ARCHETYPE Ceilings of treatment directive (openEHR-EHR-EVALUATION.treatment_directive.v0)

ARCHETYPE IDopenEHR-EHR-EVALUATION.treatment_directive.v0
ConceptCeilings of treatment directive
DescriptionAnticipatory directive about appropriate medical treatments, usually asserted by an authorised clinician.
UseUse to record an anticipatory directive about the overall intent of care and appropriate medical treatments or interventions for an individual. These directives are personalised in response to the individual's overall health and circumstances, usually asserted by an authorised clinician after consideration of the individual's advance care directives or stated preferences. The ceilings of treatment directive is intended to be asserted and recorded as a deliberate group of clinical decisions about possible future treatments and interventions. They are usually made by an authorised clinician who is able to carefully consider the individual's overall health condition and broader circumstances and the individual's advance care directive or stated preferences for care. The directives assist treating clinicians in future clinical decision-making by providing guidance about the overall intent of care and appropriateness of CPR and other potentially life-prolonging or invasive interventions. Ideally, the directives are established as part of integrated care, or end-of-life, planning and not under duress in response to an urgent or emergency situation.
MisuseNot to be used to record an 'Advance care directive' or the individual's preferences for care - use EVALUATION.advance_care_directive for this purpose.
PurposeTo record an anticipatory directive about the overall intent of care and appropriate medical treatments or interventions for an individual, usually asserted by an authorised clinician.
ReferencesBreault JL. DNR, DNAR, or AND? Is Language Important? Ochsner J. 2011 Winter;11(4):302-6. PMID: 22190879; PMCID: PMC3241061.

Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N, Mani RK, Rajagopal MR. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report. Indian J Crit Care Med. 2018 Apr;22(4):249-262. doi: 10.4103/ijccm.IJCCM_165_18. PMID: 29743764; PMCID: PMC5930529.

Thomas RL, Zubair MY, Hayes B, Ashby MA. Goals of care: a clinical framework for limitation of medical treatment. Med J Aust. 2014 Oct 20;201(8):452-5. doi: 10.5694/mja14.00623. PMID: 25332031.
Copyright© openEHR Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
Other Details LanguageAuthor name: Heather Leslie
Organisation: Atomica Informatics, Australia
Email: heather.leslie@atomicainformatics.com
Date originally authored: 2020-07-31
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/., custodian_organisation=openEHR Foundation, references=Breault JL. DNR, DNAR, or AND? Is Language Important? Ochsner J. 2011 Winter;11(4):302-6. PMID: 22190879; PMCID: PMC3241061. Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N, Mani RK, Rajagopal MR. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report. Indian J Crit Care Med. 2018 Apr;22(4):249-262. doi: 10.4103/ijccm.IJCCM_165_18. PMID: 29743764; PMCID: PMC5930529. Thomas RL, Zubair MY, Hayes B, Ashby MA. Goals of care: a clinical framework for limitation of medical treatment. Med J Aust. 2014 Oct 20;201(8):452-5. doi: 10.5694/mja14.00623. PMID: 25332031., original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=B15B9C2BEDBFA1DEB2D51D99345D0EAF, build_uid=00551ab5-29e9-4aba-805d-bc59623faa03, revision=0.0.1-alpha}
KeywordsDNR, DNAR, DNACPR, NFR, resuscitation, resuscitate, EoL, end of life, directive, preference, goal, care, intervention, ceiling, limit, limitation, treatment
Lifecyclein_development
UID4a19faa1-44c6-4426-89e5-2e312f18d513
Language useden
Citeable Identifier1013.1.4902
Revision Number0.0.1-alpha
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Anticipatory directive about appropriate medical treatments, usually asserted by an authorised clinician., archetypeConceptComment=null, otherContributors=Dag Aarhus, Vestre Viken HF, Norway
Tor Aksel Aasmundstad, Oslo University Hospital, Norway
Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor)
Kari-Ann Baarlid, Nasjonalforeningen for folkehelsen, Norway
Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor)
Terje Bektesevic Holmlund, UiT Norges arktiske universitet, Norway
SB Bhattacharyya, Sudisa Consultancy Services, India
Greg Burch, Tiny Medical Apps, United Kingdom
Gry Caroline Aarnes, Nasjonalforeningen for folkehelsen, Norway
Fatemeh Chalabianloo, Helse Bergen, Norway
Oona Dunlop, Oslo University Hospital, Norway
Vibeche Fashing, Norwegian Cancer Society, Norway
Grant Forrest, Lunaria Ltd, United Kingdom
Reidun Førde, Prof emirata, University of Oslo, Norway
Maria G, Norway
Anne Grimstvedt Kvalvik, Haraldsplass Diakonale sykehus, Norway
Mikkel Johan Gaup Grønmo, Forvaltningssenter EPJ, Helse-Nord, Norway (openEHR Editor)
Joost Holslag, Nedap, Netherlands
Evelyn Hovenga, EJSH Consulting, Australia
Keltie Jamieson, NSHA, Canada
Heidi Koikkalainen, United Kingdom
Tomi Laptoš, Marand, Slovenia
Liv Laugen, ​Oslo University Hospital, Norway, Norway (openEHR Editor)
Heather Leslie, Atomica Informatics, Australia (openEHR Editor)
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom
Per Meinich, Helse Sør-Øst RHF, Norway
Bjoern Naess, DIPS ASA, Norway
