{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.wm-act-046","code":"wm-act-046-clinical-observation-diagnosis","url":"https://ver.cy/models/wm-act-046-clinical-observation-diagnosis/","name":"Clinical Observation / Diagnosis","alternateNames":[],"kind":"world-model","status":"published","version":"0.3.0-research.1","language":"en","classifiers":{"family":"World Models","category":"Activities and processes","entryKind":"aggregate","plane":"","domain":["ACT.HCR"],"industry":["Cross-industry"],"navPath":"NAV.ACT.HCR","tags":["clinical","observation","diagnosis","act.hcr"],"facets":{}},"whatItIs":"Owns assertion identity and lineage, profile, subject and encounter bindings, source meaning, observation design and value, interpretation, diagnostic statement, evidence-use links, participants and authority, effective and record times, result, verification and clinical statuses, correction and refutation history, quality, privacy, retention and interoperability. Patient, practitioner, encounter, specimen, device, procedure, report, disease, terminology, care action, consent, audit and record masters remain external.","purpose":"Represent one source-qualified clinical assertion, explicitly profiled as an observation result, clinical impression or diagnosis-condition, so agents can interpret evidence, status, uncertainty and lineage without conflating the assertion with the patient, encounter or disease entity.","scope":{"in":["Clinical assertion profile, identity, source, subject, focus, context, value, interpretation, evidence, uncertainty, participants, authority and time","Observation capture, clinical impression, diagnosis assertion, lifecycle, verification, correction, refutation, privacy, retention, provenance and version-pinned projections"],"out":["Independent patient, practitioner, encounter, episode, specimen, device, request, procedure, diagnostic report, disease or condition entity, terminology, care plan, treatment, medication, consent, audit or records lifecycles","Treating an observable as a result, result as diagnosis, assertion as disease entity, preliminary as final, clinical status as verification status, refuted as erased or code mapping as source truth","Giving medical advice, autonomously diagnosing, ordering or performing care, operating clinical systems or defining universally applicable professional and legal rules"],"boundaries":[{"neighbor":"WM-ACT-018 Encounter","distinction":"Encounter may contain or contextualize assertion instances, but owns its own participants, location, service and lifecycle. The ledger relation is candidate only."},{"neighbor":"WM-LIV-021 Disease / Biological Condition","distinction":"The disease or biological-condition master owns the condition entity or class. This model owns a source-qualified assertion that a subject has, may have or does not have a condition at a stated verification and clinical status."},{"neighbor":"Patient, Related Person, Practitioner, Organization and Care Team","distinction":"External identity and role masters own people and organizations. This assertion records role-qualified references, participation, informant status, delegation and responsibility."},{"neighbor":"Specimen, Device, Service Request, Procedure and Diagnostic Report","distinction":"External masters own acquisition objects, performed procedures and report lifecycle. The assertion binds the exact sources, methods and report membership needed for interpretation."},{"neighbor":"SNOMED CT, LOINC, ICD-11, UCUM and other terminology masters","distinction":"Terminology systems own concept and unit releases. This assertion preserves original source meaning, selected mappings, versions, mapping responsibility and loss."},{"neighbor":"Treatment, Care Plan, Decision Support and Clinical Action","distinction":"This model may expose clinically usable assertions and safety limitations but never turns evidence into an autonomous treatment order or action."}]},"distinguishingFeatures":["Models one clinical assertion about a patient, keeping observation, interpretation and diagnosis separate.","Keeps preliminary, final, amended, refuted and entered-in-error states distinct.","Binds assertions to terminologies such as SNOMED CT or LOINC by reference, not by copying them.","Differs from the disease entity, which is general knowledge, and from the diagnostic report."],"structure":{"bundles":[{"id":"assertion-identity-profile-subject-and-boundary","name":"Assertion identity, profile, subject and boundary","description":"Groups governed clinical assertion context for assertion identity, profile, subject and boundary.","layers":[{"id":"assertion-profile-identity-source-and-lineage","name":"Assertion profile, identity, source and lineage","description":"Groups source-qualified clinical context for assertion profile, identity, source and lineage.","findings":[{"id":"assertion-profile-kind-scope-specialty-and-semantic-boundary","name":"Assertion profile, kind, scope, specialty and semantic boundary","description":"Records assertion profile, kind, scope, specialty and semantic boundary as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish assertion profile, kind, scope, specialty and semantic boundary?","id":"assertion-profile-kind-scope-specialty-and-semantic-boundary-q01","kind":"classification"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for assertion profile, kind, scope, specialty and semantic boundary, using which method, evidence and authority?","id":"assertion-profile-kind-scope-specialty-and-semantic-boundary-q02","kind":"quality"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to assertion profile, kind, scope, specialty and semantic boundary, and how may it be validated, challenged, corrected or retained?","id":"assertion-profile-kind-scope-specialty-and-semantic-boundary-q03","kind":"privacy"}]},{"id":"assertion-identifier-source-version-predecessor-successor-and-lineage","name":"Assertion identifier, source, version, predecessor, successor and lineage","description":"Records assertion identifier, source, version, predecessor, successor and lineage