# Careplan Extensions - Breast Screening NZ FHIR Implementation Guide v1.1.0

* [**Table of Contents**](toc.md)
* **Careplan Extensions**

## Careplan Extensions

# CarePlan Extensions

This Implementation Guide defines a set of extensions to support breast screening programme workflows. These extensions enable tracking of participant enrollment, pathway progression, and screening-specific details that are not captured in the base FHIR CarePlan resource.

-------

## Extensions Overview

The following extensions are defined for use with CarePlan resources in the breast screening context:

| | | | |
| :--- | :--- | :--- | :--- |
| [Programme Status](#programme-status) | CodeableConcept | 0..1 | Enrollment status in the programme |
| [Pathway State](#pathway-state) | CodeableConcept | 0..1 | Current state in the screening pathway |
| [Pathway Substate](#pathway-substate) | CodeableConcept | 0..1 | Detailed substate within the pathway |
| [Pathway State Date Last Modified](#pathway-state-date-last-modified) | dateTime | 0..1 | When the pathway state was last changed |

-------

## Extension Definitions

### Programme Status

**URL:** `https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status`
 **Type:** CodeableConcept
 **Cardinality:** 0..1
 **Binding:** [Programme Status ValueSet](ValueSet-programme-status.md) (required)

Indicates the participant's enrollment status in the breast screening programme.

**Example Codes:**

* `PRE_ENROLLED` - Active participant
* `ENROLLED` - Temporarily suspended
* `NOT_ENROLLED` - Permanently exited from programme

**Usage:**

```
{
  "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status",
  "valueCodeableConcept": {
    "coding": [{
      "system": "https://bsa-uat.pinga.health/ig/CodeSystem/programme-status",
      "code": "enrolled",
      "display": "Enrolled"
    }]
  }
}

```

-------

### Pathway State

**URL:** [pathway-state](CodeSystem-pathway-state.md)

**Type:** CodeableConcept
 **Cardinality:** 0..1 (1..1 in BsaCarePlan profile)
 **Binding:** [Pathway State ValueSet](ValueSet-pathway-state.md) (required)

Represents the current state of the participant within the screening pathway workflow.

**Possible Values:**

* `available-for-invitation`
* `invited`
* `booked`
* `deferred`
* `screening`
* `reading`
* `returned-to-routine`
* `exited`

**Usage:**

```
{
  "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state",
  "valueCodeableConcept": {
    "coding": [{
      "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-state",
      "code": "invited",
      "display": "Invited"
    }]
  }
}

```

-------

### Pathway Substate

**URL:** [pathway-substate](CodeSystem-pathway-substate.md)
 **Type:** CodeableConcept
 **Cardinality:** 0..1 (1..1 in BsaCarePlan profile)
 **Binding:** [Pathway Substate ValueSet](ValueSet-pathway-substate.md) (required)

Provides additional granular detail about the participant's current pathway state.

**Usage:**

```
{
  "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-substate",
  "valueCodeableConcept": {
    "coding": [{
      "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-substate",
      "code": "first-invitation",
      "display": "First Invitation"
    }]
  }
}

```

-------

### Pathway State Date Last Modified

**URL:** `https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified`
 **Type:** dateTime
 **Cardinality:** 0..1 (1..1 in BsaCarePlan profile)

Records the date and time when any of the status/state indicators were last updated. This supports audit requirements and enables tracking of participant progression through the screening workflow.

**Usage:**

```
{
  "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified",
  "valueDateTime": "2025-11-14T10:30:00+13:00"
}

```

-------

## Complete Example

### Breast Screening CarePlan with Extensions

The following example shows a CarePlan for a breast screening participant who has been invited for their screening appointment:

```
{
  "resourceType": "CarePlan",
  "id": "example-careplan",
  "meta": {
    "profile": [
      "https://bsa-uat.pinga.health/ig/StructureDefinition/BsaCarePlan"
    ],
    "lastUpdated": "2025-11-14T10:30:00+13:00"
  },
  "extension": [
    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/programme-status",
      "valueCodeableConcept": {
        "coding": [{
          "system": "https://bsa-uat.pinga.health/ig/CodeSystem/programme-status",
          "code": "enrolled",
          "display": "Enrolled"
        }]
      }
    },
    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state",
      "valueCodeableConcept": {
        "coding": [{
          "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-state",
          "code": "invited",
          "display": "Invited"
        }]
      }
    },
    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-substate",
      "valueCodeableConcept": {
        "coding": [{
          "system": "https://bsa-uat.pinga.health/ig/CodeSystem/pathway-substate",
          "code": "first-invitation",
          "display": "First Invitation"
        }]
      }
    },
    {
      "url": "https://bsa-uat.pinga.health/ig/StructureDefinition/pathway-state-date-last-modified",
      "valueDateTime": "2025-11-14T10:30:00+13:00"
    }
  ],
  "status": "active",
  "intent": "plan",
  "subject": {
    "reference": "Patient/example-patient",
    "display": "Jane Doe"
  },
  "period": {
    "start": "2025-01-15"
  },
  "author": {
    "reference": "Organization/ORG-xxx",
    "display": "Example Lead Provider"
  }
}

```

-------

## Usage in BsaCarePlan Profile

When using the [BsaCarePlan profile](StructureDefinition-BsaCarePlan.md), the following extensions have stricter cardinality requirements:

| | | | |
| :--- | :--- | :--- | :--- |
| Programme Status | 0..1 | **1..1** | **Required** |
| Pathway State | 0..1 | **1..1** | **Required** |
| Pathway Substate | 0..1 | 0..1 | Optional |
| Pathway State Date Last Modified | 0..1 | **1..1** | **Required** |

This ensures that CarePlan instances conforming to the breast screening profile always include the essential tracking information needed for programme management and reporting.

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## Related Resources

* [BsaCarePlan Profile](StructureDefinition-BsaCarePlan.md)
* [Pathway State CodeSystem](CodeSystem-pathway-state.md)
* [Pathway Substate CodeSystem](CodeSystem-pathway-substate.md)
* [Programme Status CodeSystem](CodeSystem-programme-status.md)
* [Profiles and Extensions](profiles-and-extensions.md)

