{
  "resourceType": "StructureDefinition",
  "id": "nexus-emr-core-item-consent",
  "extension": [
    {
      "url": "https://fhir.apps.health/StructureDefinition/effective-date",
      "extension": [
        {
          "url": "paths",
          "valueString": "dateTime"
        }
      ]
    },
    {
      "url": "https://fhir.apps.health/StructureDefinition/smart-exposed",
      "extension": [
        {
          "url": "read",
          "valueString": "consent:read"
        }
      ]
    }
  ],
  "url": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-item-consent",
  "name": "NexusEmrCoreItemConsent",
  "title": "Nexus EMR Item Consent Profile Core",
  "status": "draft",
  "description": "Patient-level consent for one catalogue item — whether the clinic may email the patient, text\nthe patient, or use an AI scribe during their visit. Recorded manually by clinic staff from\nwhat the patient tells them, not captured through a patient-facing flow.\n\nOne Consent resource exists per (patient, item) and is updated in place as the patient changes\ntheir mind. `category` identifies the item and is the lookup key; **`provision.type` carries the\ndecision** -- `permit` is Provided, `deny` is Declined -- and `status` says only whether the record\nis operative.\n\nThis profile used to carry its answer in `status` alone. That made an active item consent mean\npermission while an active privacy directive means a restriction in force, across resources sharing\na resource type, a scope and a search. Every Consent profile in this guide now states its decision\nin the same element.",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Consent",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Consent",
  "derivation": "constraint",
  "snapshot": {
    "element": [
      {
        "id": "Consent",
        "path": "Consent",
        "short": "Patient consent for one catalogue item (Email | SMS | AI Scribe) Core",
        "definition": "Records the patient's current answer for a single consent item, as recorded by clinic staff.\n\n**One resource per (patient, item), updated in place.** There is never more than one Consent\nfor a given patient and item. When the patient changes their mind, the same resource is updated\n— `status` flips, `dateTime` is re-stamped, `performer` is set to whoever recorded the change —\nrather than a second Consent being created. The decision history is therefore the resource's\nFHIR version history: read prior versions through `_history` to see what was decided before,\nby whom, and with what reason and evidence attached.\n\n**The decision lives in `provision.type`.** `permit` is Provided, `deny` is Declined. This is the\nsame element, carrying the same meaning, as every other Consent profile in this guide:\n\n| `provision.type` | `status`            | Meaning                                                    |\n|------------------|---------------------|------------------------------------------------------------|\n| `permit`         | `active`            | Provided — the patient consented to this item              |\n| `deny`           | `active`            | Declined — the patient did not consent, or withdrew        |\n| *(any)*          | `entered-in-error`  | The record was created in error and must be ignored        |\n| *(no Consent)*   | —                   | Not Recorded — nobody has asked, or nobody wrote it down   |\n\n`deny` covers both an initial decline and a revocation of a previously provided consent, so a\nconsumer checks exactly one value to know the item is not permitted; it never needs to distinguish\n\"said no\" from \"said yes then changed their mind\". That distinction is recoverable from version\nhistory, and from the status-reason extension when staff recorded one.\n\nTransitions between `permit` and `deny` are expected and legal in both directions, any number of\ntimes. `status` stays `active` throughout: the record is operative whichever way the answer points.\n\n**The gate reads `provision.type`.** A consumer deciding whether it may act on an item MUST permit\nthe behaviour only where a Consent exists, `status` is `active`, and `provision.type` is `permit`.\nEverything else withholds it: no Consent at all, `deny`, `entered-in-error`, and a root provision\nthat states no type. Consent is opt-in, so silence is never a yes.\n\nA gate written on `status` alone permits a declined item, because a declined item consent is\n`active`. The answer is not in `status`, and this profile does not write `rejected`.\n\n**Absence is meaningful, and it is not a refusal.** No Consent for a (patient, item) pair means Not\nRecorded. It withholds the behaviour exactly as `deny` does, and it is shown to staff distinctly,\nbecause a patient who has never been asked is a prompt to ask. `entered-in-error` reads the same way\non both counts: unanswered to a reader, no permission to a gate.\n\n**Finding an item consent.** Search by patient and item coding:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|{code}\n```\n\nAt most one resource comes back. That same search is also the WRITE path: a conditional update\nagainst it creates-or-updates in one call, with no prior read. See `identifier` for the form.",
        "comment": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent",
          "min": 0,
          "max": "*"
        },
        "constraint": [
          {
            "key": "dom-2",
            "severity": "error",
            "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
            "expression": "contained.contained.empty()",
            "xpath": "not(parent::f:contained and f:contained)",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-3",
            "severity": "error",
            "human": "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",
            "expression": "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()",
            "xpath": "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='#'])]))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-4",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
            "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
            "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "dom-5",
            "severity": "error",
            "human": "If a resource is contained in another resource, it SHALL NOT have a security label",
            "expression": "contained.meta.security.empty()",
            "xpath": "not(exists(f:contained/*/f:meta/f:security))",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
                "valueBoolean": true
              },
              {
                "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
                "valueMarkdown": "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."
              }
            ],
            "key": "dom-6",
            "severity": "warning",
            "human": "A resource should have narrative for robust management",
            "expression": "text.`div`.exists()",
            "xpath": "exists(f:text/h:div)",
            "source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
          },
          {
            "key": "ppc-1",
            "severity": "error",
            "human": "Either a Policy or PolicyRule",
            "expression": "policy.exists() or policyRule.exists()",
            "xpath": "exists(f:policy) or exists(f:policyRule)"
          },
          {
            "key": "ppc-2",
            "severity": "error",
            "human": "IF Scope=privacy, there must be a patient",
            "expression": "patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()",
            "xpath": "exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='patient-privacy'])))"
          },
          {
            "key": "ppc-3",
            "severity": "error",
            "human": "IF Scope=research, there must be a patient",
            "expression": "patient.exists() or scope.coding.where(system='something' and code='research').exists().not()",
            "xpath": "exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='research'])))"
          },
          {
            "key": "ppc-4",
            "severity": "error",
            "human": "IF Scope=adr, there must be a patient",
            "expression": "patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()",
            "xpath": "exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='adr'])))"
          },
          {
            "key": "ppc-5",
            "severity": "error",
            "human": "IF Scope=treatment, there must be a patient",
            "expression": "patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()",
            "xpath": "exists(f:patient) or not(exists(f:scope/f:coding[f:system/@value='something' and f:code/@value='treatment'])))"
          },
          {
            "key": "item-consent-status-is-defined",
            "severity": "warning",
            "human": "SHOULD carry one of the two status codes this profile gives meaning: active (the record is operative) or entered-in-error (retracted). The DECISION is `provision.type`, not `status` — recommended, not enforced",
            "expression": "status = 'active' or status = 'entered-in-error'",
            "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-item-consent"
          },
          {
            "key": "item-consent-performer-is-attributable",
            "severity": "warning",
            "human": "SHOULD name who made the decision and carry their display text, since the decision-maker is shown to staff from performer.display (recommended, not enforced)",
            "expression": "performer.exists() and performer.display.exists()",
            "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-item-consent"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "Entity. Role, or Act"
          },
          {
            "identity": "workflow",
            "map": "Event"
          },
          {
            "identity": "v2",
            "map": "CON"
          },
          {
            "identity": "rim",
            "map": "FinancialConsent"
          }
        ]
      },
      {
        "id": "Consent.id",
        "path": "Consent.id",
        "short": "Logical id of this artifact",
        "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
        "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta",
        "path": "Consent.meta",
        "short": "Metadata about the resource",
        "definition": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.meta",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Meta"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta.id",
        "path": "Consent.meta.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.meta.extension",
        "path": "Consent.meta.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.meta.versionId",
        "path": "Consent.meta.versionId",
        "short": "Version specific identifier",
        "definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.",
        "comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Meta.versionId",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "id"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta.lastUpdated",
        "path": "Consent.meta.lastUpdated",
        "short": "When the resource version last changed",
        "definition": "When the resource last changed - e.g. when the version changed.",
        "comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Meta.lastUpdated",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "instant"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta.source",
