HL7 Norway
FHIR Implementation Guide for the Norwegian Municipal Sector
Shared starting point for understanding and consistent use of FHIR in municipal health and care services.
Norwegian

FHIR Implementation Guide for the Norwegian Municipal Sector
0.2.0 - ci-build NO

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: Example municipal follow-up plan - XML Representation

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<CarePlan xmlns="http://hl7.org/fhir">
  <id value="example-careplan"/>
  <meta>
    <profile
             value="https://kommune.conteir.no/StructureDefinition/kommune-careplan"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CarePlan example-careplan</b></p><a name="example-careplan"> </a><a name="hcexample-careplan"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-kommune-careplan.html">no-kommune-CarePlan</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Plan</p><p><b>category</b>: <span title="Codes:">Municipal follow-up</span></p><p><b>title</b>: Follow-up plan after discharge - Grünerløkka district</p><p><b>subject</b>: <a href="Patient-example-patient.html">Kari Hansen  Female, DoB: 1948-09-12 ( urn:oid:2.16.578.1.12.4.1.4.1#Foedselsnummer#12094812345)</a></p><p><b>period</b>: 2026-01-13 --&gt; 2026-03-31</p><p><b>author</b>: <a href="PractitionerRole-example-practitionerrole.html">PractitionerRole</a></p><p><b>careTeam</b>: <a href="CareTeam-example-careteam.html">CareTeam Multidisciplinary follow-up team, Grünerløkka district</a></p><p><b>addresses</b>: <a href="Condition-example-health-concern.html">Health concern after hip fracture</a></p><p><b>supportingInfo</b>: </p><ul><li><a href="Condition-example-health-concern.html">Health concern after hip fracture</a></li><li><a href="Observation-example-observation.html">Observation </a></li><li><a href="DocumentReference-example-documentreference.html">DocumentReference: status = current; type = Clinical note; date = 2026-01-12 09:00:00+0100; description = Decision on home nursing and practical assistance after discharge</a></li><li><a href="Goal-example-goal.html">Goal: lifecycleStatus = active; description = ; start[x] = 2026-01-20</a></li></ul><p><b>goal</b>: <a href="Goal-example-goal.html">Goal: lifecycleStatus = active; description = ; start[x] = 2026-01-20</a></p><blockquote><p><b>activity</b></p><p><b>outcomeReference</b>: </p><ul><li><a href="Encounter-example-encounter.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = ; serviceType = ; period = 2026-01-15 10:00:00+0100 --&gt; 2026-01-15 10:45:00+0100</a></li><li><a href="Encounter-example-encounter-followup.html">Encounter: status = finished; class = virtual (ActCode#VR); type = ; serviceType = ; period = 2026-01-22 11:00:00+0100 --&gt; 2026-01-22 11:20:00+0100</a></li><li><a href="Encounter-example-encounter-phone.html">Encounter: status = finished; class = virtual (ActCode#VR); type = ; serviceType = ; period = 2026-01-29 09:00:00+0100 --&gt; 2026-01-29 09:10:00+0100</a></li><li><a href="Encounter-example-encounter-evaluation.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = ; serviceType = ; period = 2026-02-05 13:00:00+0100 --&gt; 2026-02-05 13:40:00+0100</a></li><li><a href="Encounter-example-short-term-stay.html">Encounter: status = finished; class = inpatient encounter (ActCode#IMP); type = ; serviceType = ; period = 2026-01-13 15:00:00+0100 --&gt; 2026-01-15 09:30:00+0100</a></li></ul><p><b>reference</b>: <a href="ServiceRequest-example-servicerequest.html">ServiceRequest </a></p></blockquote><blockquote><p><b>activity</b></p><p><b>reference</b>: <a href="Appointment-example-appointment.html">Appointment: status = booked; serviceType = ; appointmentType = ; description = Planned home visit for medication follow-up and function assessment; start = 2026-01-22 11:00:00+0100; end = 2026-01-22 11:30:00+0100; created = 2026-01-13 12:00:00+0100</a></p></blockquote><blockquote><p><b>activity</b></p><p><b>outcomeReference</b>: <a href="Encounter-example-encounter-evaluation.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = ; serviceType = ; period = 2026-02-05 13:00:00+0100 --&gt; 2026-02-05 13:40:00+0100</a></p><p><b>reference</b>: <a href="ServiceRequest-example-rehabilitation-servicerequest.html">ServiceRequest </a></p></blockquote></div>
  </text>
  <status value="active"/>
  <intent value="plan"/>
  <category>
    <text value="Municipal follow-up"/>
  </category>
  <title value="Follow-up plan after discharge - Grünerløkka district"/>
  <subject>🔗 
    <reference value="Patient/example-patient"/>
  </subject>
  <period>
    <start value="2026-01-13"/>
    <end value="2026-03-31"/>
  </period>
  <author>🔗 
    <reference value="PractitionerRole/example-practitionerrole"/>
  </author>
  <careTeam>🔗 
    <reference value="CareTeam/example-careteam"/>
  </careTeam>
  <addresses>🔗 
    <reference value="Condition/example-health-concern"/>
    <display value="Health concern after hip fracture"/>
  </addresses>
  <supportingInfo>🔗 
    <reference value="Condition/example-health-concern"/>
    <display value="Health concern after hip fracture"/>
  </supportingInfo>
  <supportingInfo>🔗 
    <reference value="Observation/example-observation"/>
  </supportingInfo>
  <supportingInfo>🔗 
    <reference value="DocumentReference/example-documentreference"/>
  </supportingInfo>
  <supportingInfo>🔗 
    <reference value="Goal/example-goal"/>
  </supportingInfo>
  <goal>🔗 
    <reference value="Goal/example-goal"/>
  </goal>
  <activity>
    <outcomeReference>🔗 
      <reference value="Encounter/example-encounter"/>
    </outcomeReference>
    <outcomeReference>🔗 
      <reference value="Encounter/example-encounter-followup"/>
    </outcomeReference>
    <outcomeReference>🔗 
      <reference value="Encounter/example-encounter-phone"/>
    </outcomeReference>
    <outcomeReference>🔗 
      <reference value="Encounter/example-encounter-evaluation"/>
    </outcomeReference>
    <outcomeReference>🔗 
      <reference value="Encounter/example-short-term-stay"/>
    </outcomeReference>
    <reference>🔗 
      <reference value="ServiceRequest/example-servicerequest"/>
    </reference>
  </activity>
  <activity>
    <reference>🔗 
      <reference value="Appointment/example-appointment"/>
    </reference>
  </activity>
  <activity>
    <outcomeReference>🔗 
      <reference value="Encounter/example-encounter-evaluation"/>
    </outcomeReference>
    <reference>🔗 
      <reference
                 value="ServiceRequest/example-rehabilitation-servicerequest"/>
    </reference>
  </activity>
</CarePlan>