Polaris Core ClinicalImpression Profile

Overview

The Polaris Core ClinicalImpression profile represents clinical assessments and impressions within primary care EMR systems. This profile specifically captures the Assessment ('A') section from SOAP (Subjective, Objective, Assessment, Plan) encounter notes, providing structured access to clinical reasoning and diagnostic thinking across the Polaris ecosystem.

Key Features

• SOAP Note Integration: Extracts and structures the Assessment portion of SOAP documentation
• Free-text Narrative: Preserves clinical reasoning in narrative form
• Status Tracking: Monitors whether assessment is draft, completed, or in-progress
• Encounter Linkage: Connects assessments to specific clinical encounters
• Flexible Coding: Supports both standard and EMR-specific assessment type codes

Clinical Purpose

The ClinicalImpression serves to:

• Document clinical reasoning and diagnostic thinking
• Capture differential diagnoses consideration
• Record clinical synthesis of findings
• Provide assessment narrative for care coordination
• Support clinical decision-making documentation

SOAP Note Context

In SOAP documentation:

• Subjective: Patient's complaints and history
• Objective: Physical findings and test results
• Assessment: Clinical impression and reasoning (captured here)
• Plan: Treatment and follow-up plans

This profile focuses on extracting and structuring the Assessment component for systems that can parse SOAP notes.

Status Management

Assessment states include:

• Preparation: Assessment being formulated
• In-progress: Assessment underway
• Completed: Final assessment documented
• Entered-in-error: Erroneous entry to ignore
• On-hold: Assessment temporarily suspended
• Stopped: Assessment terminated

Clinical Workflow

The profile supports:

• Encounter-based assessments
• Progress note documentation
• Consultation assessments
• Diagnostic reasoning capture
• Clinical summary generation

Data Export Considerations

This profile is specifically designed for EMRs that can:

• Parse structured SOAP notes
• Extract Assessment text separately
• Export assessment narratives
• Link assessments to encounters

Systems without SOAP parsing capabilities may not implement this profile.

Future Considerations

Potential enhancements being evaluated:

• Structured findings and interpretations
• Problem list linkages
• Differential diagnosis lists
• Prognosis documentation
• Assessment scoring systems
• Clinical reasoning ontologies

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
meta	Σ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris ClinicalImpression ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	Σ	1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris clinicalimpression ID value: unique in source system Example General: 123456
identifier:rawCode	SΣ	1..*	Identifier	Source EMR clinicalimpression identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
code	SΣ	0..1	CodeableConcept	Assessment type with raw code support Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	SΣ	0..*	Coding	Standard assessment code
system	Σ	1..1	uri	Standard terminology system URI
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	SΣ	1..*	Coding	Source EMR assessment code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
code	Σ	1..1	code	EMR-specific assessment code
display	Σ	1..1	string	EMR's display text for this assessment type
description	SΣ	1..1	string	Assessment narrative from SOAP note
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	SΣ	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
date	SΣ	1..1	dateTime	When assessment was recorded
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClinicalImpression.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard
ClinicalImpression.code	example

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))
dom-2	error	ClinicalImpression	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClinicalImpression	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %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()
dom-4	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClinicalImpression	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from ClinicalImpression

