HL7.FHIR.US.MCC\MCC FHIR Care Plan Example - TTL Representation

MCC eCare Plan Draft Implementation Guide - Local Development build (v0.1.0). See the Directory of published versions
: MCC FHIR Care Plan Example - TTL Representation


@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CarePlan;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "cc-careplan-pnoelle-ckd"];
  fhir:Resource.meta [
     fhir:Meta.versionId [ fhir:value "1" ];
     fhir:Meta.lastUpdated [ fhir:value "2020-09-22T16:07:27.537+00:00"^^xsd:dateTime ];
     fhir:Meta.source [ fhir:value "#SCrKC33XSmQLsqWF" ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "additional" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><strong>Multiple Chronic Condition Care Plan</strong><ol><li>Addresses: Chronic Kidney Disease.</li><li>Narrative Block information will be developed in a later draft.</li><li>Supplemental Information:</li><li>Supplemental Information:</li><li>Supplemental Information:</li></ol></div>"
  ];
  fhir:CarePlan.status [ fhir:value "active"];
  fhir:CarePlan.intent [ fhir:value "plan"];
  fhir:CarePlan.category [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       a sct:737429003;
       fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
       fhir:Coding.code [ fhir:value "737429003" ]     ];
     fhir:CodeableConcept.text [ fhir:value "Chronic kidney disease clinical management plan" ]
  ];
  fhir:CarePlan.subject [
     fhir:Reference.reference [ fhir:value "Patient/cc-pat-pnoelle" ];
     fhir:Reference.display [ fhir:value "Patricia Noelle" ]
  ];
  fhir:CarePlan.period [
     fhir:Period.start [ fhir:value "2018-05-01"^^xsd:date ]
  ];
  fhir:CarePlan.created [ fhir:value "2019-01-01"^^xsd:date];
  fhir:CarePlan.author [
     fhir:Reference.reference [ fhir:value "Device/SMARTapp123" ];
     fhir:Reference.display [ fhir:value "MCCSmartonFHIRApp" ]
  ];
  fhir:CarePlan.contributor [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "PractitionerRole/HenryLevVII123" ];
     fhir:Reference.display [ fhir:value "Henry Levin VII MD Nephrologist" ]
  ], [
     fhir:index 1;
     fhir:Reference.reference [ fhir:value "PractitionerRole/NNR123" ];
     fhir:Reference.display [ fhir:value "Nancy Nurse RN" ]
  ], [
     fhir:index 2;
     fhir:Reference.reference [ fhir:value "PractitionerRole/PPLev54321" ];
     fhir:Reference.display [ fhir:value "Peter Primary MD Primary Provider" ]
  ];
  fhir:CarePlan.careTeam [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "CareTeam/cc-team-pnoelle" ];
     fhir:Reference.display [ fhir:value "Longitudinal care-coordination focused care team" ]
  ];
  fhir:CarePlan.addresses [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Condition/cc-cond-pnoelle-ckd" ];
     fhir:Reference.display [ fhir:value "Chronic Kidney Disease" ]
  ];
  fhir:CarePlan.supportingInfo [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Condition/cc-cond-pnoelle-cp" ];
     fhir:Reference.display [ fhir:value "Chronic Pain" ]
  ], [
     fhir:index 1;
     fhir:Reference.reference [ fhir:value "QuestionnaireResponse/cc-QR-pnoelle-pc" ];
     fhir:Reference.display [ fhir:value "PROMIS short form - pain intensity 3a - version 1.0 - 11 Moderate to Severe" ]
  ], [
     fhir:index 2;
     fhir:Reference.reference [ fhir:value "Condition/cc-cond-pnoelle-dp" ];
     fhir:Reference.display [ fhir:value "Recurrent major depressive episodes, moderate (disorder)" ]
  ], [
     fhir:index 3;
     fhir:Reference.reference [ fhir:value "Observation/cc-EstimatedGFR-pnoelle-cp" ];
     fhir:Reference.display [ fhir:value "eGFR 35 mL/min/{1.73_m2}" ]
  ];
  fhir:CarePlan.goal [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Goal/cc-goal-pnoelle-cp-overallgoaltext" ];
     fhir:Reference.display [ fhir:value "(From Description text in the referenced goal resource. The patient and care team would like Patricia's overall health status to improve as much as possible with her exisitng CKD:\n			Lose weight, decrease chronic pain with less use of pain medication and improved lab results" ]
  ];
  fhir:CarePlan.activity [
     fhir:index 0;
     fhir:CarePlan.activity.outcomeReference [
       fhir:index 0;
       fhir:Reference.reference [ fhir:value "Procedure/cc-actPerf-pnoelle-cp-dailyWeights" ];
       fhir:Reference.display [ fhir:value "DailyWeightsPerformed" ]     ];
     fhir:CarePlan.activity.progress [
       fhir:index 0;
       fhir:Annotation.time [ fhir:value "2019-01-10"^^xsd:date ];
       fhir:Annotation.text [ fhir:value "Patricia Noelle is measuring her weight daily" ]     ];
     fhir:CarePlan.activity.reference [
       fhir:Reference.reference [ fhir:value "Task/cc-taskReq-pnoelle-cp-weight" ];
       fhir:Reference.display [ fhir:value "Patricia Noelle or cargiver to perform daily weights" ]     ]
  ], [
     fhir:index 1;
     fhir:CarePlan.activity.outcomeReference [
       fhir:index 0;
       fhir:Reference.reference [ fhir:value "Encounter/cc-actPerf-pnoelle-cp-Encounter321" ];
       fhir:Reference.display [ fhir:value "PreOp Encounter For Creation of external arteriovenous shunt (procedure)" ]     ], [
       fhir:index 1;
       fhir:Reference.reference [ fhir:value "Procedure/cc-actPerf-pnoelle-cp-upperlimbveinultrsound" ];
       fhir:Reference.display [ fhir:value "Fluoroscopic venography of bilateral upper limbs Performed. Results: Normal" ]     ];
     fhir:CarePlan.activity.progress [
       fhir:index 0;
       fhir:Annotation.time [ fhir:value "2019-01-10"^^xsd:date ];
       fhir:Annotation.text [ fhir:value "Patricia Noelle Completed prep for an AV Shunt. She needs the shunt due to the need for diayalis related to the goal to improve her health related to CKD" ]     ];
     fhir:CarePlan.activity.reference [
       fhir:Reference.reference [ fhir:value "Appointment/cc-servReq-pnoelle-cp-preOp" ];
       fhir:Reference.display [ fhir:value "PreOp Encounter Request For Creation of external arteriovenous shunt (procedure). Relates to overall health improvement goal and encounter requestActivity" ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.