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.

Invariants

Every rule in force on a conforming instance. This profile rows are stated here; inherited rows come from the base resource and are listed so that a constraint named on an element is findable. Invariant keys elsewhere on this page link into this table.

Key	Source	Severity	On	Rule
composition-has-narrative	this profile	warning	Composition	SHOULD carry readable narrative -- at least one section with text, or a resource-level text. A note with no body renders as a blank chart entry rather than a visible error section.where(text.exists()).exists() or text.exists()
composition-signed-has-attester	this profile	error	Composition	A note or letter with status final or amended SHALL identify who signed it -- attester with mode legal or professional. Generated summaries are exempt: nothing attests to a machine-generated summary, and naming an attester who never attested would fabricate a medico-legal signature. A summary is one whose type carries LOINC 34133-9. category is not consulted, so a note cannot buy the exemption by acquiring a refinement, and a converted summary must be remapped to say 34133-9 on type rather than carrying a source constant there. (status = 'final' or status = 'amended') implies (type.coding.where(system = 'http://loinc.org' and code = '34133-9').exists() or attester.where(mode = 'legal' or mode = 'professional').exists())
cmp-1	inherited	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	inherited	error	Composition.section	A section can only have an emptyReason if it is empty emptyReason.empty() or entry.empty()
dom-2	inherited	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3	inherited	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
dom-4	inherited	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	inherited	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6	inherited	warning	Composition	A resource should have narrative for robust management text.div.exists()
ele-1	inherited	error	Composition.meta	All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1	inherited	error	Composition.meta.extension	Must have either extensions or value[x], not both extension.exists() != value.exists()
txt-1	inherited	error	Composition.section.text.div	The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2	inherited	error	Composition.section.text.div	The narrative SHALL have some non-whitespace content htmlChecks()