        "path": "Consent.meta.source",
        "short": "Identifies EMR instance & pipeline version the resource came from",
        "definition": "A URI that identifies the EMR pipeline and version from which this resource originated.  This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.",
        "comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Meta.source",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta.profile",
        "path": "Consent.meta.profile",
        "short": "Profiles this resource claims to conform to",
        "definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).",
        "comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time.  The list of profile URLs is a set.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Meta.profile",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "canonical",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/StructureDefinition"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.meta.security",
        "path": "Consent.meta.security",
        "short": "Security Labels applied to this resource",
        "definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
        "comment": "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Meta.security",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "SecurityLabels"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
              "valueBoolean": true
            }
          ],
          "strength": "extensible",
          "description": "Security Labels from the Healthcare Privacy and Security Classification System.",
          "valueSet": "http://hl7.org/fhir/ValueSet/security-labels"
        }
      },
      {
        "id": "Consent.meta.tag",
        "path": "Consent.meta.tag",
        "short": "Tags applied to this resource",
        "definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
        "comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Meta.tag",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "Tags"
            }
          ],
          "strength": "example",
          "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".",
          "valueSet": "http://hl7.org/fhir/ValueSet/common-tags"
        }
      },
      {
        "id": "Consent.implicitRules",
        "path": "Consent.implicitRules",
        "short": "A set of rules under which this content was created",
        "definition": "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.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.implicitRules",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "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",
        "isSummary": true
      },
      {
        "id": "Consent.language",
        "path": "Consent.language",
        "short": "Language of the resource content",
        "definition": "The base language in which the resource is written.",
        "comment": "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).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Resource.language",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
              "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "Language"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
              "valueBoolean": true
            }
          ],
          "strength": "preferred",
          "description": "A human language.",
          "valueSet": "http://hl7.org/fhir/ValueSet/languages"
        }
      },
      {
        "id": "Consent.text",
        "path": "Consent.text",
        "short": "Text summary of the resource, for human interpretation",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "narrative",
          "html",
          "xhtml",
          "display"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "DomainResource.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Narrative"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "Act.text?"
          }
        ]
      },
      {
        "id": "Consent.contained",
        "path": "Consent.contained",
        "short": "Contained, inline Resources",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "inline resources",
          "anonymous resources",
          "contained resources"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.contained",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Resource"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.extension",
        "path": "Consent.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "May be used to represent additional information that is not part of the basic definition of the resource. 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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.extension:statusReason",
        "path": "Consent.extension",
        "sliceName": "statusReason",
        "short": "Free-text reason for the current status (typically on revocation)",
        "definition": "Optional free text explaining why the consent is in its current status — most often what the\npatient said when withdrawing a consent they had previously provided.\n\nAlways optional, on every status. Absence carries no meaning, and consumers must render a status\nchange with no reason as a complete record. The reason is deliberately uncoded free text so it\nkeeps the patient's own words.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "DomainResource.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.apps.health/StructureDefinition/nexus-consent-status-reason"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.modifierExtension",
        "path": "Consent.modifierExtension",
        "short": "Extensions that cannot be ignored",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "DomainResource.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.identifier",
        "path": "Consent.identifier",
        "short": "Business identifier(s) for item consent",
        "definition": "Unique identifiers for the item consent.\n\nUnlike the profiles describing resources converted from a source EMR, this one expects no\nsource-system identifier: an item consent is created here, when staff record the patient's answer,\nso there is no upstream record for it to point back at. A resource carrying no identifier at all is\ncomplete.\n\n**The singleton is stated by the search, not by a computed key.** Exactly one Consent exists per\n(patient, item), and the patient and the item are both modelled elements, so a writer addresses the\npair directly and creates-or-updates in a single call:\n\n  PUT Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|ai-scribe\n\nThe server matches the existing resource and adds a version, or creates the resource when there is\nno match — which is exactly the intended lifecycle, and means two staff saving the same item at the\nsame moment produce two versions of one resource rather than two competing resources. It is the same\nsearch a reader uses to find an item consent, so a reader and a writer name the pair the same way,\nand there is no second value to keep in step with it.\n\n**A retired identifier appears on older records.** `NamingSystem/nexus-item-consent-identifier`\ncarried a value composed as `{patient-logical-id}:{item-code}`, and it is retired. The patient half\nis `Resource.id` — the address a resource has on one server — so a re-ingest, a store migration or a\ncopy between deployments leaves a recorded value naming an id that no longer exists, and the\nconsequence is quiet: a conditional update keyed on a stale value matches nothing and creates a\nsecond resource for a pair that must have exactly one, while a writer that reads the value back as a\nprecondition stops writing for that patient instead, with no error that names the cause. Read such a\nvalue as what it is, a key computed at write time. Do not recompute one, match on one, or use one as\na precondition, and do not write new ones.",
        "comment": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.identifier",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "example": [
          {
            "label": "General",
            "valueIdentifier": {
              "system": "urn:ietf:rfc:3986",
              "value": "Local eCMS identifier"
            }
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "w5",
            "map": "FiveWs.identifier"
          },
          {
            "identity": "rim",
            "map": ".id"
          }
        ]
      },
      {
        "id": "Consent.identifier.id",
        "path": "Consent.identifier.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.identifier.extension",
        "path": "Consent.identifier.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.identifier.use",
        "path": "Consent.identifier.use",
        "short": "usual | official | temp | secondary | old (If known)",
        "definition": "The purpose of this identifier.",
        "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
        "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Identifier.use",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": true,
        "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "IdentifierUse"
            }
          ],
          "strength": "required",
          "description": "Identifies the purpose for this identifier, if known .",
          "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "N/A"
          },
          {
            "identity": "rim",
            "map": "Role.code or implied by context"
          }
        ]
      },
      {
        "id": "Consent.identifier.type",
        "path": "Consent.identifier.type",
        "short": "Description of identifier",
        "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
        "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
        "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Identifier.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "IdentifierType"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
              "valueBoolean": true
            }
          ],
          "strength": "extensible",
          "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
          "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type"
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "CX.5"
          },
          {
            "identity": "rim",
            "map": "Role.code or implied by context"
          }
        ]
      },
      {
        "id": "Consent.identifier.system",
        "path": "Consent.identifier.system",
        "short": "The namespace for the identifier value",
        "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
        "comment": "Identifier.system is always case sensitive.",
        "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Identifier.system",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "example": [
          {
            "label": "General",
            "valueUri": "http://www.acme.com/identifiers/patient"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "CX.4 / EI-2-4"
          },
          {
            "identity": "rim",
            "map": "II.root or Role.id.root"
          },
          {
            "identity": "servd",
            "map": "./IdentifierType"
          }
        ]
      },
      {
        "id": "Consent.identifier.value",
        "path": "Consent.identifier.value",
        "short": "The value that is unique",
        "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
        "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Identifier.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "example": [
          {
            "label": "General",
            "valueString": "123456"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "CX.1 / EI.1"
