ARCHETYPE Shared Health Summary (openEHR-EHR-COMPOSITION.shared_health_summary.v1)

ARCHETYPE IDopenEHR-EHR-COMPOSITION.shared_health_summary.v1
ConceptShared Health Summary
DescriptionA clinical document written by the nominated provider, which contains key pieces of information about an individual’s health status and is useful to a wide range of providers in assessing individuals and delivering care. (PCEHR Concept of Operations document)
Purpose
References
Copyright© openEHR Foundation
AuthorsAuthor name:
Organisation: National E-Health Transition Authority
Email: clinicalinfo@nehta.gov.au
Date originally authored: 24-Mar-2011
Other Details LanguageAuthor name:
Organisation: National E-Health Transition Authority
Email: clinicalinfo@nehta.gov.au
Date originally authored: 24-Mar-2011
Other Details (Language Independent)
  • Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.
  • Custodian Organisation: Ocean Informatics
  • Original Namespace: com.oceaninformatics
  • Original Publisher: Ocean Informatics
  • Custodian Namespace: com.oceaninformatics
  • MD5-CAM-1.0.1: 69561BA083CE155AF5EE841EC585CD71
  • Build Uid: 94efae53-de3f-4f95-8d88-df88139ee340
  • Revision: 1.0.0
Keywords
Lifecyclepublished
UIDd5eebcdc-32be-4a41-8a03-77b361a892a3
Language useden
Citeable Identifier1013.1.1151
Revision Number1.0.0
context
DateTime AttestedDateTime Attested: The date (and time if known) that the document author or document authoriser/approver confirms (usually by signature) that a document is complete and genuine.
For use in a healthcare setting. The date and time value when the document author determines the document is complete and can be sent by the authoring provider to the document recipients. In an electronic environment, the date and time when the document is last saved by the document authoring application.
Optional[{detail_docref=data_elements/NEHTA-20106-DateTime_Attested-Data_Element.xml, dc_id=20106}]
content
Adverse ReactionsAdverse Reactions: Information about adverse reactions and/or propensity to adverse reaction of the patient (including allergies and intolerances), and any relevant reaction details.
Includes allergies and adverse reaction to all substances not just medications / medicines. This might include food allergies, bee sting allergies as well as prescription and nonprescription medicines.
Optional[{detail_docref=sections/NEHTA-20113-Adverse_Reactions-Section.xml, dc_id=20113.120.1, spec_id=88}]
Include:
openEHR-EHR-SECTION.adverse_reactions.v1 and specialisations
Exclude:
All not explicitly included archetypes
MedicationsMedications: Medicines which the subject of care is using, this includes self-prescribed, clinician prescribed and nonprescription medicines.
Inclusion of medicines will be at the discretion of the clinician; however it is likely that predominantly long-term medicines will be shared. Must not be used to record vaccine administration record of the subject of care. The Administered Immunisation section must be used for this purpose.
Optional[{detail_docref=sections/NEHTA-16146-Medications-Section.xml, dc_id=16146.120.1, spec_id=86}]
Include:
openEHR-EHR-SECTION.medication_orders.v1 and specialisations
Exclude:
All not explicitly included archetypes
Past and Current Medical HistoryPast and Current Medical History: The past and current medical history of the subject of care which is relevant to the clinical event, this includes problem/diagnosis and medical or surgical procedures performed.
This includes diagnoses that were identified at the event which are significant to it, and also any interventions performed during the event or those occurring in the past that are significant to it.
Optional[{detail_docref=sections/NEHTA-16117-Past_and_Current_Medical_History-Section.xml, dc_id=16117.120.1, spec_id=134}]
Include:
openEHR-EHR-SECTION.medical_history.v1 and specialisations
Exclude:
All not explicitly included archetypes
ImmunisationsImmunisations: Information about the immunisation history of the subject of care.
Includes immunisations/vaccinations that have been administered or reported to have been administered.
Optional[{detail_docref=sections/NEHTA-16638-Immunisations-Section.xml, dc_id=16638.120.1, spec_id=137}]
Include:
openEHR-EHR-SECTION.immunisations.v1 and specialisations
Exclude:
All not explicitly included archetypes
data
Category
null
  • event
Other contributorsEric Browne, NEHTA
Stephen Chu, NEHTA
cka cka, Test Organisation, Australia (Test Editor)
Project Editor, Antigua & Barbuda (Test Editor)
Sebastian Garde, Ocean Health Systems, Germany (Test Editor)
Sarmad Kufaishi, Ocean Health Systems, Australia (Test Editor)
Robert L'egan, NEHTA
Sebastianåæâß Ocean, Ocean Infws, Germany (Test Editor)
Ning Pan, NEHTA
Stephen Royce, NEHTA
Eleanor Royle, NEHTA
Don Stewart, NEHTA
Translators