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
meta
source	S	0..1	uri	Identifies EMR instance & pipeline version the resource came from
Slices for identifier	S	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	S	1..1	Identifier	Polaris ClinicalImpression ID
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system		1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier
value		1..1	string	The actual Polaris clinicalimpression ID value: unique in source system
identifier:rawCode	S	1..*	Identifier	Source EMR clinicalimpression identifier
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code
value		1..1	string	The value that is unique
status	S	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
code	S	0..1	CodeableConcept	Assessment type with raw code support
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	S	0..*	Coding	Standard assessment code
system		1..1	uri	Standard terminology system URI
code		1..1	code	Symbol in syntax defined by the system
coding:rawCode	S	1..*	Coding	Source EMR assessment code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
code		1..1	code	EMR-specific assessment code
display		1..1	string	EMR's display text for this assessment type
description	S	1..1	string	Assessment narrative from SOAP note
subject	S	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	S	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
date	S	1..1	dateTime	When assessment was recorded
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris ClinicalImpression ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris clinicalimpression ID value: unique in source system Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:rawCode	SΣ	1..*	Identifier	Source EMR clinicalimpression identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
statusReason		0..1	CodeableConcept	Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression.
code	SΣ	0..1	CodeableConcept	Assessment type with raw code support Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	SΣ	0..*	Coding	Standard assessment code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Standard terminology system URI
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	SΣ	1..*	Coding	Source EMR assessment code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	EMR-specific assessment code
display	Σ	1..1	string	EMR's display text for this assessment type
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
description	SΣ	1..1	string	Assessment narrative from SOAP note
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	SΣ	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
effective[x]	Σ	0..1		Time of assessment
effectiveDateTime			dateTime
effectivePeriod			Period
date	SΣ	1..1	dateTime	When assessment was recorded
assessor	Σ	0..1	Reference(Practitioner | PractitionerRole)	The clinician performing the assessment
previous		0..1	Reference(ClinicalImpression)	Reference to last assessment
problem	Σ	0..*	Reference(Condition | AllergyIntolerance)	Relevant impressions of patient state
investigation		0..*	BackboneElement	One or more sets of investigations (signs, symptoms, etc.)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations.
item		0..*	Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media)	Record of a specific investigation
protocol		0..*	uri	Clinical Protocol followed
summary		0..1	string	Summary of the assessment
finding		0..*	BackboneElement	Possible or likely findings and diagnoses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemCodeableConcept		0..1	CodeableConcept	What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
itemReference		0..1	Reference(Condition | Observation | Media)	What was found
basis		0..1	string	Which investigations support finding
prognosisCodeableConcept		0..*	CodeableConcept	Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.
prognosisReference		0..*	Reference(RiskAssessment)	RiskAssessment expressing likely outcome
supportingInfo		0..*	Reference(Resource)	Information supporting the clinical impression
note		0..*	Annotation	Comments made about the ClinicalImpression
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClinicalImpression.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
ClinicalImpression.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClinicalImpression.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClinicalImpression.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:polarisId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClinicalImpression.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:rawCode.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard
ClinicalImpression.statusReason	example
ClinicalImpression.code	example
ClinicalImpression.investigation.code	example	InvestigationType http://hl7.org/fhir/ValueSet/investigation-sets From the FHIR Standard
ClinicalImpression.finding.itemCodeableConcept	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code From the FHIR Standard
ClinicalImpression.prognosisCodeableConcept	example	ClinicalImpressionPrognosis http://hl7.org/fhir/ValueSet/clinicalimpression-prognosis From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))
dom-2	error	ClinicalImpression	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClinicalImpression	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %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()
dom-4	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClinicalImpression	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
meta	Σ	0..1	Meta	Metadata about the resource
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris ClinicalImpression ID
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
system	Σ	1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris clinicalimpression ID value: unique in source system Example General: 123456
identifier:rawCode	SΣ	1..*	Identifier	Source EMR clinicalimpression identifier
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
code	SΣ	0..1	CodeableConcept	Assessment type with raw code support Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	SΣ	0..*	Coding	Standard assessment code
system	Σ	1..1	uri	Standard terminology system URI
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:rawCode	SΣ	1..*	Coding	Source EMR assessment code
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
code	Σ	1..1	code	EMR-specific assessment code
display	Σ	1..1	string	EMR's display text for this assessment type
description	SΣ	1..1	string	Assessment narrative from SOAP note
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	SΣ	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
date	SΣ	1..1	dateTime	When assessment was recorded
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClinicalImpression.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard
ClinicalImpression.code	example

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))
dom-2	error	ClinicalImpression	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClinicalImpression	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %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()
dom-4	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClinicalImpression	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from ClinicalImpression