          },
          {
            "identity": "rim",
            "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)"
          },
          {
            "identity": "servd",
            "map": "./Value"
          }
        ]
      },
      {
        "id": "Consent.identifier.period",
        "path": "Consent.identifier.period",
        "short": "Time period when id is/was valid for use",
        "definition": "Time period during which identifier is/was valid for use.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Identifier.period",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Period"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "CX.7 + CX.8"
          },
          {
            "identity": "rim",
            "map": "Role.effectiveTime or implied by context"
          },
          {
            "identity": "servd",
            "map": "./StartDate and ./EndDate"
          }
        ]
      },
      {
        "id": "Consent.identifier.assigner",
        "path": "Consent.identifier.assigner",
        "short": "Organization that issued id (may be just text)",
        "definition": "Organization that issued/manages the identifier.",
        "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Identifier.assigner",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "CX.4 / (CX.4,CX.9,CX.10)"
          },
          {
            "identity": "rim",
            "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper"
          },
          {
            "identity": "servd",
            "map": "./IdentifierIssuingAuthority"
          }
        ]
      },
      {
        "id": "Consent.status",
        "path": "Consent.status",
        "short": "active (the record is operative) | entered-in-error",
        "definition": "Required field in FHIR R4 Consent. Whether this record is operative — **not** what the patient\ndecided.\n\n- `active` — the record stands. Read `provision.type` for the answer.\n- `entered-in-error` — the record was created in error. Ignore it; it is not a decision.\n\nAbsence of any Consent for a (patient, item) pair means **Not Recorded** — no answer has been\nwritten down. Show it distinctly from a `deny`; gate it the same, under the rule stated on the\nresource itself.\n\n**`rejected` is not written by this profile, and this is a change.** Earlier releases used it for a\ndeclined or withdrawn item, which made `status` carry the decision. R4 defines `rejected` as a\nlifecycle state — a party rejected the consent — and borrowing it for a patient's answer meant one\nelement meant opposite things across the Consent families sharing this store: an `active` item\nconsent was permission, an `active` privacy directive is a restriction in force. A reader that\nchecked `status` first read a lockbox as permission.\n\nThe decision is now `provision.type`, which is where the other families already carried it. One\nelement, one meaning, whatever family a consumer is holding.\n\nThe remaining R4 consent-state codes (`draft`, `proposed`, `inactive`, `rejected`) carry no meaning\nin this profile and are not written by the EMR; a reader that meets one treats it as Not Recorded,\nand `item-consent-status-is-defined` warns on it, since the binding alone cannot express that\nnarrowing.",
        "comment": "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.",
        "requirements": "The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.status",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": true,
        "isModifierReason": "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",
        "isSummary": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-state-codes"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "FiveWs.status"
          },
          {
            "identity": "v2",
            "map": "HL7 Table 0498 - Consent Status"
          },
          {
            "identity": "rim",
            "map": ".statusCode"
          }
        ]
      },
      {
        "id": "Consent.scope",
        "path": "Consent.scope",
        "short": "patient-privacy - Privacy consent",
        "definition": "Required field in FHIR R4 Consent. For this item consent use case, always set to 'patient-privacy' as we're dealing with patient privacy consent for clinic-recorded consent items.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.scope",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "fixedCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/consentscope",
              "code": "patient-privacy",
              "display": "Privacy Consent"
            }
          ]
        },
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": true,
        "isModifierReason": "Allows changes to codes based on scope selection",
        "isSummary": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-scope"
        }
      },
      {
        "id": "Consent.category",
        "path": "Consent.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "coding.system"
            }
          ],
          "rules": "open",
          "description": "Slice category by code system: the item code, and the family code"
        },
        "short": "The consent item this resource records (Email | SMS | AI Scribe), plus the family code",
        "definition": "Required field in FHIR R4 Consent. This profile carries two codings, in two slices discriminated by\ncode system, and neither substitutes for the other.\n\n**`item` says WHICH item the patient answered.** It is the key consumers look the resource up by:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|{code}\n```\n\n**`family` says this Consent is an item consent.** Three Consent families share this store, one\n`GET Consent?patient={id}` returns them mixed, and all three carry `scope = patient-privacy` — so\n`category` is the only element that separates them, and every family in this guide carries the\nfamily code. Select this family with:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-family|item\n```\n\nThe slicing is open, so further categories may be carried alongside these two — a jurisdictional or\nworkflow classification, say. No other category identifies the item or the family, and a consumer\nMUST NOT infer either from one.",
        "comment": "Both codings sit outside HL7's consent-category value set on purpose. That value set classifies\nconsent *documents* (research consent, advance directive, privacy policy acknowledgement) and has\nno concept for a per-item communication preference, nor for this guide's own family axis, which is\nthe case an extensible binding exists to cover. Terminology-aware validators may note that the base\nextensible binding is unmet on these resources; that note is expected, not a defect.",
        "min": 2,
        "max": "*",
        "base": {
          "path": "Consent.category",
          "min": 1,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentCategory"
            }
          ],
          "strength": "extensible",
          "description": "A classification of the type of consents found in a consent statement.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-category"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "HL7 Table 0497 - Consent Type"
          },
          {
            "identity": "rim",
            "map": "CNTRCT"
          }
        ]
      },
      {
        "id": "Consent.category:item",
        "path": "Consent.category",
        "sliceName": "item",
        "short": "The consent item (single coding from the Nexus consent-item CodeSystem)",
        "definition": "The catalogue item this Consent answers, as a single coding from the Nexus consent-item\nCodeSystem. The concept definition in that CodeSystem is the standard description shown to staff\nand patients when the item is presented for a decision.",
        "comment": "Slice membership is discriminated by `coding.system`, so the item coding MUST use the Nexus\nconsent-item system. The binding is extensible rather than required because clinic-defined items\nare expected in a later phase and will be published in tenant-scoped CodeSystems; when they land,\nthis profile gains a slice for them rather than any code being smuggled into the `item` slice\nunder a foreign system.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.category",
          "min": 1,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.apps.health/ValueSet/nexus-consent-items"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "HL7 Table 0497 - Consent Type"
          },
          {
            "identity": "rim",
            "map": "CNTRCT"
          }
        ]
      },
      {
        "id": "Consent.category:item.id",
        "path": "Consent.category.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:item.extension",
        "path": "Consent.category.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding",
        "path": "Consent.category.coding",
        "short": "Code defined by a terminology system",
        "definition": "A reference to a code defined by a terminology system.",
        "comment": "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.",
        "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "CodeableConcept.coding",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.1-8, C*E.10-22"
          },
          {
            "identity": "rim",
            "map": "union(., ./translation)"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.id",
        "path": "Consent.category.coding.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.extension",
        "path": "Consent.category.coding.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.system",
        "path": "Consent.category.coding.system",
        "short": "Identity of the terminology system",
        "definition": "The identification of the code system that defines the meaning of the symbol in the code.",
        "comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
        "requirements": "Need to be unambiguous about the source of the definition of the symbol.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Coding.system",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "fixedUri": "https://fhir.apps.health/CodeSystem/nexus-consent-item",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.3"
          },
          {
            "identity": "rim",
            "map": "./codeSystem"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.version",
        "path": "Consent.category.coding.version",
        "short": "Version of the system - if relevant",
        "definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
        "comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.version",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.7"
          },
          {
            "identity": "rim",
            "map": "./codeSystemVersion"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.code",
        "path": "Consent.category.coding.code",
        "short": "Symbol in syntax defined by the system",
        "definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
        "requirements": "Need to refer to a particular code in the system.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Coding.code",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.1"
          },
          {
            "identity": "rim",
            "map": "./code"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.category.coding.display",
        "short": "Representation defined by the system",
        "definition": "A representation of the meaning of the code in the system, following the rules of the system.",