as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish assertion identifier, source, version, predecessor, successor and lineage?","id":"assertion-identifier-source-version-predecessor-successor-and-lineage-q01","kind":"identity"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for assertion identifier, source, version, predecessor, successor and lineage, using which method, evidence and authority?","id":"assertion-identifier-source-version-predecessor-successor-and-lineage-q02","kind":"authority"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to assertion identifier, source, version, predecessor, successor and lineage, and how may it be validated, challenged, corrected or retained?","id":"assertion-identifier-source-version-predecessor-successor-and-lineage-q03","kind":"retention"}]}]},{"id":"subject-focus-encounter-and-phenomenon-boundaries","name":"Subject, focus, encounter and phenomenon boundaries","description":"Groups source-qualified clinical context for subject, focus, encounter and phenomenon boundaries.","findings":[{"id":"subject-focus-related-person-group-and-encounter-binding","name":"Subject, focus, related person, group and encounter binding","description":"Records subject, focus, related person, group and encounter binding as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish subject, focus, related person, group and encounter binding?","id":"subject-focus-related-person-group-and-encounter-binding-q01","kind":"relationship"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for subject, focus, related person, group and encounter binding, using which method, evidence and authority?","id":"subject-focus-related-person-group-and-encounter-binding-q02","kind":"ownership"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to subject, focus, related person, group and encounter binding, and how may it be validated, challenged, corrected or retained?","id":"subject-focus-related-person-group-and-encounter-binding-q03","kind":"access"}]},{"id":"observable-question-result-finding-diagnosis-condition-and-disease-distinction","name":"Observable question, result, finding, diagnosis, condition and disease distinction","description":"Records observable question, result, finding, diagnosis, condition and disease distinction as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish observable question, result, finding, diagnosis, condition and disease distinction?","id":"observable-question-result-finding-diagnosis-condition-and-disease-distinction-q01","kind":"definition"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for observable question, result, finding, diagnosis, condition and disease distinction, using which method, evidence and authority?","id":"observable-question-result-finding-diagnosis-condition-and-disease-distinction-q02","kind":"temporal"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to observable question, result, finding, diagnosis, condition and disease distinction, and how may it be validated, challenged, corrected or retained?","id":"observable-question-result-finding-diagnosis-condition-and-disease-distinction-q03","kind":"validation"}]}]}]},{"id":"observation-design-acquisition-and-result","name":"Observation design, acquisition and result","description":"Groups governed clinical assertion context for observation design, acquisition and result.","layers":[{"id":"observable-method-specimen-device-procedure-and-request","name":"Observable, method, specimen, device, procedure and request","description":"Groups source-qualified clinical context for observable, method, specimen, device, procedure and request.","findings":[{"id":"observation-code-property-system-time-aspect-scale-method-and-body-site","name":"Observation code, property, system, time aspect, scale, method and body site","description":"Records observation code, property, system, time aspect, scale, method and body site as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish observation code, property, system, time aspect, scale, method and body site?","id":"observation-code-property-system-time-aspect-scale-method-and-body-site-q01","kind":"composition"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for observation code, property, system, time aspect, scale, method and body site, using which method, evidence and authority?","id":"observation-code-property-system-time-aspect-scale-method-and-body-site-q02","kind":"state"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to observation code, property, system, time aspect, scale, method and body site, and how may it be validated, challenged, corrected or retained?","id":"observation-code-property-system-time-aspect-scale-method-and-body-site-q03","kind":"interoperability"}]},{"id":"specimen-device-procedure-service-request-protocol-and-calibration-binding","name":"Specimen, device, procedure, service request, protocol and calibration binding","description":"Records specimen, device, procedure, service request, protocol and calibration binding as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish specimen, device, procedure, service request, protocol and calibration binding?","id":"specimen-device-procedure-service-request-protocol-and-calibration-binding-q01","kind":"relationship"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for specimen, device, procedure, service request, protocol and calibration binding, using which method, evidence and authority?","id":"specimen-device-procedure-service-request-protocol-and-calibration-binding-q02","kind":"lifecycle"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to specimen, device, procedure, service request, protocol and calibration binding, and how may it be validated, challenged, corrected or retained?","id":"specimen-device-procedure-service-request-protocol-and-calibration-binding-q03","kind":"decision"}]}]},{"id":"value-unit-range-component-derivation-and-interpretation","name":"Value, unit, range, component, derivation and interpretation","description":"Groups source-qualified clinical context for value, unit, range, component, derivation and