> ## Documentation Index
> Fetch the complete documentation index at: https://docs.connectivehealth.io/llms.txt
> Use this file to discover all available pages before exploring further.

# Patient Summary

> FHIR resources produced from the curated, clinically-relevant summary of a patient

# Overview

The Patient Summary bundle is the FHIR representation of a **curated** view of a patient's history -- the subset of
records judged clinically relevant, rather than everything on file. It is produced automatically alongside the
[Patient Everything](/fhir/patient-everything-bundle) bundle whenever a new set of clinical data finishes processing
for a patient.

The curation is targeted and configurable rather than one-size-fits-all: recency-based limits apply where recency
matters (encounters), and clinical rules apply where relevance matters (chronic problems, active medications). See
[Basics](/fhir/overview#basics) for more on the curation philosophy.

The bundle uses the same resource types, the same field mappings, and the same
[stable ID](/fhir/overview#fhir-ids) rules as the Patient Everything bundle. The differences are in *which* records
are included and in some additional links between them -- both covered under
[Differences from Patient Everything](#differences-from-patient-everything).

# Bundle Structure

Identical to the [Patient Everything bundle structure](/fhir/patient-everything-bundle#bundle-structure): a
`collection` [Bundle](https://www.hl7.org/fhir/R4/bundle.html) with a freshly generated UUID `id`, one entry per
resource, each entry addressed as `urn:uuid:{resource id}`, and `meta.source` of `https://connectivehealth.io` on
every resource. `timestamp`, `total`, `entry.request`, and `entry.response` are not set.

# Resources Included

| Resource                                                  | US Core Profile                                                                                                                                           | Description                                                                                    |
| --------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------- |
| [Patient](/fhir/resources/patient)                        | [US Core Patient](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-patient.html)                                                             | The patient's demographics. Exactly one per bundle, and the `subject` of every other resource. |
| [AllergyIntolerance](/fhir/resources/allergy-intolerance) | [US Core AllergyIntolerance](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-allergyintolerance.html)                                       | Allergies, including the reaction manifestation and severity.                                  |
| [Condition](/fhir/resources/condition)                    | [US Core Condition (Problems and Health Concerns)](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-condition-problems-health-concerns.html) | The curated problem list.                                                                      |
| [Encounter](/fhir/resources/encounter)                    | [US Core Encounter](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-encounter.html)                                                         | Visits, with follow-up visits linked back to the visit they follow up on.                      |
| [Procedure](/fhir/resources/procedure)                    | [US Core Procedure](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-procedure.html)                                                         | Procedures performed, linked to the encounter they occurred at.                                |
| [CarePlan](/fhir/resources/care-plan)                     | [US Core CarePlan](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-careplan.html)                                                           | Assessment and plan-of-treatment narrative, linked to the encounter it was recorded at.        |
| [DocumentReference](/fhir/resources/document-reference)   | [US Core DocumentReference](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-documentreference.html)                                         | Clinical notes, linked to the encounter they were written for.                                 |
| [Immunization](/fhir/resources/immunization)              | [US Core Immunization](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-immunization.html)                                                   | Vaccine administrations.                                                                       |
| [MedicationRequest](/fhir/resources/medication-request)   | [US Core MedicationRequest](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-medicationrequest.html)                                         | The curated medication list.                                                                   |
| [Observation](/fhir/resources/observation)                | [US Core Laboratory Result Observation](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-observation-lab.html)                               | Laboratory results.                                                                            |
| [Observation](/fhir/resources/observation)                | [US Core Vital Signs](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-vital-signs.html)                                                     | Vital signs, including blood pressure panels.                                                  |
| [DiagnosticReport](/fhir/resources/diagnostic-report)     | [US Core DiagnosticReport (Report and Note)](https://hl7.org/fhir/us/core/STU9/StructureDefinition-us-core-diagnosticreport-note.html)                    | Imaging results, with their findings as contained `Observation` resources.                     |

The same resource types are emitted **contained** rather than as their own bundle entries as in the Patient
Everything bundle -- `Practitioner`, `PractitionerRole`, `Location`, `Medication`, and the encounter-diagnosis
`Condition`. See [Contained resources](/fhir/patient-everything-bundle#contained-resources).