        "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know  the system.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.display",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.2 - but note this is not well followed"
          },
          {
            "identity": "rim",
            "map": "CV.displayName"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"
          }
        ]
      },
      {
        "id": "Consent.category:item.coding.userSelected",
        "path": "Consent.category.coding.userSelected",
        "short": "If this coding was chosen directly by the user",
        "definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
        "comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
        "requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.userSelected",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "boolean"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Sometimes implied by being first"
          },
          {
            "identity": "rim",
            "map": "CD.codingRationale"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [     fhir:source \"true\";     fhir:target dt:CDCoding.codingRationale\\#O   ]"
          }
        ]
      },
      {
        "id": "Consent.category:item.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.category.text",
        "short": "Plain text representation of the concept",
        "definition": "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.",
        "comment": "Very often the text is the same as a displayName of one of the codings.",
        "requirements": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "CodeableConcept.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.9. But note many systems use C*E.2 for this"
          },
          {
            "identity": "rim",
            "map": "./originalText[mediaType/code=\"text/plain\"]/data"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
          }
        ]
      },
      {
        "id": "Consent.category:family",
        "path": "Consent.category",
        "sliceName": "family",
        "short": "Fixed: this Consent is an item consent",
        "definition": "The family this Consent belongs to, fixed to `item`. It tells a consumer which interpretation\ncontract governs the resource in its hand before the resource is interpreted, which is the point of\ncarrying it on a searchable element: a mixed result can be partitioned in the search rather than\nafter it.\n\nIt says WHAT this decision governs and nothing about how to read it. The decision is\n`provision.type` in every family, so a reader never needs the family code to answer the dangerous\nquestion — it answers the cheap one.",
        "comment": "The binding is required, not extensible: the value of this element is that a consumer can enumerate\nthe families it knows how to interpret and refuse the ones it does not. A family minted under a\ndeployment's own system would arrive looking like a known one, which is the failure the element\nexists to prevent.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.category",
          "min": 1,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.apps.health/ValueSet/nexus-consent-families"
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.code"
          },
          {
            "identity": "w5",
            "map": "FiveWs.class"
          },
          {
            "identity": "v2",
            "map": "HL7 Table 0497 - Consent Type"
          },
          {
            "identity": "rim",
            "map": "CNTRCT"
          }
        ]
      },
      {
        "id": "Consent.category:family.id",
        "path": "Consent.category.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:family.extension",
        "path": "Consent.category.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding",
        "path": "Consent.category.coding",
        "short": "Code defined by a terminology system",
        "definition": "A reference to a code defined by a terminology system.",
        "comment": "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.",
        "requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "CodeableConcept.coding",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.1-8, C*E.10-22"
          },
          {
            "identity": "rim",
            "map": "union(., ./translation)"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.id",
        "path": "Consent.category.coding.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.extension",
        "path": "Consent.category.coding.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.system",
        "path": "Consent.category.coding.system",
        "short": "Identity of the terminology system",
        "definition": "The identification of the code system that defines the meaning of the symbol in the code.",
        "comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
        "requirements": "Need to be unambiguous about the source of the definition of the symbol.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Coding.system",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "fixedUri": "https://fhir.apps.health/CodeSystem/nexus-consent-family",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.3"
          },
          {
            "identity": "rim",
            "map": "./codeSystem"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.version",
        "path": "Consent.category.coding.version",
        "short": "Version of the system - if relevant",
        "definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
        "comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.version",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.7"
          },
          {
            "identity": "rim",
            "map": "./codeSystemVersion"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.code",
        "path": "Consent.category.coding.code",
        "short": "Symbol in syntax defined by the system",
        "definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
        "requirements": "Need to refer to a particular code in the system.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Coding.code",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "fixedCode": "item",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.1"
          },
          {
            "identity": "rim",
            "map": "./code"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.category.coding.display",
        "short": "Representation defined by the system",
        "definition": "A representation of the meaning of the code in the system, following the rules of the system.",
        "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know  the system.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.display",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.2 - but note this is not well followed"
          },
          {
            "identity": "rim",
            "map": "CV.displayName"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"
          }
        ]
      },
      {
        "id": "Consent.category:family.coding.userSelected",
        "path": "Consent.category.coding.userSelected",
        "short": "If this coding was chosen directly by the user",
        "definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
        "comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
        "requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coding.userSelected",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "boolean"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Sometimes implied by being first"
          },
          {
            "identity": "rim",
            "map": "CD.codingRationale"
          },
          {
            "identity": "orim",
            "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [     fhir:source \"true\";     fhir:target dt:CDCoding.codingRationale\\#O   ]"
          }
        ]
      },
      {
        "id": "Consent.category:family.text",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.category.text",
        "short": "Plain text representation of the concept",
        "definition": "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.",
        "comment": "Very often the text is the same as a displayName of one of the codings.",
        "requirements": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "CodeableConcept.text",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "C*E.9. But note many systems use C*E.2 for this"
          },
          {
            "identity": "rim",
            "map": "./originalText[mediaType/code=\"text/plain\"]/data"
          },
          {
            "identity": "orim",
            "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"
          }
        ]
      },
      {
        "id": "Consent.patient",
        "path": "Consent.patient",
        "short": "The patient whose consent this is",
        "definition": "The patient/healthcare consumer to whom this consent applies.",
        "comment": "Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.patient",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.subject"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject[x]"
          },
          {
            "identity": "rim",
            "map": "Role"
          },
          {
            "identity": "w5",
            "map": "FiveWs.subject"
          }
        ]
      },
      {
        "id": "Consent.dateTime",
        "path": "Consent.dateTime",
        "short": "When THIS status was recorded",
        "definition": "When the current status was recorded — re-stamped on every status change, not fixed at the first\ndecision. Reading a historical version yields the dateTime of that version's status, so the\nsequence of dateTimes across versions is the decision timeline.",
        "comment": "This is not the time of the original consent, but the time that this statement was made or derived.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.dateTime",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.occurrence[x]"
          },
          {
            "identity": "w5",
            "map": "FiveWs.recorded"
          },
          {
            "identity": "v2",
            "map": "Field 13/ Consent Decision Date"
          },
          {
            "identity": "rim",
            "map": "FinancialConsent effectiveTime"
          }
        ]
      },
      {
        "id": "Consent.performer",
        "path": "Consent.performer",
        "short": "Who made the consent decision (the patient, or the staff member who recorded it)",
        "definition": "Who made this consent decision: the patient themselves, or the named staff member who recorded\nit on the patient's behalf.\n\nThis is the display source for \"who made it\" wherever the decision is shown. It is not the audit\nvalue — the server-stamped UpdatedBy meta extension remains the tamper-evident record of who\nwrote the resource, and the two can legitimately differ (staff records what the patient decided).\nWriters MUST set performer on every status change so the displayed attribution tracks the\ndecision rather than lagging on whoever happened to record the previous one.\n\nThe element stays `0..1` so a historical version written before this profile existed still\nconforms; `item-consent-performer-is-attributable` carries the requirement as a warning instead.\n`display` is must-support for the same reason the requirement exists at all: attribution is\nrendered from the display text, so a reference without one shows the reader nothing, and\nresolving it after the fact is not always possible — a patient-made decision references the\nPatient, which a reader holding only consent permission may not be able to read.",