interpretation.","findings":[{"id":"result-value-type-quantity-unit-code-text-media-absence-and-uncertainty","name":"Result value type, quantity, unit, code, text, media, absence and uncertainty","description":"Records result value type, quantity, unit, code, text, media, absence and uncertainty as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish result value type, quantity, unit, code, text, media, absence and uncertainty?","id":"result-value-type-quantity-unit-code-text-media-absence-and-uncertainty-q01","kind":"measurement"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for result value type, quantity, unit, code, text, media, absence and uncertainty, using which method, evidence and authority?","id":"result-value-type-quantity-unit-code-text-media-absence-and-uncertainty-q02","kind":"provenance"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to result value type, quantity, unit, code, text, media, absence and uncertainty, and how may it be validated, challenged, corrected or retained?","id":"result-value-type-quantity-unit-code-text-media-absence-and-uncertainty-q03","kind":"exception"}]},{"id":"component-panel-member-reference-range-flag-interpretation-and-derived-from","name":"Component, panel, member, reference range, flag, interpretation and derived-from","description":"Records component, panel, member, reference range, flag, interpretation and derived-from as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish component, panel, member, reference range, flag, interpretation and derived-from?","id":"component-panel-member-reference-range-flag-interpretation-and-derived-from-q01","kind":"relationship"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for component, panel, member, reference range, flag, interpretation and derived-from, using which method, evidence and authority?","id":"component-panel-member-reference-range-flag-interpretation-and-derived-from-q02","kind":"privacy"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to component, panel, member, reference range, flag, interpretation and derived-from, and how may it be validated, challenged, corrected or retained?","id":"component-panel-member-reference-range-flag-interpretation-and-derived-from-q03","kind":"security"}]}]}]},{"id":"diagnostic-reasoning-evidence-and-clinical-assertion","name":"Diagnostic reasoning, evidence and clinical assertion","description":"Groups governed clinical assertion context for diagnostic reasoning, evidence and clinical assertion.","layers":[{"id":"signs-symptoms-observations-reports-and-evidence-basis","name":"Signs, symptoms, observations, reports and evidence basis","description":"Groups source-qualified clinical context for signs, symptoms, observations, reports and evidence basis.","findings":[{"id":"subjective-symptom-objective-sign-observation-report-image-and-document-evidence","name":"Subjective symptom, objective sign, observation, report, image and document evidence","description":"Records subjective symptom, objective sign, observation, report, image and document evidence as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish subjective symptom, objective sign, observation, report, image and document evidence?","id":"subjective-symptom-objective-sign-observation-report-image-and-document-evidence-q01","kind":"evidence"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for subjective symptom, objective sign, observation, report, image and document evidence, using which method, evidence and authority?","id":"subjective-symptom-objective-sign-observation-report-image-and-document-evidence-q02","kind":"retention"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to subjective symptom, objective sign, observation, report, image and document evidence, and how may it be validated, challenged, corrected or retained?","id":"subjective-symptom-objective-sign-observation-report-image-and-document-evidence-q03","kind":"identity"}]},{"id":"evidence-relevance-quality-conflict-missingness-and-alternative-explanation","name":"Evidence relevance, quality, conflict, missingness and alternative explanation","description":"Records evidence relevance, quality, conflict, missingness and alternative explanation as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish evidence relevance, quality, conflict, missingness and alternative explanation?","id":"evidence-relevance-quality-conflict-missingness-and-alternative-explanation-q01","kind":"quality"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for evidence relevance, quality, conflict, missingness and alternative explanation, using which method, evidence and authority?","id":"evidence-relevance-quality-conflict-missingness-and-alternative-explanation-q02","kind":"access"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to evidence relevance, quality, conflict, missingness and alternative explanation, and how may it be validated, challenged, corrected or retained?","id":"evidence-relevance-quality-conflict-missingness-and-alternative-explanation-q03","kind":"classification"}]}]},{"id":"impression-diagnosis-differential-verification-and-condition-context","name":"Impression, diagnosis, differential, verification and condition context","description":"Groups source-qualified clinical context for impression, diagnosis, differential, verification and condition context.","findings":[{"id":"clinical-statement-code-category-severity-stage-body-site-and-context","name":"Clinical statement, code, category, severity, stage, body site and context","description":"Records clinical statement, code, category, severity, stage, body site and context as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish clinical statement, code, category, severity, stage, body site and context?","id":"clinical-statement-code-category-severity-stage-body-site-and-context-q01","kind":"classification"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for clinical statement, code, category, severity, stage, body site and context, using which method, evidence and authority?","id":"clinical-statement-code-category-severity-stage-body-site-and-context-q02","kind":"validation"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to