CarePlan Example: careplan-example-asthma

Narrative

Eves Asthma Care Plan. Authored by Eve and David.

The target peak flow is a minimum of 500.

Eve will take daily peak flow measurements.

If the Peakflow drops below 350, then start a course of oral prednisone, with a starting dose of 30mg, reducing by 5 mg every 2 days.

If the peakflow drops below 250, seek urgent medical assistance

A reducing dose of steroids, starting with 30mg and reducing by 5 mg every 2 days

Example XML

<?xml version="1.0" encoding="UTF-8"?>
<CarePlan xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://hl7.org/fhir" xsi:schemaLocation="http://hl7.org/fhir ../../schema/careplan.xsd">
  <id value="asthma"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p>Eves Asthma Care Plan. Authored by Eve and David.</p>
      <p>The target peak flow is a minimum of 500.</p>
      <p>Eve will take daily peak flow measurements.</p>
      <p>If the Peakflow drops below 350, then start a course of oral prednisone, with
      a starting dose of 30mg, reducing by 5 mg every 2 days.</p>
      <p>If the peakflow drops below 250, seek urgent medical assistance</p>
    </div>
  </text>
  <!-- The provenance resource. Identifies the author and date created-->
  <contained>
    <Provenance>
      <id value="prov1"/>
      <target>
        <reference value="#cp1"/>
        <display value="This Careplan"/>
      </target>
      <recorded value="2013-05-09T15:20:00-07:00"/>
      <agent>
        <role>
          <system value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
          <code value="author"/>
        </role>
        <actor>
          <display value="David Hay"/>
        </actor>
      </agent>
      <!-- Indicate that the patient (Eve) was also an author of this plan -->
      <agent>
        <role>
          <system value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
          <code value="author"/>
        </role>
        <actor>
          <reference value="Patient/1"/>
          <display value="Eve Everywoman"/>
        </actor>
      </agent>
    </Provenance>
  </contained>
  <!-- The Condition that this careplan refers to. It is referenced from the concern. -->
  <contained>
    <Condition>
      <id value="p1"/>
      <clinicalStatus value="active"/>
      <verificationStatus value="confirmed"/>
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="195967001"/>
          <display value="Asthma (disorder)"/>
        </coding>
        <text value="Asthma"/>
      </code>
      <subject>
        <reference value="Patient/1"/>
        <display value="Eve Everywoman"/>
      </subject>
    </Condition>
  </contained>
  <!-- The medication that the prescription refers to -->
  <contained>
    <Medication>
      <id value="med1"/>
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="373994007"/>
          <display value="Prednisone 5mg Tablet"/>
        </coding>
        <text value="Prednisone 5mg Tablet"/>
      </code>
    </Medication>
  </contained>
  <!-- The sliding scale of steroids -->
  <contained>
    <MedicationRequest>
      <id value="rx1"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
          <p>A reducing dose of steroids, starting with 30mg and reducing by 5 mg every 2 days</p>
        </div>
      </text>
      <patient>
        <reference value="Patient/1"/>
        <display value="Eve Everywoman"/>
      </patient>
      <medicationReference>
        <reference value="#med1"/>
        <display value="Prednisone 5mg tablet"/>
      </medicationReference>
      <dosageInstruction>
      <step>
        <component>
        <text value="Take 6 tablets once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="12"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        </component>
      </step>
      <step>
        <component>
        <text value="Take 5 tablets once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="10"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        <doseQuantity>
          <value value="5"/>
        </doseQuantity>
        </component>
      </step>
      <step>
        <component>
        <text value="Take 4 tablets once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="8"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        <doseQuantity>
          <value value="4"/>
        </doseQuantity>
        </component>
      </step>
      <step>
        <component>
        <text value="Take 3 tablets once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="6"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        <doseQuantity>
          <value value="3"/>
        </doseQuantity>
        </component>
      </step>
      <step>
        <component>
        <text value="Take 2 tablets once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="4"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        <doseQuantity>
          <value value="2"/>
        </doseQuantity>
        </component>
      </step>
      <step>
        <component>
        <text value="Take 1 tablet once a day for 2 days"/>
        <timing>
          <repeat>
            <count value="2"/>
            <period value="1"/>
            <periodUnit value="d"/>
          </repeat>
        </timing>
        <doseQuantity>
          <value value="1"/>
        </doseQuantity>
        </component>
      </step>
      </dosageInstruction>
    </MedicationRequest>
  </contained>
  <contained>
    <Goal>
      <id value="g1"/>
      <!-- An extension that specifies the minimum peak flow target for this person. Its coded so that UI's can display this in charts for example-->
      <extension url="http://hl7.org/fhir/StructureDefinition/goal-target">
        <extension url="goal-target.measure">
          <valueCodeableConcept>
            <coding>
              <system value="http://loinc.org"/>
              <code value="19935-6"/>
              <display value="Maximum expiratory gas flow Respiratory system airway by Peak flow meter --post therapy"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension url="goal-target.detail">
          <valueRange>
            <low>
              <value value="500"/>
            </low>
          </valueRange>
        </extension>
      </extension>
      <status value="in-progress"/>
      <description>
        <text value="Maintain Peak flow above 500"/>
      </description>
      <subject>
        <reference value="Patient/1"/>
        <display value="Eve Everywoman"/>
      </subject>
    </Goal>
  </contained>
  <contained>
    <Goal>
      <id value="g1"/>
      <status value="in-progress"/>
      <description>
        <text value="Eve will aim to record Peak Flow daily. An activity is created to prompt her."/>
      </description>
      <subject>
        <reference value="Patient/1"/>
        <display value="Eve Everywoman"/>
      </subject>
    </Goal>
  </contained>
  <status value="active"/>
  <intent value="plan"/>
  <subject>
    <reference value="Patient/1"/>
    <display value="Eve Everywoman"/>
  </subject>
  <addresses>
    <reference>
      <!-- The concern points to the contained Condition. Other options are to point to a 'real' Condition resource-->
      <reference value="#p1"/>
      <!-- Local reference -->
      <display value="Asthma"/>
    </reference>
  </addresses>
  <goal>
    <reference value="#g1"/>
  </goal>
  <goal>
    <reference value="#g2"/>
  </goal>
  <!-- This activity specifies that the patient take a peak flow daily -->
  <activity>
    <plannedActivityReference>
        <reference value="ServiceRequest/daily-peak-flow"/>
    </plannedActivityReference>
  </activity>
  <activity>
    <!-- Specifies that this activity (start a reducing dose of steriods) is only triggered when the peak flow drops below 350-->
    <plannedActivityReference>
        <reference value="MedicationRequest/steriods"/>
    </plannedActivityReference>
  </activity>
</CarePlan>