Composition Profile

Canonical	../StructureDefinition/nexus-emr-core-composition
Status	draft · 1.26.0
Base	Composition (constraint)
Source	FSH · JSON

Nexus EMR profile for an AUTHORED clinical note -- principally the encounter note (progress note, consult note, telephone note) written by an EMR user or drafted by an AI scribe and attested by a clinician.

Examples

AI Pre-Visit Summary (cited document) · Progress Note - 8 Apr 2025 · Referral - Internal Medicine - Avery Linwood · Signed Encounter Note (extraction source) · Since last visit - Avery Linwood · Since last visit - Avery Linwood (converted) · Telephone Note - 20 May 2025 (amended)

Referral - Internal Medicine - Avery Linwood

Composition/letter-avery-20250522 — claims conformance to Composition Profile

{
  "resourceType": "Composition",
  "id": "letter-avery-20250522",
  "meta": {
    "profile": [
      "../StructureDefinition/nexus-emr-core-composition"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p>A referral letter for Avery Linwood, written and signed by Dr. Emil Navarro. Classified as a letter on both <code>category</code> and <code>type</code> (LOINC 51852-2). Status <code>final</code> with a legal attester: a letter goes out over a clinician's name, so unlike a generated summary it is never exempt from the signed-has-attester rule. A letter's three dates are all distinct and all present here: the referral was decided at 09:15 (<code>event.period.start</code>, the clinical date), the letter was written at 09:40 (<code>date</code>), and it was signed at 09:47 (<code>attester.time</code>). The body is the letter itself, carried as authored XHTML in <code>section.text</code> — letterhead, salutation, body and signature block are all narrative, exactly as the author composed them.</p></div>"
  },
  "status": "final",
  "type": {
    "coding": [
      {
        "system": "http://loinc.org",
        "code": "51852-2",
        "display": "Letter"
      }
    ]
  },
  "category": [
    {
      "coding": [
        {
          "system": "http://loinc.org",
          "code": "51852-2",
          "display": "Letter"
        }
      ]
    }
  ],
  "subject": {
    "reference": "Patient/avery-linwood",
    "display": "Avery Linwood"
  },
  "date": "2025-05-22T09:40:00-06:00",
  "author": [
    {
      "reference": "Practitioner/dr-emil-navarro",
      "display": "Dr. Emil Navarro"
    }
  ],
  "title": "Referral - Internal Medicine - Avery Linwood",
  "attester": [
    {
      "mode": "legal",
      "time": "2025-05-22T09:47:00-06:00",
      "party": {
        "reference": "Practitioner/dr-emil-navarro",
        "display": "Dr. Emil Navarro"
      }
    }
  ],
  "event": [
    {
      "code": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "3457005",
              "display": "Patient referral"
            }
          ]
        }
      ],
      "period": {
        "start": "2025-05-22T09:15:00-06:00"
      }
    }
  ],
  "section": [
    {
      "title": "Referral - Internal Medicine - Avery Linwood",
      "text": {
        "status": "additional",
        "div": "<div xmlns="http://www.w3.org/1999/xhtml"><h3>Cedarbrook Family Health — Site A</h3><p>Calgary, AB T2N 1A1 | Tel (403) 555-0142 | Fax (403) 555-0143</p><h3>Referral letter</h3><p>22 May 2025</p><p>Dear Internal Medicine consult service,</p><p>Re: Avery Linwood | Date of birth: 1990-06-05 | Health number: 1234567890</p><p>I would appreciate your assessment of this 34-year-old patient with iron deficiency anemia whose iron stores are not repleting as expected on oral therapy.</p><p>Avery was diagnosed in February 2025 (Hgb 102 g/L, ferritin 8 ug/L) and started on ferrous sulfate 325 mg daily. The hemoglobin has responded (118 g/L on 8 April), but the ferritin remains well below target — 24 ug/L on 12 May after three months of replacement with good adherence. There has been no melena, no hematochezia, and no heavy menstrual bleeding; the only medication side effect has been constipation, managed with docusate.</p><p>Given the sluggish repletion despite adherence, I would value your opinion on whether evaluation for an occult source of loss — including endoscopic assessment — is warranted at this point, or whether a further period of oral replacement with escalation criteria is reasonable.</p><p>Current medications: ferrous sulfate 325 mg PO daily; docusate sodium 100 mg PO BID PRN. No known drug allergies.</p><p>Thank you for seeing this patient. I have asked Avery to expect your office's call, and I am happy to provide any further records you need.</p><p>Yours sincerely,</p><p>Dr. Emil Navarro, MD CCFP</p></div>"
      }
    },
    {
      "title": "Enclosures",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "28562-7",
            "display": "Chart section Set"
          }
        ]
      },
      "entry": [
        {
          "reference": "List/packet-avery-20250522",
          "display": "Enclosures - Internal Medicine referral letter - Avery Linwood"
        }
      ],
      "text": {
        "status": "generated",
        "div": "<div xmlns="http://www.w3.org/1999/xhtml">Three enclosures travel with this letter: the anemia consult summary, the April CBC (pages 1 and 4 excluded), and the filed WSIB Form 8. Membership and order live on the packet, which is what this section's single entry points at.</div>"
      }
    }
  ]
}