Arunakiry Natarajan, management4health, Germany
Svenne Naumann, Finnmarkssykehuset, Norway
Andrej Orel, Marand d.o.o., Slovenia
Vanessa Pereira, Better - Pathfinder, Portugal
Anne Rita Øksengård, Nasjonalforeningen for folkehelsen, Norway
Nina Saastad, Norwegian Cancer Society, Norway
Joran Slaaen, Norwegian Cancer Society, Norway
Norwegian Review Summary, Nasjonal IKT HF, Norway
Nyree Taylor, Ocean Informatics, Australia
Rowan Thomas, St. Vincent's Hospital Melbourne, Australia
John Tore Valand, Helse Bergen, Norway (openEHR Editor)
Marit Alice Venheim, Helse Vest IKT, Norway (openEHR Editor)
Lin Zhang, Taikang Insurance Group, China, originalLanguage=en, translators=Norwegian Bokmål: Vebjørn Arntzen, John Tore Valand, Oslo University Hospital, Helse Bergen, varntzen@ous-hf.no, john.tore.valand@helse-bergen.no
, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={capabilities=[], source=[], description=[], state=[], target=[], details=[], credentials=[], relationships=[], identities=[], provider=[], items=[], activities=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0002], code=at0002, itemType=ELEMENT, level=2, text=Intent of care, description=Description of the overall intent for future care and treatment for the individual., comment=For example: the values suggested in the Thomas et al MJA reference - 'Curative', 'Restorative', 'Supportive', 'Terminal'; and 'Unknown'., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0003], code=at0003, itemType=ELEMENT, level=2, text=Rationale, description=Narrative description about the logic and justification for the 'Intent of care' statement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0004], code=at0004, itemType=ELEMENT, level=2, text=CPR recommendation, description=Directive about future cardiopulmonary resuscitation (CPR) intervention., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Text
  •  Coded Text
    • Attempt CPR [All appropriate cardiopulmonary resuscitation treatments should be attempted to save or prolong life.]
    • Attempt modified CPR [Some cardiopulmonary resuscitation treatments should be attempted. See 'CPR modification' for details.]
    • Do not attempt CPR [No cardiopulmonary resuscitation treatments should be attempted to save or prolong life. All treatments to be focused on symptom relief and quality of life. Also known as 'Do not resuscitate (DNR)'; 'Do not attempt resuscitation (DNAR)'; 'Not for resuscitation (NFR)' or similar.]
    • Unknown [CPR guidance decision is not known.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0009], code=at0009, itemType=ELEMENT, level=2, text=CPR modification, description=Description of the recommended CPR modification., comment=This data element is only relevant if 'Attempt modified CPR' is selected in the 'CPR recommendation' data element., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0010], code=at0010, itemType=CLUSTER, level=2, text=Per intervention, description=Details of the decision about a treatment or intervention., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=1..*, cardinalityText=, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0010]/items[at0011], code=at0011, itemType=ELEMENT, level=3, text=Intervention, description=Name of the intervention., comment=The proposed DV_CODED_TEXT value set for the 'Intervention' data element is not intended to be exhaustive but to include many of the common life-saving treatments. The alternate choice of the DV_TEXT option can be used to add a local value set or bind to an external value set within a template., uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Coded Text
    • Intubation [Placement of a flexible plastic tube into the trachea to maintain an open airway.]
    • Mechanical ventilation [Artificial ventilation where mechanical means are used to assist or replace spontaneous breathing.]
    • Non-invasive ventilation [Artificial ventilation where non-invasive means are used to assist or replace spontaneous breathing.]
    • Circulatory regulation [Medication that supports heart function, including but not limited to: vasopressors, inotropes and chronotropes.]
    • Dialysis [Process of removing excess water, solutes, and toxins from the blood.]
    • Blood products [Therapeutic substance prepared from human blood including, but not limited to: whole blood; blood components; and plasma derivatives.]
    • Antibiotics, antiviral or antifungal agents [Medications to treat infections.]
    • Parenteral or artificial nutrition [Provision of nutrients by means other than eating or drinking.]
    • Transfer to Intensive Care [Transfer and admission to an intensive care or high dependency unit.]
    • Transfer to hospital [Transfer to hospital for assessment or admission.]
    • Parenteral fluids [Maintenance of hydration by means other than eating or drinking.]
    • IV access [Insertion of an intravenous line.]
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0010]/items[at0024], code=at0024, itemType=ELEMENT, level=3, text=Decision, description=Decision about the identified intervention., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Recommended [The treatment is recommended, if clinically appropriate.]
  • Recommended, with caveat [The treatment is recommended, although modified by the conditions of the caveat.]
  • Not recommended [The treatment is not recommended.]