clinical statement, code, category, severity, stage, body site and context, and how may it be validated, challenged, corrected or retained?","id":"clinical-statement-code-category-severity-stage-body-site-and-context-q03","kind":"relationship"}]},{"id":"working-provisional-differential-confirmed-refuted-error-and-confidence-state","name":"Working, provisional, differential, confirmed, refuted, error and confidence state","description":"Records working, provisional, differential, confirmed, refuted, error and confidence state as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish working, provisional, differential, confirmed, refuted, error and confidence state?","id":"working-provisional-differential-confirmed-refuted-error-and-confidence-state-q01","kind":"state"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for working, provisional, differential, confirmed, refuted, error and confidence state, using which method, evidence and authority?","id":"working-provisional-differential-confirmed-refuted-error-and-confidence-state-q02","kind":"interoperability"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to working, provisional, differential, confirmed, refuted, error and confidence state, and how may it be validated, challenged, corrected or retained?","id":"working-provisional-differential-confirmed-refuted-error-and-confidence-state-q03","kind":"measurement"}]}]}]},{"id":"participants-authority-time-and-clinical-context","name":"Participants, authority, time and clinical context","description":"Groups governed clinical assertion context for participants, authority, time and clinical context.","layers":[{"id":"performer-recorder-author-interpreter-asserter-and-responsibility","name":"Performer, recorder, author, interpreter, asserter and responsibility","description":"Groups source-qualified clinical context for performer, recorder, author, interpreter, asserter and responsibility.","findings":[{"id":"performer-device-recorder-author-interpreter-asserter-and-informant-role","name":"Performer, device, recorder, author, interpreter, asserter and informant role","description":"Records performer, device, recorder, author, interpreter, asserter and informant role as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish performer, device, recorder, author, interpreter, asserter and informant role?","id":"performer-device-recorder-author-interpreter-asserter-and-informant-role-q01","kind":"authority"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for performer, device, recorder, author, interpreter, asserter and informant role, using which method, evidence and authority?","id":"performer-device-recorder-author-interpreter-asserter-and-informant-role-q02","kind":"decision"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to performer, device, recorder, author, interpreter, asserter and informant role, and how may it be validated, challenged, corrected or retained?","id":"performer-device-recorder-author-interpreter-asserter-and-informant-role-q03","kind":"evidence"}]},{"id":"organization-care-team-specialty-credential-delegation-signature-and-accountability","name":"Organization, care team, specialty, credential, delegation, signature and accountability","description":"Records organization, care team, specialty, credential, delegation, signature and accountability as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish organization, care team, specialty, credential, delegation, signature and accountability?","id":"organization-care-team-specialty-credential-delegation-signature-and-accountability-q01","kind":"ownership"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for organization, care team, specialty, credential, delegation, signature and accountability, using which method, evidence and authority?","id":"organization-care-team-specialty-credential-delegation-signature-and-accountability-q02","kind":"exception"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to organization, care team, specialty, credential, delegation, signature and accountability, and how may it be validated, challenged, corrected or retained?","id":"organization-care-team-specialty-credential-delegation-signature-and-accountability-q03","kind":"quality"}]}]},{"id":"effective-specimen-onset-issued-recorded-and-context-times","name":"Effective, specimen, onset, issued, recorded and context times","description":"Groups source-qualified clinical context for effective, specimen, onset, issued, recorded and context times.","findings":[{"id":"effective-period-instant-specimen-collection-onset-abatement-and-duration","name":"Effective period, instant, specimen collection, onset, abatement and duration","description":"Records effective period, instant, specimen collection, onset, abatement and duration as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish effective period, instant, specimen collection, onset, abatement and duration?","id":"effective-period-instant-specimen-collection-onset-abatement-and-duration-q01","kind":"temporal"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for effective period, instant, specimen collection, onset, abatement and duration, using which method, evidence and authority?","id":"effective-period-instant-specimen-collection-onset-abatement-and-duration-q02","kind":"security"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to effective period, instant, specimen collection, onset, abatement and duration, and how may it be validated, challenged, corrected or retained?","id":"effective-period-instant-specimen-collection-onset-abatement-and-duration-q03","kind":"authority"}]},{"id":"issued-authored-recorded-ingested-known-time-location-posture-fasting-and-context","name":"Issued, authored, recorded, ingested, known time, location, posture, fasting and context","description":"Records issued, authored, recorded, ingested, known time, location, posture, fasting and context as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish issued, authored, recorded, ingested, known