        "comment": "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.",
        "alias": [
          "consentor"
        ],
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.performer",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient",
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner",
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.performer"
          },
          {
            "identity": "w5",
            "map": "FiveWs.actor"
          },
          {
            "identity": "v2",
            "map": "Field 24/ ConsenterID"
          }
        ]
      },
      {
        "id": "Consent.performer.id",
        "path": "Consent.performer.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.performer.extension",
        "path": "Consent.performer.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "description": "Extensions are always sliced by (at least) url",
          "rules": "open"
        },
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.performer.reference",
        "path": "Consent.performer.reference",
        "short": "Literal reference, Relative, internal or absolute URL",
        "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
        "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.reference",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "condition": [
          "ref-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.performer.type",
        "path": "Consent.performer.type",
        "short": "Type the reference refers to (e.g. \"Patient\")",
        "definition": "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).",
        "comment": "This element is used to indicate the type of  the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "FHIRResourceTypeExt"
            }
          ],
          "strength": "extensible",
          "description": "Aa resource (or, for logical models, the URI of the logical model).",
          "valueSet": "http://hl7.org/fhir/ValueSet/resource-types"
        },
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.performer.identifier",
        "path": "Consent.performer.identifier",
        "short": "Logical reference, when literal reference is not known",
        "definition": "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
        "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference.  For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport).  One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.identifier",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": ".identifier"
          }
        ]
      },
      {
        "id": "Consent.performer.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.performer.display",
        "short": "How the decision-maker is named to the reader",
        "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
        "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Reference.display",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "string"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.organization",
        "path": "Consent.organization",
        "short": "Custodian of the consent",
        "definition": "The organization that manages the consent, and the framework within which it is executed.",
        "alias": [
          "custodian"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.organization",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.performer"
          },
          {
            "identity": "w5",
            "map": "FiveWs.witness"
          }
        ]
      },
      {
        "id": "Consent.source[x]",
        "path": "Consent.source[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "short": "Source from which this consent is taken",
        "definition": "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.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.source[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Field 19 Informational Material Supplied Indicator"
          }
        ]
      },
      {
        "id": "Consent.source[x]:sourceReference",
        "path": "Consent.source[x]",
        "sliceName": "sourceReference",
        "short": "Evidence document for THIS status change, if one was captured",
        "definition": "Optional supporting document for the current status — a scanned signed consent or withdrawal\nform, for instance.\n\nThe reference belongs to the status it was recorded with. Because the resource is updated in\nplace, each stored version keeps its own sourceReference, so evidence attached to an earlier\ndecision stays with that version in history instead of being overwritten by the next one.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.source[x]",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "Field 19 Informational Material Supplied Indicator"
          }
        ]
      },
      {
        "id": "Consent.policy",
        "path": "Consent.policy",
        "short": "The policy this consent is given under",
        "definition": "A URI identifying the policy under which this consent is recorded -- the custodian's published\nprivacy policy, or the statutory provision that governs the decision.\n\nR4's `ppc-1` invariant requires either `policy` or `policyRule`; this element satisfies it.\n\n**`policyRule` is not used, and the reason is a correction.** Earlier releases fixed `policyRule`\nto `consentpolicycodes#cric`. That code is 45 CFR 46 -- the United States Common Rule for\ninformed consent in human-subjects research. It is not a communication-preference policy, not a\ndata-sharing policy, and not Canadian. It was never the right value here, and the code system it\ncomes from contains no Canadian concept at all: its 27 codes are US federal and state instruments\nplus three European ones. Rather than substitute another wrong code, this profile names the actual\ngoverning policy by URI, which is both truthful and machine-readable.",
        "min": 1,
        "max": "*",
        "base": {
          "path": "Consent.policy",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.policy.id",
        "path": "Consent.policy.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.policy.extension",
        "path": "Consent.policy.extension",
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.policy.modifierExtension",
        "path": "Consent.policy.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.policy.authority",
        "path": "Consent.policy.authority",
        "short": "Enforcement source for policy",
        "definition": "Entity or Organization having regulatory jurisdiction or accountability for  enforcing policies pertaining to Consent Directives.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.policy.authority",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "condition": [
          "ppc-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.policy.uri",
        "path": "Consent.policy.uri",
        "short": "Specific policy covered by this consent",
        "definition": "The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.",
        "comment": "This element is for discoverability / documentation and does not modify or qualify the policy rules.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.policy.uri",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "uri"
          }
        ],
        "condition": [
          "ppc-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.policyRule",
        "path": "Consent.policyRule",
        "short": "Regulation that this consents to",
        "definition": "A reference to the specific base computable regulation or policy.",
        "comment": "If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.",
        "requirements": "Might be a unique identifier of a policy set in XACML, or other rules engine.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.policyRule",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "condition": [
          "ppc-1"
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentPolicyRule"
            }
          ],
          "strength": "extensible",
          "description": "Regulatory policy examples.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-policy"
        }
      },
      {
        "id": "Consent.verification",
        "path": "Consent.verification",
        "short": "Consent Verified by patient or family",
        "definition": "Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.verification",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.verification.id",
        "path": "Consent.verification.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.verification.extension",
        "path": "Consent.verification.extension",
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.verification.modifierExtension",
        "path": "Consent.verification.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.verification.verified",
        "path": "Consent.verification.verified",
        "short": "Has been verified",
        "definition": "Has the instruction been verified.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.verification.verified",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "boolean"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.verification.verifiedWith",
        "path": "Consent.verification.verifiedWith",
        "short": "Person who verified",
        "definition": "Who verified the instruction (Patient, Relative or other Authorized Person).",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.verification.verifiedWith",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.verification.verificationDate",
        "path": "Consent.verification.verificationDate",
        "short": "When consent verified",
        "definition": "Date verification was collected.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.verification.verificationDate",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.provision",
        "path": "Consent.provision",
        "short": "The decision: permit (Provided) | deny (Declined)",
        "definition": "Carries the patient's answer for this item.\n\nThis element used to be reserved and unused, with the decision in `status`. It is now where the\nanswer lives, matching every other Consent profile in this guide.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.provision.id",
        "path": "Consent.provision.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.extension",
        "path": "Consent.provision.extension",
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.modifierExtension",
        "path": "Consent.provision.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.provision.type",
        "path": "Consent.provision.type",
        "short": "permit (Provided) | deny (Declined or withdrawn)",
        "definition": "The patient's answer. `permit` means the clinic may do the thing this item names; `deny` means it\nmay not, whether the patient declined from the start or withdrew a consent they had given.\n\n**Required on the root provision.** R4's element definition says `type` is \"not permitted in root\nrule\", and this guide does not follow that reading -- IHE Privacy Consent on FHIR and Ontario's\nProvincial Consent Override Interface both require it there, and a consent whose base rule states no\ndecision states none where a reader looks first. Every Consent profile in this guide takes the same\nconvention, so one rule reads all of them.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision.type",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-provision-type"
