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

: MCC Goal Example - Weight Loss - JSON Representation

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{
  "resourceType" : "Goal",
  "id" : "WGT-loss",
  "meta" : {
    "versionId" : "5",
    "lastUpdated" : "2022-04-21T19:31:16.605+00:00",
    "source" : "#4cEZQ9s0b9YiJuf3",
    "profile" : [
      "http://hl7.org/fhir/us/mcc/StructureDefinition/MCCGoal"
    ]
  },
  "text" : {
    "status" : "extensions",
    "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 \"WGT-loss\" Version \"5\" Updated \"2022-04-21 07:31:16+0000\" </p><p style=\"margin-bottom: 0px\">Information Source: #4cEZQ9s0b9YiJuf3!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-MCCGoal.html\">Multiple Chronic Condition Care Plan Goal</a></p></div><blockquote><p><b>Goal acceptance</b></p><p><b>value</b>: <a href=\"Patient-cc-pat-pnoelle.html\">Patient/cc-pat-pnoelle</a> \" NOELLE\"</p><p><b>value</b>: disagree</p><p><b>value</b>: low-priority <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (codesystem-goal-priority.html#low-priority)</span></p></blockquote><blockquote><p><b>Goal acceptance</b></p><p><b>value</b>: <a href=\"Practitioner/PractitionerMCC-3\">Practitioner/PractitionerMCC-3</a></p><p><b>value</b>: agree</p><p><b>value</b>: high-priority <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (codesystem-goal-priority.html#high-priority)</span></p></blockquote><p><b>reason rejected</b>: Food is my only pleasure in life <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><blockquote><p><b>related goal</b></p><p><b>value</b>: this goal relates to the BMI goal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-goal-relationship-type.html\">GoalRelationshipType</a>#other)</span></p><p><b>value</b>: <a href=\"Goal/BMI\">Goal/BMI</a></p></blockquote><p><b>lifecycleStatus</b>: active</p><p><b>category</b>: Dietary <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-goal-category.html\">Goal category</a>#dietary)</span></p><p><b>priority</b>: high <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-goal-priority.html\">Goal priority</a>#high-priority \"High Priority\")</span></p><p><b>description</b>: Target weight is 150 to 155 lbs. <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> ()</span></p><p><b>subject</b>: <a href=\"Patient-cc-pat-pnoelle.html\">Patient/cc-pat-pnoelle: Patricia Noelle</a> \" NOELLE\"</p><p><b>start</b>: 2019-10-14</p><h3>Targets</h3><table class=\"grid\"><tr><td>-</td><td><b>Measure</b></td><td><b>Detail[x]</b></td><td><b>Due[x]</b></td></tr><tr><td>*</td><td>Body Weight <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#29463-7)</span></td><td>150-155 lbs</td><td>2020-04-05</td></tr></table><p><b>statusDate</b>: 2019-10-14</p><p><b>statusReason</b>: Patient wants to lose weight for general health and pain relief.</p><p><b>expressedBy</b>: <a href=\"Patient-cc-pat-pnoelle.html\">Patient/cc-pat-pnoelle: Patricia Noelle</a> \" NOELLE\"</p><p><b>addresses</b>: <span>: obesity condition</span></p><p><b>outcomeReference</b>: <a href=\"Observation/example\">Observation/example: Body Weight Measured</a></p></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/goal-acceptance",
      "extension" : [
        {
          "url" : "individual",
          "valueReference" : {
            "reference" : "Patient/cc-pat-pnoelle"
          }
        },
        {
          "url" : "status",
          "valueCode" : "disagree"
        },
        {
          "url" : "priority",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/R4/codesystem-goal-priority.html",
                "code" : "low-priority"
              }
            ]
          }
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/goal-acceptance",
      "extension" : [
        {
          "url" : "individual",
          "valueReference" : {
            "reference" : "Practitioner/PractitionerMCC-3"
          }
        },
        {
          "url" : "status",
          "valueCode" : "agree"
        },
        {
          "url" : "priority",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/R4/codesystem-goal-priority.html",
                "code" : "high-priority"
              }
            ]
          }
        }
      ]
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/goal-reasonRejected",
      "valueCodeableConcept" : {
        "text" : "Food is my only pleasure in life"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/goal-relationship",
      "extension" : [
        {
          "url" : "type",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/goal-relationship-type",
                "code" : "other"
              }
            ],
            "text" : "this goal relates to the BMI goal"
          }
        },
        {
          "url" : "target",
          "valueReference" : {
            "reference" : "Goal/BMI"
          }
        }
      ]
    }
  ],
  "lifecycleStatus" : "active",
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/goal-category",
          "code" : "dietary"
        }
      ]
    }
  ],
  "priority" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
        "code" : "high-priority",
        "display" : "High Priority"
      }
    ],
    "text" : "high"
  },
  "description" : {
    "text" : "Target weight is 150 to 155 lbs."
  },
  "subject" : {
    "reference" : "Patient/cc-pat-pnoelle",
    "display" : "Patricia Noelle"
  },
  "startDate" : "2019-10-14",
  "target" : [
    {
      "measure" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "29463-7",
            "display" : "Body Weight"
          }
        ]
      },
      "detailRange" : {
        "low" : {
          "value" : 150,
          "unit" : "lbs",
          "system" : "http://unitsofmeasure.org",
          "code" : "[lb_av]"
        },
        "high" : {
          "value" : 155,
          "unit" : "lbs",
          "system" : "http://unitsofmeasure.org",
          "code" : "[lb_av]"
        }
      },
      "dueDate" : "2020-04-05"
    }
  ],
  "statusDate" : "2019-10-14",
  "statusReason" : "Patient wants to lose weight for general health and pain relief.",
  "expressedBy" : {
    "reference" : "Patient/cc-pat-pnoelle",
    "display" : "Patricia Noelle"
  },
  "addresses" : [
    {
      "display" : "obesity condition"
    }
  ],
  "outcomeReference" : [
    {
      "reference" : "Observation/example",
      "display" : "Body Weight Measured"
    }
  ]
}