReference</b>: </p><ul><li><a href=\"http://example.org/Encounter/123\">http://example.org/Encounter/123: PreOp Encounter For Creation of external arteriovenous shunt (procedure)</a></li><li><a href=\"http://example.org/Procedure/upperlimbveinUS\">http://example.org/Procedure/upperlimbveinUS: Fluoroscopic venography of bilateral upper limbs Performed. Results: Normal</a></li></ul><p><b>progress</b>: Patricia Noelle Completed prep for an AV Shunt. She needs the shunt due to the need for diayalis related to the goal to improve her health related to CKD ( @2019-01-10)</p><p><b>reference</b>: <a href=\"http://example.org/Appointment/AVShunt\">http://example.org/Appointment/AVShunt: PreOp Encounter Request For Creation of external arteriovenous shunt (procedure). Relates to overall health improvement goal and encounter requestActivity</a></p></blockquote></div>"
];
fhir:CarePlan.status [ fhir:value "active"];
fhir:CarePlan.intent [ fhir:value "plan"];
fhir:CarePlan.category [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:734163000;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "734163000" ];
fhir:Coding.display [ fhir:value "Care Plan" ] ], [
fhir:index 1;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/core/CodeSystem/careplan-category" ];
fhir:Coding.code [ fhir:value "assess-plan" ] ]
];
fhir:CarePlan.subject [
fhir:Reference.reference [ fhir:value "Patient/cc-pat-pnoelle" ];
fhir:Reference.display [ fhir:value "Patricia Noelle" ]
];
fhir:CarePlan.period [
fhir:Period.start [ fhir:value "2018-05-01"^^xsd:date ]
];
fhir:CarePlan.created [ fhir:value "2019-01-01"^^xsd:date];
fhir:CarePlan.author [
fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRoleMCC2" ];
fhir:Reference.display [ fhir:value "Nancy Nurse RN" ]
];
fhir:CarePlan.contributor [
fhir:index 0;
fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRoleMCC1" ];
fhir:Reference.display [ fhir:value "Henry Levin VII MD Nephrologist" ]
], [
fhir:index 1;
fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRoleMCC2" ];
fhir:Reference.display [ fhir:value "Nancy Nurse RN" ]
], [
fhir:index 2;
fhir:Reference.reference [ fhir:value "PractitionerRole/PractitionerRoleMCC3" ];
fhir:Reference.display [ fhir:value "Peter Primary MD Primary Provider" ]
];
fhir:CarePlan.careTeam [
fhir:index 0;
fhir:Reference.reference [ fhir:value "CareTeam/MCCCareTeamexample" ];
fhir:Reference.display [ fhir:value "Longitudinal care-coordination focused care team" ]
];
fhir:CarePlan.addresses [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Condition/ConditionCKD" ];
fhir:Reference.display [ fhir:value "Chronic Kidney Disease" ]
];
fhir:CarePlan.supportingInfo [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Procedure/Dialysis" ];
fhir:Reference.display [ fhir:value "Chronic Pain" ]
], [
fhir:index 1;
fhir:link <http://hl7.org/fhir/uv/sdc/QuestionnaireResponse/questionnaireresponse-sdc-profile-example-PHQ9>;
fhir:Reference.reference [ fhir:value "http://hl7.org/fhir/uv/sdc/QuestionnaireResponse/questionnaireresponse-sdc-profile-example-PHQ9" ];
fhir:Reference.display [ fhir:value "Patient health questionnaire 9 item total score: 13 Moderate Depression" ]
], [
fhir:index 2;
fhir:Reference.reference [ fhir:value "Observation/bunMCC" ];
fhir:Reference.display [ fhir:value "BUN 24 mL/min/{1.73_m2}" ]
];
fhir:CarePlan.goal [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Goal/WGT-loss" ];
fhir:Reference.display [ fhir:value "Lose weight, decrease chronic pain with less use of pain medication and improved lab results" ]
];
fhir:CarePlan.activity [
fhir:index 0;
fhir:CarePlan.activity.outcomeReference [
fhir:index 0;
fhir:Reference.reference [ fhir:value "Procedure/Dialysis" ];
fhir:Reference.display [ fhir:value "Dialysis" ] ];
fhir:CarePlan.activity.progress [
fhir:index 0;
fhir:Annotation.time [ fhir:value "2019-01-10"^^xsd:date ];
fhir:Annotation.text [ fhir:value "Patricia Noelle is measuring her weight daily" ] ];
fhir:CarePlan.activity.reference [
fhir:link <http://example.org/Task/123>;
fhir:Reference.reference [ fhir:value "http://example.org/Task/123" ];
fhir:Reference.display [ fhir:value "Patricia Noelle or cargiver to perform daily weights" ] ]
], [
fhir:index 1;
fhir:CarePlan.activity.outcomeReference [
fhir:index 0;
fhir:link <http://example.org/Encounter/123>;
fhir:Reference.reference [ fhir:value "http://example.org/Encounter/123" ];
fhir:Reference.display [ fhir:value "PreOp Encounter For Creation of external arteriovenous shunt (procedure)" ] ], [
fhir:index 1;
fhir:link <http://example.org/Procedure/upperlimbveinUS>;
fhir:Reference.reference [ fhir:value "http://example.org/Procedure/upperlimbveinUS" ];
fhir:Reference.display [ fhir:value "Fluoroscopic venography of bilateral upper limbs Performed. Results: Normal" ] ];
fhir:CarePlan.activity.progress [
fhir:index 0;
fhir:Annotation.time [ fhir:value "2019-01-10"^^xsd:date ];
fhir:Annotation.text [ fhir:value "Patricia Noelle Completed prep for an AV Shunt. She needs the shunt due to the need for diayalis related to the goal to improve her health related to CKD" ] ];
fhir:CarePlan.activity.reference [
fhir:link <http://example.org/Appointment/AVShunt>;
fhir:Reference.reference [ fhir:value "http://example.org/Appointment/AVShunt" ];
fhir:Reference.display [ fhir:value "PreOp Encounter Request For Creation of external arteriovenous shunt (procedure). Relates to overall health improvement goal and encounter requestActivity" ] ]
].
<http://hl7.org/fhir/uv/sdc/QuestionnaireResponse/questionnaireresponse-sdc-profile-example-PHQ9> a fhir:uv.
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2020+ HL7 International - Patient Care WG. Package hl7.fhir.us.mcc#0.1.0 based on FHIR 4.0.1. Generated 2022-04-21
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