time, location, posture, fasting and context?","id":"issued-authored-recorded-ingested-known-time-location-posture-fasting-and-context-q01","kind":"temporal"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for issued, authored, recorded, ingested, known time, location, posture, fasting and context, using which method, evidence and authority?","id":"issued-authored-recorded-ingested-known-time-location-posture-fasting-and-context-q02","kind":"identity"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to issued, authored, recorded, ingested, known time, location, posture, fasting and context, and how may it be validated, challenged, corrected or retained?","id":"issued-authored-recorded-ingested-known-time-location-posture-fasting-and-context-q03","kind":"ownership"}]}]}]},{"id":"lifecycle-correction-refutation-safety-and-use","name":"Lifecycle, correction, refutation, safety and use","description":"Groups governed clinical assertion context for lifecycle, correction, refutation, safety and use.","layers":[{"id":"result-condition-verification-and-publication-lifecycles","name":"Result, condition, verification and publication lifecycles","description":"Groups source-qualified clinical context for result, condition, verification and publication lifecycles.","findings":[{"id":"registered-preliminary-final-amended-corrected-cancelled-unknown-and-entered-in-error","name":"Registered, preliminary, final, amended, corrected, cancelled, unknown and entered-in-error","description":"Records registered, preliminary, final, amended, corrected, cancelled, unknown and entered-in-error as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish registered, preliminary, final, amended, corrected, cancelled, unknown and entered-in-error?","id":"registered-preliminary-final-amended-corrected-cancelled-unknown-and-entered-in-error-q01","kind":"lifecycle"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for registered, preliminary, final, amended, corrected, cancelled, unknown and entered-in-error, using which method, evidence and authority?","id":"registered-preliminary-final-amended-corrected-cancelled-unknown-and-entered-in-error-q02","kind":"classification"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to registered, preliminary, final, amended, corrected, cancelled, unknown and entered-in-error, and how may it be validated, challenged, corrected or retained?","id":"registered-preliminary-final-amended-corrected-cancelled-unknown-and-entered-in-error-q03","kind":"temporal"}]},{"id":"active-recurrence-relapse-inactive-remission-resolved-and-verification-status","name":"Active, recurrence, relapse, inactive, remission, resolved and verification status","description":"Records active, recurrence, relapse, inactive, remission, resolved and verification status as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish active, recurrence, relapse, inactive, remission, resolved and verification status?","id":"active-recurrence-relapse-inactive-remission-resolved-and-verification-status-q01","kind":"state"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for active, recurrence, relapse, inactive, remission, resolved and verification status, using which method, evidence and authority?","id":"active-recurrence-relapse-inactive-remission-resolved-and-verification-status-q02","kind":"relationship"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to active, recurrence, relapse, inactive, remission, resolved and verification status, and how may it be validated, challenged, corrected or retained?","id":"active-recurrence-relapse-inactive-remission-resolved-and-verification-status-q03","kind":"state"}]}]},{"id":"amendment-supersession-refutation-decision-support-and-contestability","name":"Amendment, supersession, refutation, decision support and contestability","description":"Groups source-qualified clinical context for amendment, supersession, refutation, decision support and contestability.","findings":[{"id":"amendment-correction-replacement-duplicate-refutation-retraction-and-history","name":"Amendment, correction, replacement, duplicate, refutation, retraction and history","description":"Records amendment, correction, replacement, duplicate, refutation, retraction and history as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish amendment, correction, replacement, duplicate, refutation, retraction and history?","id":"amendment-correction-replacement-duplicate-refutation-retraction-and-history-q01","kind":"provenance"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for amendment, correction, replacement, duplicate, refutation, retraction and history, using which method, evidence and authority?","id":"amendment-correction-replacement-duplicate-refutation-retraction-and-history-q02","kind":"measurement"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to amendment, correction, replacement, duplicate, refutation, retraction and history, and how may it be validated, challenged, corrected or retained?","id":"amendment-correction-replacement-duplicate-refutation-retraction-and-history-q03","kind":"lifecycle"}]},{"id":"clinical-use-alert-decision-support-risk-limit-review-and-contestability","name":"Clinical use, alert, decision support, risk, limit, review and contestability","description":"Records clinical use, alert, decision support, risk, limit, review and contestability as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish clinical use, alert, decision support, risk, limit, review and contestability?","id":"clinical-use-alert-decision-support-risk-limit-review-and-contestability-q01","kind":"decision"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for clinical use, alert, decision support, risk, limit, review and contestability, using which method, evidence and authority?","id":"clinical-use-alert-decision-support-risk-limit-review-and-contestability-q02","kind":"evidence"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to clinical use, alert, decision support, risk, limit, review and contestability, and how may it be validated, challenged, corrected or