        }
      },
      {
        "id": "Consent.provision.period",
        "path": "Consent.provision.period",
        "short": "Timeframe for this rule",
        "definition": "The timeframe in this rule is valid.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.provision.period",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Period"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.provision.actor",
        "path": "Consent.provision.actor",
        "short": "Who|what controlled by this rule (or group, by role)",
        "definition": "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').",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.actor",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "meaningWhenMissing": "There is no specific actor associated with the exception",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.provision.actor.id",
        "path": "Consent.provision.actor.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.actor.extension",
        "path": "Consent.provision.actor.extension",
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.actor.modifierExtension",
        "path": "Consent.provision.actor.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.provision.actor.role",
        "path": "Consent.provision.actor.role",
        "short": "How the actor is involved",
        "definition": "How the individual is involved in the resources content that is described in the exception.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision.actor.role",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentActorRole"
            }
          ],
          "strength": "extensible",
          "description": "How an actor is involved in the consent considerations.",
          "valueSet": "http://hl7.org/fhir/ValueSet/security-role-type"
        }
      },
      {
        "id": "Consent.provision.actor.reference",
        "path": "Consent.provision.actor.reference",
        "short": "Resource for the actor (or group, by role)",
        "definition": "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').",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision.actor.reference",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Device",
              "http://hl7.org/fhir/StructureDefinition/Group",
              "http://hl7.org/fhir/StructureDefinition/CareTeam",
              "http://hl7.org/fhir/StructureDefinition/Organization",
              "http://hl7.org/fhir/StructureDefinition/Patient",
              "http://hl7.org/fhir/StructureDefinition/Practitioner",
              "http://hl7.org/fhir/StructureDefinition/RelatedPerson",
              "http://hl7.org/fhir/StructureDefinition/PractitionerRole"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      },
      {
        "id": "Consent.provision.action",
        "path": "Consent.provision.action",
        "short": "Actions controlled by this rule",
        "definition": "Actions controlled by this Rule.",
        "comment": "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'.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.action",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "meaningWhenMissing": "all actions",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentAction"
            }
          ],
          "strength": "example",
          "description": "Detailed codes for the consent action.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-action"
        }
      },
      {
        "id": "Consent.provision.securityLabel",
        "path": "Consent.provision.securityLabel",
        "short": "Security Labels that define affected resources",
        "definition": "A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.",
        "comment": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.securityLabel",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "SecurityLabels"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
              "valueBoolean": true
            }
          ],
          "strength": "extensible",
          "description": "Security Labels from the Healthcare Privacy and Security Classification System.",
          "valueSet": "http://hl7.org/fhir/ValueSet/security-labels"
        }
      },
      {
        "id": "Consent.provision.purpose",
        "path": "Consent.provision.purpose",
        "short": "Context of activities covered by this rule",
        "definition": "The context of the activities a user is taking - why the user is accessing the data - that are controlled by this rule.",
        "comment": "When the purpose of use tag is on the data, access request purpose of use shall not conflict.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.purpose",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "PurposeOfUse"
            }
          ],
          "strength": "extensible",
          "description": "What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.",
          "valueSet": "http://terminology.hl7.org/ValueSet/v3-PurposeOfUse"
        }
      },
      {
        "id": "Consent.provision.class",
        "path": "Consent.provision.class",
        "short": "e.g. Resource Type, Profile, CDA, etc.",
        "definition": "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.",
        "comment": "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.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.class",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Coding"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentContentClass"
            }
          ],
          "strength": "extensible",
          "description": "The class (type) of information a consent rule covers.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-content-class"
        }
      },
      {
        "id": "Consent.provision.code",
        "path": "Consent.provision.code",
        "short": "e.g. LOINC or SNOMED CT code, etc. in the content",
        "definition": "If this code is found in an instance, then the rule applies.",
        "comment": "Typical use of this is a Document code with class = CDA.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.code",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentContentCode"
            }
          ],
          "strength": "example",
          "description": "If this code is found in an instance, then the exception applies.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-content-code"
        }
      },
      {
        "id": "Consent.provision.dataPeriod",
        "path": "Consent.provision.dataPeriod",
        "short": "Timeframe for data controlled by this rule",
        "definition": "Clinical or Operational Relevant period of time that bounds the data controlled by this rule.",
        "comment": "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.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Consent.provision.dataPeriod",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Period"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.provision.data",
        "path": "Consent.provision.data",
        "short": "Data controlled by this rule",
        "definition": "The resources controlled by this rule if specific resources are referenced.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.data",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "meaningWhenMissing": "all data",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "Role"
          }
        ]
      },
      {
        "id": "Consent.provision.data.id",
        "path": "Consent.provision.data.id",
        "representation": [
          "xmlAttr"
        ],
        "short": "Unique id for inter-element referencing",
        "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Element.id",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "http://hl7.org/fhirpath/System.String",
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
                "valueUrl": "string"
              }
            ]
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.data.extension",
        "path": "Consent.provision.data.extension",
        "short": "Additional content defined by implementations",
        "definition": "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.",
        "comment": "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.",
        "alias": [
          "extensions",
          "user content"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "Element.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": false,
        "isSummary": false,
        "mapping": [
          {
            "identity": "rim",
            "map": "n/a"
          }
        ]
      },
      {
        "id": "Consent.provision.data.modifierExtension",
        "path": "Consent.provision.data.modifierExtension",
        "short": "Extensions that cannot be ignored even if unrecognized",
        "definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
        "comment": "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.",
        "requirements": "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](extensibility.html#modifierExtension).",
        "alias": [
          "extensions",
          "user content",
          "modifiers"
        ],
        "min": 0,
        "max": "*",
        "base": {
          "path": "BackboneElement.modifierExtension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          },
          {
            "key": "ext-1",
            "severity": "error",
            "human": "Must have either extensions or value[x], not both",
            "expression": "extension.exists() != value.exists()",
            "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
            "source": "http://hl7.org/fhir/StructureDefinition/Extension"
          }
        ],
        "isModifier": true,
        "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
        "isSummary": true,
        "mapping": [
          {
            "identity": "rim",
            "map": "N/A"
          }
        ]
      },
      {
        "id": "Consent.provision.data.meaning",
        "path": "Consent.provision.data.meaning",
        "short": "instance | related | dependents | authoredby",
        "definition": "How the resource reference is interpreted when testing consent restrictions.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision.data.meaning",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "code"
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "ConsentDataMeaning"
            }
          ],
          "strength": "required",
          "description": "How a resource reference is interpreted when testing consent restrictions.",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-data-meaning|4.0.1"
        }
      },
      {
        "id": "Consent.provision.data.reference",
        "path": "Consent.provision.data.reference",
        "short": "The actual data reference",
        "definition": "A reference to a specific resource that defines which resources are covered by this consent.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Consent.provision.data.reference",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Resource"
            ]
          }
        ],
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Consent.provision.provision",
        "path": "Consent.provision.provision",
        "short": "Reserved for future per-purpose granularity",
        "definition": "Left unconstrained and unused. Reserved for a future phase needing per-purpose granularity within a\nsingle item -- consenting to email for appointment reminders but not for lab results, say. Those\nwould be nested exceptions to the root decision, which is the shape R4 intends and the shape the\nprivacy-directive profile already uses for its own exceptions.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Consent.provision.provision",
