# title
VA PGHD FamilyMemberHistory Base Profile for Mobile App Data

# description
VA PGHD FamilyMemberHistory base profile defining the common constraints for all PGHD familymemberhistories. It should have a meta tag with system = 'https://wiki.mobilehealth.va.gov/x/Onc1C', a code, and a display value.

# purpose
This is the PGHD familymemberhistory base profile defining the common constraints for all VA PGHD familymemberhistory profiles. Other PGHD familymemberhistory profiles should derive from this base profile.

# snapshot.element[].short
PGHD Governance Rules for FamilyMemberHistorys

# snapshot.element[].definition
Significant health conditions for a person related to the patient relevant in the context of care for the patient.

# snapshot.element[].constraint[].human
If the resource is contained in another resource, it SHALL NOT contain nested Resources

# snapshot.element[].constraint[].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

# snapshot.element[].constraint[].human
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated

# snapshot.element[].constraint[].human
If a resource is contained in another resource, it SHALL NOT have a security label

# snapshot.element[].constraint[].extension[].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.

# snapshot.element[].constraint[].human
A resource should have narrative for robust management

# snapshot.element[].constraint[].human
Can have age[x] or born[x], but not both

# snapshot.element[].constraint[].human
Can only have estimatedAge if age[x] is present

# snapshot.element[].constraint[].human
A FamilyMemberHistory must have at least one meta tag, one or more of which has system = 'https://wiki.mobilehealth.va.gov/x/Onc1C', a code, and a display value

# snapshot.element[].definition
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
A set of rules under which this content was created

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].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

# snapshot.element[].definition
The base language in which the resource is written.

# snapshot.element[].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).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Text summary of the resource, for human interpretation

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].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.  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

# snapshot.element[].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.

# snapshot.element[].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).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them

# snapshot.element[].definition
Business identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

# snapshot.element[].comment
This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)).  It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types.  For example, multiple Patient and a Person resource instance might share the same social insurance number.

# snapshot.element[].requirements
Allows identification of the family member history as it is known by various participating systems and in a way that remains consistent across servers.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Instantiates FHIR protocol or definition

# snapshot.element[].definition
The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
Instantiates external protocol or definition

# snapshot.element[].definition
The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.

# snapshot.element[].comment
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
partial | completed | entered-in-error | health-unknown

# snapshot.element[].definition
A code specifying the status of the record of the family history of a specific family member.

# snapshot.element[].comment
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].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

# snapshot.element[].binding.description
A code that identifies the status of the family history record.

# snapshot.element[].short
subject-unknown | withheld | unable-to-obtain | deferred

# snapshot.element[].definition
Describes why the family member's history is not available.

# snapshot.element[].requirements
This is a separate element to allow it to have a distinct binding from reasonCode.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Codes describing the reason why a family member's history is not available.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].short
When history was recorded or last updated

# snapshot.element[].definition
The date (and possibly time) when the family member history was recorded or last updated.

# snapshot.element[].comment
This should be captured even if the same as the date on the List aggregating the full family history.

# snapshot.element[].requirements
Allows determination of how current the summary is.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
This will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".

# snapshot.element[].requirements
Allows greater ease in ensuring the same person is being talked about.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
The type of relationship this person has to the patient (father, mother, brother etc.).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The nature of the relationship between the patient and the related person being described in the family member history.

# snapshot.element[].comment
This element should ideally reflect whether the individual is genetically male or female.  However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate.  E.g. 'Aunt Sue' might be XY rather than XX.  Questions soliciting this information should be phrased to encourage capture of genetic sex where known.  However, systems performing analysis should also allow for the possibility of imprecision with this element.

# snapshot.element[].requirements
Not all relationship codes imply sex and the relative's sex can be relevant for risk assessments.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Codes describing the sex assigned at birth as documented on the birth registration.

# snapshot.element[].definition
The actual or approximate date of birth of the relative.

# snapshot.element[].requirements
Allows calculation of the relative's age.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
The age of the relative at the time the family member history is recorded.

# snapshot.element[].comment
use estimatedAge to indicate whether the age is actual or not.

# snapshot.element[].requirements
While age can be calculated from date of birth, sometimes recording age directly is more natural for clinicians.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
If true, indicates that the age value specified is an estimated value.

# snapshot.element[].comment
This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.

# snapshot.element[].requirements
Clinicians often prefer to specify an estimaged age rather than an age range.

# snapshot.element[].meaningWhenMissing
It is unknown whether the age is an estimate or not

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Deceased flag or the actual or approximate age of the relative at the time of death for the family member history record.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].mapping[].map
player[classCode=LIV, determinerCode=INSTANCE].deceasedInd, deceasedDate (could be URG)  For age, you'd hang an observation off the role

# snapshot.element[].short
Why was family member history performed?

# snapshot.element[].definition
Describes why the family member history occurred in coded or textual form.

# snapshot.element[].comment
Textual reasons can be captured using reasonCode.text.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Codes indicating why the family member history was done.

# snapshot.element[].short
Why was family member history performed?

# snapshot.element[].definition
Indicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
This property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
The significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

# snapshot.element[].short
Additional content defined by implementations

# snapshot.element[].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.

# snapshot.element[].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.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].short
Extensions that cannot be ignored even if unrecognized

# snapshot.element[].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.  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

# snapshot.element[].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.

# snapshot.element[].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).

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].constraint[].human
Must have either extensions or value[x], not both

# snapshot.element[].isModifierReason
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them

# snapshot.element[].definition
The actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
Identification of the Condition or diagnosis.

# snapshot.element[].definition
Indicates what happened following the condition.  If the condition resulted in death, deceased date is captured on the relation.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].binding.description
The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.

# snapshot.element[].short
Whether the condition contributed to the cause of death

# snapshot.element[].definition
This condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
Either the age of onset, range of approximate age or descriptive string can be recorded.  For conditions with multiple occurrences, this describes the first known occurrence.

# snapshot.element[].requirements
Age of onset of a condition in relatives is predictive of risk for the patient.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# snapshot.element[].definition
An area where general notes can be placed about this specific condition.

# snapshot.element[].constraint[].human
All FHIR elements must have a @value or children

# snapshot.element[].constraint[].expression
hasValue() or (children().count() > id.count())

# differential.element[].short
PGHD Governance Rules for FamilyMemberHistorys

# differential.element[].constraint[].human
A FamilyMemberHistory must have at least one meta tag, one or more of which has system = 'https://wiki.mobilehealth.va.gov/x/Onc1C', a code, and a display value