retained?","id":"clinical-use-alert-decision-support-risk-limit-review-and-contestability-q03","kind":"provenance"}]}]}]},{"id":"quality-provenance-privacy-retention-interoperability-and-agents","name":"Quality, provenance, privacy, retention, interoperability and agents","description":"Groups governed clinical assertion context for quality, provenance, privacy, retention, interoperability and agents.","layers":[{"id":"source-quality-provenance-access-consent-and-confidentiality","name":"Source quality, provenance, access, consent and confidentiality","description":"Groups source-qualified clinical context for source quality, provenance, access, consent and confidentiality.","findings":[{"id":"source-record-terminology-release-mapping-transformation-derivation-and-quality","name":"Source record, terminology release, mapping, transformation, derivation and quality","description":"Records source record, terminology release, mapping, transformation, derivation and quality as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish source record, terminology release, mapping, transformation, derivation and quality?","id":"source-record-terminology-release-mapping-transformation-derivation-and-quality-q01","kind":"provenance"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for source record, terminology release, mapping, transformation, derivation and quality, using which method, evidence and authority?","id":"source-record-terminology-release-mapping-transformation-derivation-and-quality-q02","kind":"quality"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to source record, terminology release, mapping, transformation, derivation and quality, and how may it be validated, challenged, corrected or retained?","id":"source-record-terminology-release-mapping-transformation-derivation-and-quality-q03","kind":"privacy"}]},{"id":"sensitivity-consent-purpose-access-redaction-break-glass-and-disclosure","name":"Sensitivity, consent, purpose, access, redaction, break-glass and disclosure","description":"Records sensitivity, consent, purpose, access, redaction, break-glass and disclosure as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish sensitivity, consent, purpose, access, redaction, break-glass and disclosure?","id":"sensitivity-consent-purpose-access-redaction-break-glass-and-disclosure-q01","kind":"privacy"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for sensitivity, consent, purpose, access, redaction, break-glass and disclosure, using which method, evidence and authority?","id":"sensitivity-consent-purpose-access-redaction-break-glass-and-disclosure-q02","kind":"authority"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to sensitivity, consent, purpose, access, redaction, break-glass and disclosure, and how may it be validated, challenged, corrected or retained?","id":"sensitivity-consent-purpose-access-redaction-break-glass-and-disclosure-q03","kind":"retention"}]}]},{"id":"retention-projection-validation-and-safe-agent-operation","name":"Retention, projection, validation and safe agent operation","description":"Groups source-qualified clinical context for retention, projection, validation and safe agent operation.","findings":[{"id":"retention-hold-disposition-tombstone-correction-duty-and-audit-reference","name":"Retention, hold, disposition, tombstone, correction duty and audit reference","description":"Records retention, hold, disposition, tombstone, correction duty and audit reference as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish retention, hold, disposition, tombstone, correction duty and audit reference?","id":"retention-hold-disposition-tombstone-correction-duty-and-audit-reference-q01","kind":"retention"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for retention, hold, disposition, tombstone, correction duty and audit reference, using which method, evidence and authority?","id":"retention-hold-disposition-tombstone-correction-duty-and-audit-reference-q02","kind":"ownership"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to retention, hold, disposition, tombstone, correction duty and audit reference, and how may it be validated, challenged, corrected or retained?","id":"retention-hold-disposition-tombstone-correction-duty-and-audit-reference-q03","kind":"access"}]},{"id":"fhir-openehr-snomed-loinc-icd-omop-dicom-ucum-projection-and-loss","name":"FHIR, openEHR, SNOMED, LOINC, ICD, OMOP, DICOM, UCUM projection and loss","description":"Records fhir, openehr, snomed, loinc, icd, omop, dicom, ucum projection and loss as a source-qualified clinical assertion while preserving external clinical masters and the separation between observable, result, interpretation and diagnosis.","questions":[{"text":"Which stable identities, profile, clinical meanings, values and explicit unknowns establish fhir, openehr, snomed, loinc, icd, omop, dicom, ucum projection and loss?","id":"fhir-openehr-snomed-loinc-icd-omop-dicom-ucum-projection-and-loss-q01","kind":"interoperability"},{"text":"Who or what supplied, performed, recorded, interpreted or accepted responsibility for fhir, openehr, snomed, loinc, icd, omop, dicom, ucum projection and loss, using which method, evidence and authority?","id":"fhir-openehr-snomed-loinc-icd-omop-dicom-ucum-projection-and-loss-q02","kind":"temporal"},{"text":"Which event, effective, specimen, onset, issued, recorded and knowledge times apply to fhir, openehr, snomed, loinc, icd, omop, dicom, ucum projection and loss, and how may it be validated, challenged, corrected or retained?","id":"fhir-openehr-snomed-loinc-icd-omop-dicom-ucum-projection-and-loss-q03","kind":"validation"}]}]}]}]},"agentConduct":{"may":["Capture observation values with units and method from devices or forms.","Map local codes to standard terminologies with a stated mapping version.","Flag values outside reference ranges for clinician review.","Propose a candidate condition as decision support, labelled as such."],"mustNot":["Diagnose, refute or change the verification status of a condition.","Present decision-support output as a confirmed diagnosis.","Delete or overwrite an assertion instead of marking it entered-in-error.","Treat absent data as a negative finding.","Disclose diagnoses beyond the care and consent context."],"requiresHuman":["Making or refuting a diagnosis.","Communicating a diagnosis to the patient.","Releasing sensitive diagnoses such as mental health or HIV status."]