          "min": 0,
          "max": "*"
        },
        "contentReference": "#Consent.provision",
        "constraint": [
          {
            "key": "ele-1",
            "severity": "error",
            "human": "All FHIR elements must have a @value or children",
            "expression": "hasValue() or (children().count() > id.count())",
            "xpath": "@value|f:*|h:div",
            "source": "http://hl7.org/fhir/StructureDefinition/Element"
          }
        ],
        "isModifier": false,
        "isSummary": false
      }
    ]
  },
  "differential": {
    "element": [
      {
        "id": "Consent",
        "path": "Consent",
        "short": "Patient consent for one catalogue item (Email | SMS | AI Scribe) Core",
        "definition": "Records the patient's current answer for a single consent item, as recorded by clinic staff.\n\n**One resource per (patient, item), updated in place.** There is never more than one Consent\nfor a given patient and item. When the patient changes their mind, the same resource is updated\n— `status` flips, `dateTime` is re-stamped, `performer` is set to whoever recorded the change —\nrather than a second Consent being created. The decision history is therefore the resource's\nFHIR version history: read prior versions through `_history` to see what was decided before,\nby whom, and with what reason and evidence attached.\n\n**The decision lives in `provision.type`.** `permit` is Provided, `deny` is Declined. This is the\nsame element, carrying the same meaning, as every other Consent profile in this guide:\n\n| `provision.type` | `status`            | Meaning                                                    |\n|------------------|---------------------|------------------------------------------------------------|\n| `permit`         | `active`            | Provided — the patient consented to this item              |\n| `deny`           | `active`            | Declined — the patient did not consent, or withdrew        |\n| *(any)*          | `entered-in-error`  | The record was created in error and must be ignored        |\n| *(no Consent)*   | —                   | Not Recorded — nobody has asked, or nobody wrote it down   |\n\n`deny` covers both an initial decline and a revocation of a previously provided consent, so a\nconsumer checks exactly one value to know the item is not permitted; it never needs to distinguish\n\"said no\" from \"said yes then changed their mind\". That distinction is recoverable from version\nhistory, and from the status-reason extension when staff recorded one.\n\nTransitions between `permit` and `deny` are expected and legal in both directions, any number of\ntimes. `status` stays `active` throughout: the record is operative whichever way the answer points.\n\n**The gate reads `provision.type`.** A consumer deciding whether it may act on an item MUST permit\nthe behaviour only where a Consent exists, `status` is `active`, and `provision.type` is `permit`.\nEverything else withholds it: no Consent at all, `deny`, `entered-in-error`, and a root provision\nthat states no type. Consent is opt-in, so silence is never a yes.\n\nA gate written on `status` alone permits a declined item, because a declined item consent is\n`active`. The answer is not in `status`, and this profile does not write `rejected`.\n\n**Absence is meaningful, and it is not a refusal.** No Consent for a (patient, item) pair means Not\nRecorded. It withholds the behaviour exactly as `deny` does, and it is shown to staff distinctly,\nbecause a patient who has never been asked is a prompt to ask. `entered-in-error` reads the same way\non both counts: unanswered to a reader, no permission to a gate.\n\n**Finding an item consent.** Search by patient and item coding:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|{code}\n```\n\nAt most one resource comes back. That same search is also the WRITE path: a conditional update\nagainst it creates-or-updates in one call, with no prior read. See `identifier` for the form.",
        "constraint": [
          {
            "key": "item-consent-status-is-defined",
            "severity": "warning",
            "human": "SHOULD carry one of the two status codes this profile gives meaning: active (the record is operative) or entered-in-error (retracted). The DECISION is `provision.type`, not `status` — recommended, not enforced",
            "expression": "status = 'active' or status = 'entered-in-error'",
            "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-item-consent"
          },
          {
            "key": "item-consent-performer-is-attributable",
            "severity": "warning",
            "human": "SHOULD name who made the decision and carry their display text, since the decision-maker is shown to staff from performer.display (recommended, not enforced)",
            "expression": "performer.exists() and performer.display.exists()",
            "source": "https://fhir.apps.health/StructureDefinition/nexus-emr-core-item-consent"
          }
        ]
      },
      {
        "id": "Consent.meta.source",
        "path": "Consent.meta.source",
        "short": "Identifies EMR instance & pipeline version the resource came from",
        "definition": "A URI that identifies the EMR pipeline and version from which this resource originated.  This tells you which EMR instance (recommend using the instance identifier), and the version of the pipeline code/transformations.",
        "mustSupport": true
      },
      {
        "id": "Consent.extension",
        "path": "Consent.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "Consent.extension:statusReason",
        "path": "Consent.extension",
        "sliceName": "statusReason",
        "short": "Free-text reason for the current status (typically on revocation)",
        "definition": "Optional free text explaining why the consent is in its current status — most often what the\npatient said when withdrawing a consent they had previously provided.\n\nAlways optional, on every status. Absence carries no meaning, and consumers must render a status\nchange with no reason as a complete record. The reason is deliberately uncoded free text so it\nkeeps the patient's own words.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.apps.health/StructureDefinition/nexus-consent-status-reason"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Consent.identifier",
        "path": "Consent.identifier",
        "short": "Business identifier(s) for item consent",
        "definition": "Unique identifiers for the item consent.\n\nUnlike the profiles describing resources converted from a source EMR, this one expects no\nsource-system identifier: an item consent is created here, when staff record the patient's answer,\nso there is no upstream record for it to point back at. A resource carrying no identifier at all is\ncomplete.\n\n**The singleton is stated by the search, not by a computed key.** Exactly one Consent exists per\n(patient, item), and the patient and the item are both modelled elements, so a writer addresses the\npair directly and creates-or-updates in a single call:\n\n  PUT Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|ai-scribe\n\nThe server matches the existing resource and adds a version, or creates the resource when there is\nno match — which is exactly the intended lifecycle, and means two staff saving the same item at the\nsame moment produce two versions of one resource rather than two competing resources. It is the same\nsearch a reader uses to find an item consent, so a reader and a writer name the pair the same way,\nand there is no second value to keep in step with it.\n\n**A retired identifier appears on older records.** `NamingSystem/nexus-item-consent-identifier`\ncarried a value composed as `{patient-logical-id}:{item-code}`, and it is retired. The patient half\nis `Resource.id` — the address a resource has on one server — so a re-ingest, a store migration or a\ncopy between deployments leaves a recorded value naming an id that no longer exists, and the\nconsequence is quiet: a conditional update keyed on a stale value matches nothing and creates a\nsecond resource for a pair that must have exactly one, while a writer that reads the value back as a\nprecondition stops writing for that patient instead, with no error that names the cause. Read such a\nvalue as what it is, a key computed at write time. Do not recompute one, match on one, or use one as\na precondition, and do not write new ones.",
        "mustSupport": true
      },
      {
        "id": "Consent.identifier.system",
        "path": "Consent.identifier.system",
        "min": 1
      },
      {
        "id": "Consent.identifier.value",
        "path": "Consent.identifier.value",
        "min": 1
      },
      {
        "id": "Consent.status",
        "path": "Consent.status",
        "short": "active (the record is operative) | entered-in-error",
        "definition": "Required field in FHIR R4 Consent. Whether this record is operative — **not** what the patient\ndecided.\n\n- `active` — the record stands. Read `provision.type` for the answer.\n- `entered-in-error` — the record was created in error. Ignore it; it is not a decision.\n\nAbsence of any Consent for a (patient, item) pair means **Not Recorded** — no answer has been\nwritten down. Show it distinctly from a `deny`; gate it the same, under the rule stated on the\nresource itself.\n\n**`rejected` is not written by this profile, and this is a change.** Earlier releases used it for a\ndeclined or withdrawn item, which made `status` carry the decision. R4 defines `rejected` as a\nlifecycle state — a party rejected the consent — and borrowing it for a patient's answer meant one\nelement meant opposite things across the Consent families sharing this store: an `active` item\nconsent was permission, an `active` privacy directive is a restriction in force. A reader that\nchecked `status` first read a lockbox as permission.\n\nThe decision is now `provision.type`, which is where the other families already carried it. One\nelement, one meaning, whatever family a consumer is holding.\n\nThe remaining R4 consent-state codes (`draft`, `proposed`, `inactive`, `rejected`) carry no meaning\nin this profile and are not written by the EMR; a reader that meets one treats it as Not Recorded,\nand `item-consent-status-is-defined` warns on it, since the binding alone cannot express that\nnarrowing.",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-state-codes"
        }
      },
      {
        "id": "Consent.scope",
        "path": "Consent.scope",
        "short": "patient-privacy - Privacy consent",
        "definition": "Required field in FHIR R4 Consent. For this item consent use case, always set to 'patient-privacy' as we're dealing with patient privacy consent for clinic-recorded consent items.",
        "fixedCodeableConcept": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/consentscope",
              "code": "patient-privacy",
              "display": "Privacy Consent"
            }
          ]
        },
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-scope"
        }
      },
      {
        "id": "Consent.category",
        "path": "Consent.category",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "coding.system"
            }
          ],
          "rules": "open",
