| # | | Name | Source | Ver | Description |
| 1 | | ACC Provider ID | hl7.org.nz.fhir.ig.icp#current | R4 | This represents the person submitting this form to ACC. It should take the form of their ACC Provider ID. |
| 2 | | Based on | hl7.fhir.uv.extensions.r4#1.0.0 | R4 | A plan, proposal or order that is fulfilled in whole or in part by this event. |
| 3 | | Category Co-morbidities | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 4 | | Category Co-morbidities | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 5 | | Category Co-morbidities | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 6 | | Category contextual | hl7.org.nz.fhir.ig.icp#current | R4 | The contextual category. |
| 7 | | Category contextual | hl7.org.nz.fhir.ig.icp#current | R4 | The contextual category. |
| 8 | | Category contextual | hl7.org.nz.fhir.ig.icp#current | R4 | The contextual category. |
| 9 | | Category disciplines | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 10 | | Category disciplines | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 11 | | Category disciplines | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 12 | | Category psychosocial | hl7.org.nz.fhir.ig.icp#current | R4 | The psychosocial category. |
| 13 | | Category psychosocial | hl7.org.nz.fhir.ig.icp#current | R4 | The psychosocial category. |
| 14 | | Category psychosocial | hl7.org.nz.fhir.ig.icp#current | R4 | The psychosocial category. |
| 15 | | Category vocational | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 16 | | Category vocational | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 17 | | Category vocational | hl7.org.nz.fhir.ig.icp#current | R4 | The complexity category. |
| 18 | | Client Authority | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates that the Client has agreed to ACC being able to collect, store, use, & share their information. |
| 19 | | Client Participation Agreement | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates that the Client has agreed to participating in ICP. |
| 20 | | Complexity Score | hl7.org.nz.fhir.ig.icp#current | R4 | The score (low, medium, high) for each category/sub-category obtained from the ICP complexity assessment/tool. |
| 21 | | Complexity Score | hl7.org.nz.fhir.ig.icp#current | R4 | The score (low, medium, high) for each category/sub-category obtained from the ICP complexity assessment/tool. |
| 22 | | Complexity Score | hl7.org.nz.fhir.ig.icp#current | R4 | The score (low, medium, high) for each category/sub-category obtained from the ICP complexity assessment/tool. |
| 23 | | Complexity Scores | hl7.org.nz.fhir.ig.icp#current | R4 | The scores obtained from the ICP complexity assessment/tool. |
| 24 | | Complexity Scores | hl7.org.nz.fhir.ig.icp#current | R4 | The scores obtained from the ICP complexity assessment/tool. |
| 25 | | CPG Enrolled In Extension | hl7.fhir.uv.cpg#current | R4 | Tracks the episode of care for a particular patient enrolled in a particular pathway. |
| 26 | | Diagnoses | hl7.org.nz.fhir.ig.icp#current | R4 | The diagnoses for the injury being treated. |
| 27 | | Diagnosis | hl7.org.nz.fhir.ig.icp#current | R4 | A diagnosis for the injury being treated. |
| 28 | | Diagnosis | hl7.org.nz.fhir.ig.icp#current | R4 | A diagnosis for the injury being treated. |
| 29 | | Exceptional Funding | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates if exceptional is required for this treatment. |
| 30 | | Exceptional Funding | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates if exceptional is required for this treatment. |
| 31 | | Exit Reason | hl7.org.nz.fhir.ig.icp#current | R4 | Integrated Care Pathways Exit Reason |
| 32 | | Exit Reason | hl7.org.nz.fhir.ig.icp#current | R4 | Integrated Care Pathways Exit Reason |
| 33 | | ICP Service Bundle Change | hl7.org.nz.fhir.ig.icp#current | R4 | An extension to capture the reason for a change in the ICP Service Bundle. |
| 34 | | ICP Service Bundle Change | hl7.org.nz.fhir.ig.icp#current | R4 | An extension to capture the reason for a change in the ICP Service Bundle. |
| 35 | | Referral Source | hl7.org.nz.fhir.ig.icp#current | R4 | The source of the ICP referral, e.g. ACC referral, GP referral, rongoa referral, etc. |
| 36 | | Referral Source | hl7.org.nz.fhir.ig.icp#current | R4 | The source of the ICP referral, e.g. ACC referral, GP referral, rongoa referral, etc. |
| 37 | | Referral Source | hl7.org.nz.fhir.ig.icp#current | R4 | The source of the ICP referral, e.g. ACC referral, GP referral, rongoa referral, etc. |
| 38 | | Release date | hl7.fhir.uv.extensions.r4#1.0.0 | R4 | Indicates the date on which request or event resource that has a status of 'on-hold' or 'suspended' should be moved back to an active state. |
| 39 | | Service Bundle | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates the ICP service bundle selected for the treatment. |
| 40 | | Service Bundle | hl7.org.nz.fhir.ig.icp#current | R4 | Indicates the ICP service bundle selected for the treatment. |
| 41 | | Triage Assessment Date | hl7.org.nz.fhir.ig.icp#current | R4 | The date the triage assessment was completed. |