},"ethics":{"considerations":["Diagnoses shape treatment, insurance and stigma; errors cause direct harm.","Patients have rights to access and correct their records.","Decision support can carry biases from training populations."],"affectedParties":["Patients","Clinicians","Family members and carers"]},"owners":{"steward":"Dimension owner and clinical assertion governance mandate","roles":[{"name":"Clinical assertion steward","responsibilities":["Own model profile, boundary, namespace, lifecycle and quality rules."]},{"name":"Observer or performer","responsibilities":["Own source-qualified acquisition and method statements within competence."]},{"name":"Recorder or data enterer","responsibilities":["Preserve source fidelity and distinguish entry from clinical responsibility."]},{"name":"Interpreter or responsible asserter","responsibilities":["Own interpretation or diagnosis, evidence basis, uncertainty and signature."]},{"name":"Terminology and interoperability steward","responsibilities":["Own versioned code, unit and projection mappings with loss declarations."]},{"name":"Privacy and consent steward","responsibilities":["Own purpose-bound access, disclosure, redaction and break-glass policy."]},{"name":"Clinical safety reviewer","responsibilities":["Own correction impact, contested results and downstream-use review."]},{"name":"Records and assurance steward","responsibilities":["Own retention, holds, provenance, auditability and disposition evidence."]}],"masterSystems":[]},"relations":[{"target":"WM-ACT-018 Encounter","type":"references","note":"Record the candidate inverse containment and clinical context without owning Encounter lifecycle."},{"target":"WM-LIV-021 Disease / Biological Condition","type":"references","note":"Bind the external condition or disease entity while keeping the diagnosis assertion independently identified and qualified."},{"target":"Patient, Related Person, Practitioner, Organization, Care Team, Specimen, Device, Request, Procedure and Diagnostic Report models","type":"references","note":"Resolve authoritative clinical participants and acquisition context without lifecycle cascade."},{"target":"Evidence, Provenance, Consent, Access, Audit and Record models","type":"references","note":"Bind evidence, authority, protected use and reconstructable history while their masters retain execution semantics."},{"target":"FHIR R5, openEHR RM 1.1.0, SNOMED CT, LOINC 2.82, ICD-11 2026-01, OMOP CDM 5.4, DICOM and UCUM","type":"aligned","note":"Project version-pinned clinical and analytic representations with explicit profile, maturity, terminology, unit and loss declarations."},{"target":"WM-ACT-018 Encounter","type":"neighbor","note":"Encounter may contain or contextualize assertion instances, but owns its own participants, location, service and lifecycle. The ledger relation is candidate only."},{"target":"WM-LIV-021 Disease / Biological Condition","type":"neighbor","note":"The disease or biological-condition master owns the condition entity or class. This model owns a source-qualified assertion that a subject has, may have or does not have a condition at a stated verification and clinical status."},{"target":"Patient, Related Person, Practitioner, Organization and Care Team","type":"neighbor","note":"External identity and role masters own people and organizations. This assertion records role-qualified references, participation, informant status, delegation and responsibility."},{"target":"Specimen, Device, Service Request, Procedure and Diagnostic Report","type":"neighbor","note":"External masters own acquisition objects, performed procedures and report lifecycle. The assertion binds the exact sources, methods and report membership needed for interpretation."},{"target":"SNOMED CT, LOINC, ICD-11, UCUM and other terminology masters","type":"neighbor","note":"Terminology systems own concept and unit releases. This assertion preserves original source meaning, selected mappings, versions, mapping responsibility and loss."},{"target":"Treatment, Care Plan, Decision Support and Clinical Action","type":"neighbor","note":"This model may expose clinically usable assertions and safety limitations but never turns evidence into an autonomous treatment order or action."},{"target":"WM-LIV-021","type":"parent"}],"interaction":{"identity":{"applicability":"required","items":["Authoritative master-system clinical assertion identifier qualified by source organization and assertion profile.","Governed globally resolvable clinical assertion IRI.","Dimension UUID when neither preceding identifier exists."]},"properties":{"applicability":"not-applicable","items":[]},"recognition":{"applicability":"optional","items":["A clinical assertion has a patient, a code, a value or statement, an effective time, a performer and a status.","It is confused with a diagnostic report, a disease definition, a problem list entry or a lab order."]},"capabilities":{"applicability":"required","items":["Register clinical assertion: Governed operation to register clinical assertion without hidden mutation of external clinical masters.","Capture observation result: Governed operation to capture observation result without hidden mutation of external clinical masters.","Assemble observation components: Governed operation to assemble observation components without hidden mutation of external clinical masters.","Record clinical impression: Governed operation to record clinical impression without hidden mutation of external clinical masters.","Assert diagnosis or condition: Governed operation to assert diagnosis or condition without hidden mutation of external clinical masters.","Verify, refute or change status: Governed operation to verify, refute or change status without hidden mutation of external clinical masters.","Amend, correct or replace assertion: Governed operation to amend, correct or replace assertion without hidden mutation of external clinical masters.","Bind supporting evidence and report: Governed operation to bind supporting evidence and report without hidden mutation of external clinical masters.","Project or ingest clinical representation: Governed operation to project or ingest clinical representation without hidden mutation of external clinical masters.","Retire, retain, disclose and audit: Governed operation to retire, retain, disclose and audit without hidden mutation of external clinical masters."]