          "description": "Slice category by code system: the item code, and the family code"
        },
        "short": "The consent item this resource records (Email | SMS | AI Scribe), plus the family code",
        "definition": "Required field in FHIR R4 Consent. This profile carries two codings, in two slices discriminated by\ncode system, and neither substitutes for the other.\n\n**`item` says WHICH item the patient answered.** It is the key consumers look the resource up by:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-item|{code}\n```\n\n**`family` says this Consent is an item consent.** Three Consent families share this store, one\n`GET Consent?patient={id}` returns them mixed, and all three carry `scope = patient-privacy` — so\n`category` is the only element that separates them, and every family in this guide carries the\nfamily code. Select this family with:\n\n```\nGET Consent?patient={id}&category=https://fhir.apps.health/CodeSystem/nexus-consent-family|item\n```\n\nThe slicing is open, so further categories may be carried alongside these two — a jurisdictional or\nworkflow classification, say. No other category identifies the item or the family, and a consumer\nMUST NOT infer either from one.",
        "comment": "Both codings sit outside HL7's consent-category value set on purpose. That value set classifies\nconsent *documents* (research consent, advance directive, privacy policy acknowledgement) and has\nno concept for a per-item communication preference, nor for this guide's own family axis, which is\nthe case an extensible binding exists to cover. Terminology-aware validators may note that the base\nextensible binding is unmet on these resources; that note is expected, not a defect.",
        "min": 2,
        "mustSupport": true
      },
      {
        "id": "Consent.category:item",
        "path": "Consent.category",
        "sliceName": "item",
        "short": "The consent item (single coding from the Nexus consent-item CodeSystem)",
        "definition": "The catalogue item this Consent answers, as a single coding from the Nexus consent-item\nCodeSystem. The concept definition in that CodeSystem is the standard description shown to staff\nand patients when the item is presented for a decision.",
        "comment": "Slice membership is discriminated by `coding.system`, so the item coding MUST use the Nexus\nconsent-item system. The binding is extensible rather than required because clinic-defined items\nare expected in a later phase and will be published in tenant-scoped CodeSystems; when they land,\nthis profile gains a slice for them rather than any code being smuggled into the `item` slice\nunder a foreign system.",
        "min": 1,
        "max": "1",
        "mustSupport": true,
        "binding": {
          "strength": "extensible",
          "valueSet": "https://fhir.apps.health/ValueSet/nexus-consent-items"
        }
      },
      {
        "id": "Consent.category:item.coding",
        "path": "Consent.category.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Consent.category:item.coding.system",
        "path": "Consent.category.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.apps.health/CodeSystem/nexus-consent-item"
      },
      {
        "id": "Consent.category:item.coding.code",
        "path": "Consent.category.coding.code",
        "min": 1
      },
      {
        "id": "Consent.category:family",
        "path": "Consent.category",
        "sliceName": "family",
        "short": "Fixed: this Consent is an item consent",
        "definition": "The family this Consent belongs to, fixed to `item`. It tells a consumer which interpretation\ncontract governs the resource in its hand before the resource is interpreted, which is the point of\ncarrying it on a searchable element: a mixed result can be partitioned in the search rather than\nafter it.\n\nIt says WHAT this decision governs and nothing about how to read it. The decision is\n`provision.type` in every family, so a reader never needs the family code to answer the dangerous\nquestion — it answers the cheap one.",
        "comment": "The binding is required, not extensible: the value of this element is that a consumer can enumerate\nthe families it knows how to interpret and refuse the ones it does not. A family minted under a\ndeployment's own system would arrive looking like a known one, which is the failure the element\nexists to prevent.",
        "min": 1,
        "max": "1",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.apps.health/ValueSet/nexus-consent-families"
        }
      },
      {
        "id": "Consent.category:family.coding",
        "path": "Consent.category.coding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Consent.category:family.coding.system",
        "path": "Consent.category.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.apps.health/CodeSystem/nexus-consent-family"
      },
      {
        "id": "Consent.category:family.coding.code",
        "path": "Consent.category.coding.code",
        "min": 1,
        "fixedCode": "item"
      },
      {
        "id": "Consent.patient",
        "path": "Consent.patient",
        "short": "The patient whose consent this is",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Consent.dateTime",
        "path": "Consent.dateTime",
        "short": "When THIS status was recorded",
        "definition": "When the current status was recorded — re-stamped on every status change, not fixed at the first\ndecision. Reading a historical version yields the dateTime of that version's status, so the\nsequence of dateTimes across versions is the decision timeline.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Consent.performer",
        "path": "Consent.performer",
        "short": "Who made the consent decision (the patient, or the staff member who recorded it)",
        "definition": "Who made this consent decision: the patient themselves, or the named staff member who recorded\nit on the patient's behalf.\n\nThis is the display source for \"who made it\" wherever the decision is shown. It is not the audit\nvalue — the server-stamped UpdatedBy meta extension remains the tamper-evident record of who\nwrote the resource, and the two can legitimately differ (staff records what the patient decided).\nWriters MUST set performer on every status change so the displayed attribution tracks the\ndecision rather than lagging on whoever happened to record the previous one.\n\nThe element stays `0..1` so a historical version written before this profile existed still\nconforms; `item-consent-performer-is-attributable` carries the requirement as a warning instead.\n`display` is must-support for the same reason the requirement exists at all: attribution is\nrendered from the display text, so a reference without one shows the reader nothing, and\nresolving it after the fact is not always possible — a patient-made decision references the\nPatient, which a reader holding only consent permission may not be able to read.",
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-patient",
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitioner",
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-practitionerrole"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Consent.performer.display",
        "path": "Consent.performer.display",
        "short": "How the decision-maker is named to the reader",
        "mustSupport": true
      },
      {
        "id": "Consent.source[x]",
        "path": "Consent.source[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "ordered": false,
          "rules": "open"
        },
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference"
            ]
          }
        ]
      },
      {
        "id": "Consent.source[x]:sourceReference",
        "path": "Consent.source[x]",
        "sliceName": "sourceReference",
        "short": "Evidence document for THIS status change, if one was captured",
        "definition": "Optional supporting document for the current status — a scanned signed consent or withdrawal\nform, for instance.\n\nThe reference belongs to the status it was recorded with. Because the resource is updated in\nplace, each stored version keeps its own sourceReference, so evidence attached to an earlier\ndecision stays with that version in history instead of being overwritten by the next one.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.apps.health/StructureDefinition/nexus-emr-core-documentreference"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Consent.policy",
        "path": "Consent.policy",
        "short": "The policy this consent is given under",
        "definition": "A URI identifying the policy under which this consent is recorded -- the custodian's published\nprivacy policy, or the statutory provision that governs the decision.\n\nR4's `ppc-1` invariant requires either `policy` or `policyRule`; this element satisfies it.\n\n**`policyRule` is not used, and the reason is a correction.** Earlier releases fixed `policyRule`\nto `consentpolicycodes#cric`. That code is 45 CFR 46 -- the United States Common Rule for\ninformed consent in human-subjects research. It is not a communication-preference policy, not a\ndata-sharing policy, and not Canadian. It was never the right value here, and the code system it\ncomes from contains no Canadian concept at all: its 27 codes are US federal and state instruments\nplus three European ones. Rather than substitute another wrong code, this profile names the actual\ngoverning policy by URI, which is both truthful and machine-readable.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Consent.policy.uri",
        "path": "Consent.policy.uri",
        "min": 1
      },
      {
        "id": "Consent.provision",
        "path": "Consent.provision",
        "short": "The decision: permit (Provided) | deny (Declined)",
        "definition": "Carries the patient's answer for this item.\n\nThis element used to be reserved and unused, with the decision in `status`. It is now where the\nanswer lives, matching every other Consent profile in this guide.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "Consent.provision.type",
        "path": "Consent.provision.type",
        "short": "permit (Provided) | deny (Declined or withdrawn)",
        "definition": "The patient's answer. `permit` means the clinic may do the thing this item names; `deny` means it\nmay not, whether the patient declined from the start or withdrew a consent they had given.\n\n**Required on the root provision.** R4's element definition says `type` is \"not permitted in root\nrule\", and this guide does not follow that reading -- IHE Privacy Consent on FHIR and Ontario's\nProvincial Consent Override Interface both require it there, and a consent whose base rule states no\ndecision states none where a reader looks first. Every Consent profile in this guide takes the same\nconvention, so one rule reads all of them.",
        "min": 1,
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "http://hl7.org/fhir/ValueSet/consent-provision-type"
        }
      },
      {
        "id": "Consent.provision.provision",
        "path": "Consent.provision.provision",
        "short": "Reserved for future per-purpose granularity",
        "definition": "Left unconstrained and unused. Reserved for a future phase needing per-purpose granularity within a\nsingle item -- consenting to email for appointment reminders but not for lab results, say. Those\nwould be nested exceptions to the root decision, which is the shape R4 intends and the shape the\nprivacy-directive profile already uses for its own exceptions."
      }
    ]
  }
}