  • Unknown [The treatment decision is not known.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0010]/items[at0029], code=at0029, itemType=ELEMENT, level=3, text=Caveat, description=Description of any criteria, qualification, exceptions or further clarification about the intervention., comment=This data element is only relevant if 'Recommended, with caveat' option is selected in the 'Decision' data element. For example: the types of antibiotics that would be acceptable., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0010]/items[at0030], code=at0030, itemType=ELEMENT, level=3, text=Intervention comment, description=Additional narrative about the intervention decision, not captured in other fields., comment=For example: the justification or rationale for the intervention decision., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0031], code=at0031, itemType=SLOT, level=2, text=Additional details, description=Additional structured details about emergency care and treatment., comment=For example: people involved in the decision-making process, if it is not possible to use the reference model participations; or additional locally relevant considerations., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0032], code=at0032, itemType=ELEMENT, level=2, text=Patient awareness, description=Description about awareness of the ceilings of care directives by the individual., comment=Coding with an external terminology is optional., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0033], code=at0033, itemType=ELEMENT, level=2, text=Carer awareness, description=Description about awareness of the ceilings of care directives by family, carers or legal proxy., comment=Coding with an external terminology is optional., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0034], code=at0034, itemType=SLOT, level=2, text=Digital representation, description=Digital document, image or video representing the Ceilings of care directive., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.multimedia_source.v0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0035], code=at0035, itemType=ELEMENT, level=2, text=Comment, description=Additional narrative about the ceilings of care directives, not captured in other fields., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], content=[], ism_transition=[], other_participations=[], context=[], contacts=[], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0037], code=at0037, itemType=ELEMENT, level=2, text=Last updated, description=The date and/or time when this Ceilings of care directive was last updated., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0038], code=at0038, itemType=ELEMENT, level=2, text=Valid period start, description=The date/time that marks the beginning of the valid period of time for this Ceilings of care directive., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0039], code=at0039, itemType=ELEMENT, level=2, text=Valid period end, description=The date/time that marks the conclusion of the valid period of time for this Ceilings of care directive., comment='Valid period end' may often overlap with 'Review due date'. However, they may need to be recorded separately in circumstances where a document has an extended period of validity but requires an interim review. That may be due to changed personal circumstances/events or local policy., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0040], code=at0040, itemType=ELEMENT, level=2, text=Review due, description=The date when review of this Ceilings of care directive is due., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0041], code=at0041, itemType=ELEMENT, level=2, text=Mandate, description=Description of any legislation or other authoritative guidance that apply., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Text
  •  URI
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042], code=at0042, itemType=CLUSTER, level=2, text=Directive location, description=Information regarding where the ceilings of care directive is stored and who has a copy of it., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1..*, cardinalityText=, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042]/items[at0043], code=at0043, itemType=ELEMENT, level=3, text=Location, description=Information regarding where the Ceilings of care directive is stored., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042]/items[at0044], code=at0044, itemType=SLOT, level=3, text=Copy holder, description=Details of a person who has a copy of the Ceilings of care directive., comment=Comment: For example, 'John Smith, Lawyer'., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0045], code=at0045, itemType=SLOT, level=2, text=Extension, description=Additional information required to extend the model with local content or to align with other reference models or formalisms., comment=For example: local information requirements; or additional metadata to align with FHIR., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null]], events=[]}, topLevelItems={data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001], code=at0001, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0..*, subCardinalityText=Minimum of 0 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0036], code=at0036, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0..*, subCardinalityText=Minimum of 0 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0037], code=at0037, itemType=ELEMENT, level=2, text=Last updated, description=The date and/or time when this Ceilings of care directive was last updated., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0038], code=at0038, itemType=ELEMENT, level=2, text=Valid period start, description=The date/time that marks the beginning of the valid period of time for this Ceilings of care directive., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0039], code=at0039, itemType=ELEMENT, level=2, text=Valid period end, description=The date/time that marks the conclusion of the valid period of time for this Ceilings of care directive., comment='Valid period end' may often overlap with 'Review due date'. However, they may need to be recorded separately in circumstances where a document has an extended period of validity but requires an interim review. That may be due to changed personal circumstances/events or local policy., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0040], code=at0040, itemType=ELEMENT, level=2, text=Review due, description=The date when review of this Ceilings of care directive is due., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0041], code=at0041, itemType=ELEMENT, level=2, text=Mandate, description=Description of any legislation or other authoritative guidance that apply., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Text
  •  URI
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042], code=at0042, itemType=CLUSTER, level=2, text=Directive location, description=Information regarding where the ceilings of care directive is stored and who has a copy of it., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1..*, cardinalityText=, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042]/items[at0043], code=at0043, itemType=ELEMENT, level=3, text=Location, description=Information regarding where the Ceilings of care directive is stored., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0042]/items[at0044], code=at0044, itemType=SLOT, level=3, text=Copy holder, description=Details of a person who has a copy of the Ceilings of care directive., comment=Comment: For example, 'John Smith, Lawyer'., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0036]/items[at0045], code=at0045, itemType=SLOT, level=2, text=Extension, description=Additional information required to extend the model with local content or to align with other reference models or formalisms., comment=For example: local information requirements; or additional metadata to align with FHIR., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]