# Differences from Patient Everything

## Which records are included

| Domain                                                       | Patient Everything                                                                             | Patient Summary                                                                                           |
| ------------------------------------------------------------ | ---------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------- |
| Problems                                                     | Every problem on file.                                                                         | Only problems selected as clinically relevant.                                                            |
| Medications                                                  | Every medication on file.                                                                      | Only medications selected as clinically relevant.                                                         |
| Encounters                                                   | Every visit, each standing on its own.                                                         | Visits grouped into an original visit plus its follow-ups -- see [Encounter linking](#encounter-linking). |
| Notes, care plans, procedures                                | Sourced independently of encounters, across the whole record.                                  | Sourced from the visits included above, so only those attached to an included encounter appear.           |
| Imaging / diagnostic reports                                 | Every diagnostic report on file.                                                               | Only imaging results selected as clinically relevant.                                                     |
| Allergies, immunizations, labs, vital signs, blood pressures | Everything on file, subject to the [data limits](/fhir/patient-everything-bundle#data-limits). | Same records and same limits as Patient Everything.                                                       |

<Note>
  Because notes, care plans, and procedures are sourced from encounters in this bundle, a note or procedure whose
  visit was not selected for the summary will not appear -- even if the note itself exists in the Patient
  Everything bundle.
</Note>

## Encounter linking

The summary groups related visits together, and that grouping is expressed in FHIR:

* Each group's original visit produces an `Encounter` with no `partOf`.
* Each follow-up visit in the group produces its own `Encounter` whose `partOf` references the original visit's
  `Encounter`.

Because `Encounter.id` is the source visit's own identifier, these references are stable and resolve to another entry
in the same bundle.

<Note>
  `Encounter.partOf` is only populated in the Patient Summary bundle. In the Patient Everything bundle every visit
  stands alone, so `partOf` is never set.
</Note>

## Back-references to the encounter

Resources that came from a visit point back at that visit's `Encounter`. These links are only present in the Patient
Summary bundle:

| Resource                                                | Field               | References                                                    |
| ------------------------------------------------------- | ------------------- | ------------------------------------------------------------- |
| [DocumentReference](/fhir/resources/document-reference) | `context.encounter` | The `Encounter` for the visit the note was written for.       |
| [CarePlan](/fhir/resources/care-plan)                   | `encounter`         | The `Encounter` for the visit the plan was recorded at.       |
| [Procedure](/fhir/resources/procedure)                  | `encounter`         | The `Encounter` for the visit the procedure was performed at. |

## Encounter and diagnosis coding

Patient Everything publishes every code and translated code available for a visit, so an `Encounter.type` (and its
contained encounter-diagnosis `Condition.code`) can carry several codings -- one per code system.

The Patient Summary publishes a single, pre-resolved code for each: one coding on `Encounter.type` and one on the
contained encounter-diagnosis `Condition.code`. See [Encounter](/fhir/resources/encounter) for details.

# Stable IDs

Identical to [Patient Everything stable IDs](/fhir/patient-everything-bundle#stable-ids) -- the same fields feed the
same `id`s. A record that appears in both bundles therefore carries the same `id` in both, which means the two
bundles can be compared or merged directly.

<Note>
  The encounter links described above are *not* part of any resource's `id`. A note is assigned the same `id`
  whether or not it is linked to an encounter, so the same note has one `id` across both bundles.
</Note>

# Data Limits

The same per-domain caps described under
[Patient Everything data limits](/fhir/patient-everything-bundle#data-limits) apply. They act as an upper bound on
top of the curation rules, so in practice the curation -- not the cap -- determines the size of this bundle.

# Delivery

Patient Summary bundles are pushed to customer cloud storage as described in
[Delivery](/fhir/overview#delivery), and a `document.deliveryComplete` [webhook](/product/webhooks) is sent once
delivery succeeds.