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
meta
source	S	0..1	uri	Identifies EMR instance & pipeline version the resource came from
Slices for identifier	S	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	S	1..1	Identifier	Polaris ClinicalImpression ID
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system		1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier
value		1..1	string	The actual Polaris clinicalimpression ID value: unique in source system
identifier:rawCode	S	1..*	Identifier	Source EMR clinicalimpression identifier
use		0..1	code	usual | official | temp | secondary | old (If known) Required Pattern: secondary
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code
value		1..1	string	The value that is unique
status	S	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
code	S	0..1	CodeableConcept	Assessment type with raw code support
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	S	0..*	Coding	Standard assessment code
system		1..1	uri	Standard terminology system URI
code		1..1	code	Symbol in syntax defined by the system
coding:rawCode	S	1..*	Coding	Source EMR assessment code
system		1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
code		1..1	code	EMR-specific assessment code
display		1..1	string	EMR's display text for this assessment type
description	S	1..1	string	Assessment narrative from SOAP note
subject	S	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	S	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
date	S	1..1	dateTime	When assessment was recorded
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
ClinicalImpression	C	0..*	ClinicalImpression	A clinical assessment performed when planning treatments and management strategies for a patient Constraints: clinicalimpression-has-polaris-id
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	SΣ	0..1	uri	Identifies EMR instance & pipeline version the resource came from
profile	Σ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	Business identifier(s) for clinicalimpression Slice: Unordered, Open by pattern:system
identifier:polarisId	SΣ	1..1	Identifier	Polaris ClinicalImpression ID
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Polaris clinicalimpression identifier system: https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-identifier Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The actual Polaris clinicalimpression ID value: unique in source system Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:rawCode	SΣ	1..*	Identifier	Source EMR clinicalimpression identifier
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: secondary
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-raw-code Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error Binding: ClinicalImpressionStatus (required)
statusReason		0..1	CodeableConcept	Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression.
code	SΣ	0..1	CodeableConcept	Assessment type with raw code support Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by pattern:system
coding:standard	SΣ	0..*	Coding	Standard assessment code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Standard terminology system URI
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:rawCode	SΣ	1..*	Coding	Source EMR assessment code
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Source system URI or https://fhir.apps.health/NamingSystem/<instance-id>-clinicalimpression-code-raw-code
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	EMR-specific assessment code
display	Σ	1..1	string	EMR's display text for this assessment type
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
description	SΣ	1..1	string	Assessment narrative from SOAP note
subject	SΣ	1..1	Reference(Polaris Patient Core)	Patient being assessed
encounter	SΣ	0..1	Reference(Polaris Encounter Profile Core)	Encounter during which assessment was made
effective[x]	Σ	0..1		Time of assessment
effectiveDateTime			dateTime
effectivePeriod			Period
date	SΣ	1..1	dateTime	When assessment was recorded
assessor	Σ	0..1	Reference(Practitioner | PractitionerRole)	The clinician performing the assessment
previous		0..1	Reference(ClinicalImpression)	Reference to last assessment
problem	Σ	0..*	Reference(Condition | AllergyIntolerance)	Relevant impressions of patient state
investigation		0..*	BackboneElement	One or more sets of investigations (signs, symptoms, etc.)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations.
item		0..*	Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media)	Record of a specific investigation
protocol		0..*	uri	Clinical Protocol followed
summary		0..1	string	Summary of the assessment
finding		0..*	BackboneElement	Possible or likely findings and diagnoses
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
itemCodeableConcept		0..1	CodeableConcept	What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis.
itemReference		0..1	Reference(Condition | Observation | Media)	What was found
basis		0..1	string	Which investigations support finding
prognosisCodeableConcept		0..*	CodeableConcept	Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings.
prognosisReference		0..*	Reference(RiskAssessment)	RiskAssessment expressing likely outcome
supportingInfo		0..*	Reference(Resource)	Information supporting the clinical impression
note		0..*	Annotation	Comments made about the ClinicalImpression
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
ClinicalImpression.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels From the FHIR Standard
ClinicalImpression.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags From the FHIR Standard
ClinicalImpression.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
ClinicalImpression.identifier:polarisId.use	required	Pattern Value: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:polarisId.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClinicalImpression.identifier:rawCode.use	required	Pattern Value: secondary http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 From the FHIR Standard
ClinicalImpression.identifier:rawCode.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
ClinicalImpression.status	required	ClinicalImpressionStatus http://hl7.org/fhir/ValueSet/clinicalimpression-status From the FHIR Standard
ClinicalImpression.statusReason	example
ClinicalImpression.code	example
ClinicalImpression.investigation.code	example	InvestigationType http://hl7.org/fhir/ValueSet/investigation-sets From the FHIR Standard
ClinicalImpression.finding.itemCodeableConcept	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code From the FHIR Standard
ClinicalImpression.prognosisCodeableConcept	example	ClinicalImpressionPrognosis http://hl7.org/fhir/ValueSet/clinicalimpression-prognosis From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
clinicalimpression-has-polaris-id	error	ClinicalImpression	Must have at least one identifier with a canonical Polaris NamingSystem URI : identifier.exists(system.matches('^https://fhir.apps.health/NamingSystem/[A-Za-z0-9._-]+-clinicalimpression-identifier$'))
dom-2	error	ClinicalImpression	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	ClinicalImpression	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %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()
dom-4	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	ClinicalImpression	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	ClinicalImpression	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from ClinicalImpression

Summary

Mandatory: 8 elements(7 nested mandatory elements)
Must-Support: 12 elements

Structures

This structure refers to these other structures:

• Polaris Patient Core (https://fhir.apps.health/StructureDefinition/polaris-core-patient)
• Polaris Encounter Profile Core (https://fhir.apps.health/StructureDefinition/polaris-core-encounter)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of ClinicalImpression.identifier
• The element 1 is sliced based on the value of ClinicalImpression.code.coding