},"hazards":{"applicability":"required","items":["Wrong treatment from unit or code errors.","Missed critical results.","Privacy breach of sensitive diagnoses."]},"interfaces":{"applicability":"required","items":["SNOMED CT.","LOINC for observation codes.","WHO ICD-11 classification.","UCUM units of measure.","HL7 Version 2 ORU messages.","DICOM Structured Reporting."]},"context":{"applicability":"required","items":["Diagnostic authority, signing, disclosure, correction, retention, consent and patient-access rules depend on jurisdiction, care setting and professional scope.","ICD is primarily a classification and reporting system; clinical terminology, source record and diagnosis semantics must not be inferred solely from an ICD code.","Exchange profiles, value sets, units and terminology licensing differ by trading partner and jurisdiction."]}},"sources":[{"title":"FHIR R5 Observation","url":"https://hl7.org/fhir/R5/observation.html","note":"Health Level Seven International"},{"title":"FHIR R5 Condition","url":"https://hl7.org/fhir/R5/condition.html","note":"Health Level Seven International"},{"title":"FHIR R5 DiagnosticReport","url":"https://hl7.org/fhir/R5/diagnosticreport.html","note":"Health Level Seven International"},{"title":"FHIR R5 ClinicalImpression","url":"https://hl7.org/fhir/R5/clinicalimpression.html","note":"Health Level Seven International"},{"title":"openEHR Reference Model EHR Information Model","url":"https://specifications.openehr.org/releases/RM/Release-1.1.0/ehr.html","note":"openEHR Foundation"},{"title":"SNOMED CT Concept Model","url":"https://docs.snomed.org/snomed-ct-practical-guides/snomed-ct-starter-guide/6-snomed-ct-concept-model","note":"SNOMED International"},{"title":"Clinical Finding and Disorder","url":"https://docs.snomed.org/snomed-ct-specifications/snomed-ct-editorial-guide/readme/authoring/domain-specific-modeling/clinical-finding-and-disorder","note":"SNOMED International"},{"title":"LOINC Users' Guide: Clinical observations and measures","url":"https://loinc.org/kb/users-guide/clinical-observations-and-measures/introduction","note":"Regenstrief Institute"},{"title":"ICD API Supported Classifications, Versions and Languages","url":"https://icd.who.int/docs/icd-api/SupportedClassifications/","note":"World Health Organization"},{"title":"ICD API version 2 documentation","url":"https://icd.who.int/docs/icd-api/APIDoc-Version2/","note":"World Health Organization"},{"title":"OMOP Common Data Model v5.4","url":"https://ohdsi.github.io/CommonDataModel/cdm54.html","note":"Observational Health Data Sciences and Informatics"},{"title":"DICOM Standard PS3.3 Information Object Definitions","url":"https://dicom.nema.org/medical/dicom/current/output/html/part03.html","note":"DICOM Standards Committee"},{"title":"The Unified Code for Units of Measure","url":"https://ucum.org/ucum","note":"Regenstrief Institute"},{"title":"Regulation (EU) 2016/679 General Data Protection Regulation","url":"https://eur-lex.europa.eu/eli/reg/2016/679/oj","note":"European Union"},{"title":"PROV-O: The PROV Ontology","url":"https://www.w3.org/TR/prov-o/","note":"World Wide Web Consortium"},{"title":"Date and Time on the Internet: Timestamps","url":"https://www.rfc-editor.org/info/rfc3339/","note":"Internet Engineering Task Force"}],"openQuestions":["Approve or reject the WM-ACT-018 containment edge and define cardinality, encounter context, cross-encounter assertion and non-cascade semantics.","Create specialty assertion profiles for laboratory, pathology, imaging, genomics, vital signs, mental health and patient-reported outcomes.","Create jurisdiction and institution profiles for diagnostic authority, signature, consent, disclosure, correction, retention and access.","Test release-pinned FHIR, openEHR, SNOMED CT, LOINC, ICD-11, OMOP CDM, DICOM and UCUM mappings with mapping-loss and round-trip evidence.","Obtain supplemental Claude or Grok review and resolve any material challenge before canonical promotion.","Claude and Grok each timed out on one bounded attempt; no independent external result was admitted.","WM-ACT-018 Encounter CONTAINS WM-ACT-046 is candidate metadata and not an approved composition edge.","Specialty-specific diagnostics, pathology, genomics, imaging, laboratory, vital-sign, mental-health and patient-reported outcome profiles remain deferred.","FHIR R5 resources are Trial Use at varied maturity, ClinicalImpression is maturity level 1, and full SNOMED, LOINC, ICD, OMOP and DICOM conformance requires release-pinned implementation testing."],"resources":{"spec":"/models/wm-act-046-clinical-observation-diagnosis/spec.yaml","agents":"/models/wm-act-046-clinical-observation-diagnosis/AGENTS.md","source":"https://github.com/ver-cy/world-models/tree/feat/mega-model-registry/research/runs/wm-act-046"},"provenance":{"origin":"world-models research","builtFrom":["models/wm-act-046-clinical-observation-diagnosis/spec.yaml","ver-cy/world-models/card-supplements/wm-act-046-clinical-observation-diagnosis.json"],"providers":["Codex"],"researchStatus":"reviewable-draft","generatedAt":"2026-09-06T09:15:09Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"interaction.properties":"Institutional or informational subject: no invented physical properties.","_supplement":"Sections authored in card supplement 1.0.0 by Claude (Opus 5.5) (2026-10-05, unreviewed). Written from the published specification and established practice in the field; no new sources were read. Unreviewed."},"score":1.0}}