臺灣長期照顧實作指引(TW LTC IG)
1.1.0 - STU 1.1.0

臺灣長期照顧實作指引(TW LTC IG) - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: 居家護理照護計畫範例 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/CarePlan/hn-careplan-example> a fhir:CarePlan ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "hn-careplan-example"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://ltc-ig.fhir.tw/StructureDefinition/HNCarePlan" ;
       fhir:index 0 ;
       fhir:link <http://ltc-ig.fhir.tw/StructureDefinition/HNCarePlan>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "additional" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>陳明慧的居家護理照護計畫：降低跌倒風險。原措施為每日檢查走道障礙物，已停止並改採個別移位協助措施。照護者應依護理人員指導執行。</p></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index 0 ;
     fhir:Extension.url [ fhir:value "http://ltc-ig.fhir.tw/StructureDefinition/ExtHNEpisode" ] ;
     fhir:Extension.valueReference [
       fhir:link <http://hl7.org/fhir/EpisodeOfCare/hn-episode-example> ;
       fhir:Reference.reference [ fhir:value "EpisodeOfCare/hn-episode-example" ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Extension.url [ fhir:value "http://ltc-ig.fhir.tw/StructureDefinition/ExtHNSourceForm" ] ;
     fhir:Extension.valueReference [
       fhir:link <http://hl7.org/fhir/QuestionnaireResponse/hn-targets-example> ;
       fhir:Reference.reference [ fhir:value "QuestionnaireResponse/hn-targets-example" ]
     ]
  ], [
     fhir:index 2 ;
     fhir:Extension.url [ fhir:value "http://ltc-ig.fhir.tw/StructureDefinition/ExtHNSourceForm" ] ;
     fhir:Extension.valueReference [
       fhir:link <http://hl7.org/fhir/QuestionnaireResponse/hn-measures-example> ;
       fhir:Reference.reference [ fhir:value "QuestionnaireResponse/hn-measures-example" ]
     ]
  ] ;
  fhir:CarePlan.status [ fhir:value "active"] ;
  fhir:CarePlan.intent [ fhir:value "plan"] ;
  fhir:CarePlan.category [
     fhir:index 0 ;
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/careplan-category-tw" ] ;
       fhir:Coding.code [ fhir:value "assess-plan" ]
     ]
  ] ;
  fhir:CarePlan.subject [
     fhir:link <http://hl7.org/fhir/Patient/hn-patient-example> ;
     fhir:Reference.reference [ fhir:value "Patient/hn-patient-example" ]
  ] ;
  fhir:CarePlan.period [
     fhir:Period.start [ fhir:value "2025-12-08"^^xsd:date ]
  ] ;
  fhir:CarePlan.author [
     fhir:link <http://hl7.org/fhir/Practitioner/hn-nurse-example> ;
     fhir:Reference.reference [ fhir:value "Practitioner/hn-nurse-example" ]
  ] ;
  fhir:CarePlan.supportingInfo [
     fhir:index 0 ;
     fhir:link <http://hl7.org/fhir/QuestionnaireResponse/hn-casesummary-example> ;
     fhir:Reference.reference [ fhir:value "QuestionnaireResponse/hn-casesummary-example" ]
  ] ;
  fhir:CarePlan.goal [
     fhir:index 0 ;
     fhir:link <http://hl7.org/fhir/Goal/hn-goal-example> ;
     fhir:Reference.reference [ fhir:value "Goal/hn-goal-example" ]
  ] ;
  fhir:CarePlan.activity [
     fhir:index 0 ;
     fhir:Element.extension [
       fhir:index 0 ;
       fhir:Element.extension [
         fhir:index 0 ;
         fhir:Extension.url [ fhir:value "date" ] ;
         fhir:Extension.valueDate [ fhir:value "2025-12-09"^^xsd:date ]
       ], [
         fhir:index 1 ;
         fhir:Extension.url [ fhir:value "reason" ] ;
         fhir:Extension.valueString [ fhir:value "改採個別移位協助措施" ]
       ], [
         fhir:index 2 ;
         fhir:Extension.url [ fhir:value "nurse" ] ;
         fhir:Extension.valueReference [
           fhir:link <http://hl7.org/fhir/Practitioner/hn-nurse-example> ;
           fhir:Reference.reference [ fhir:value "Practitioner/hn-nurse-example" ]
         ]
       ] ;
       fhir:Extension.url [ fhir:value "http://ltc-ig.fhir.tw/StructureDefinition/ExtHNMeasureStop" ]
     ] ;
     fhir:CarePlan.activity.outcomeReference [
       fhir:index 0 ;
       fhir:link <http://hl7.org/fhir/QuestionnaireResponse/hn-evaluations-example> ;
       fhir:Reference.reference [ fhir:value "QuestionnaireResponse/hn-evaluations-example" ]
     ] ;
     fhir:CarePlan.activity.detail [
       fhir:CarePlan.activity.detail.goal [
         fhir:index 0 ;
         fhir:link <http://hl7.org/fhir/Goal/hn-goal-example> ;
         fhir:Reference.reference [ fhir:value "Goal/hn-goal-example" ]
       ] ;
       fhir:CarePlan.activity.detail.status [ fhir:value "stopped" ] ;
       fhir:CarePlan.activity.detail.scheduledPeriod [
         fhir:Period.start [ fhir:value "2025-12-08"^^xsd:date ]
       ] ;
       fhir:CarePlan.activity.detail.description [ fhir:value "每日檢查走道障礙物" ]
     ]
  ] .

<http://hl7.org/fhir/EpisodeOfCare/hn-episode-example> a fhir:EpisodeOfCare .

<http://hl7.org/fhir/QuestionnaireResponse/hn-targets-example> a fhir:QuestionnaireResponse .

<http://hl7.org/fhir/QuestionnaireResponse/hn-measures-example> a fhir:QuestionnaireResponse .

<http://hl7.org/fhir/Patient/hn-patient-example> a fhir:Patient .

<http://hl7.org/fhir/Practitioner/hn-nurse-example> a fhir:Practitioner .

<http://hl7.org/fhir/QuestionnaireResponse/hn-casesummary-example> a fhir:QuestionnaireResponse .

<http://hl7.org/fhir/Goal/hn-goal-example> a fhir:Goal .

<http://hl7.org/fhir/QuestionnaireResponse/hn-evaluations-example> a fhir:QuestionnaireResponse .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/CarePlan/hn-careplan-example.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/CarePlan/hn-careplan-example.ttl> .