ABDM Discharge Contract
Required conformance and release evidence for the future signed Hospital discharge report.
Delivery Boundary
ABDM-compatible discharge is a hard requirement for programme U8 signed discharge. Local Recovery U8 verifies ongoing care and continuing-care handoff; it does not create, sign or export a discharge report. Do not label a Recovery assessment or handoff receipt as patient discharge or ABDM compliant.
Clinical owns the signed clinical source. Integration owns FHIR conversion and
ABDM transfer. Hospital must use those owners, not create a second export engine.
Reuse Integration::Abdm::Fhir::Builders::DischargeSummaryRecordBuilder only
after verifying the current target profile and the signed-source mapping.
Standards Baseline
The official published guide checked for this work is ABDM FHIR R4 IG 6.5.0. The 7.0.0 preview is not the published baseline. Pin the package, validator, dependencies and terminology versions used for release; recheck the deployment partner's accepted version before implementation.
The DischargeSummaryRecord profile
requires a Composition with patient, encounter, author, date, status, title and
sections. Its document type is SNOMED CT 373942005, Discharge summary.
Apply the profile's actual cardinalities, section slicing and terminology rules;
do not infer that every optional section is mandatory.
The DocumentBundle profile requires a document bundle with version metadata, a namespaced identifier and timestamp. Composition comes first. Include referenced resources and resolve the reference graph. A PDF alone is not this structured document contract.
Kulcare Source Contract
- Use one signed, immutable source revision for the human-readable report and FHIR bundle. Retain author, signer, signed time, source revision and hash.
- Cover the approved discharge dataset: patient/facility/provider identity, encounter period, diagnoses, procedures, clinical course, significant findings, allergies, discharge medication plan, condition/disposition, instructions and follow-up. Clinical reviewers approve completeness. Never invent absent data.
- Map supported structured data to the target profiles. Do not place JSON text in a narrative and claim that it satisfies coded resource requirements.
- Preserve signed amendments and earlier versions. Regeneration must not silently change a signed report. Escape and validate XHTML narratives.
- Day care can have a Recovery stay without an encounter. The selected ABDM profile requires an encounter reference: programme U8 must define a real, authorized day-care encounter lifecycle. Do not fabricate an inpatient admission or export a fake encounter to satisfy validation.
- Keep ABHA linkage and consent-based sharing separate from clinical discharge. Never make up an ABHA identifier. Do not block local care only because network sharing is unavailable. Do not publish records without the required consent.
- Check tenant/facility access and required audit on private report retrieval, generation, signing and export. Keep clinical content out of logs.
Recovery Consumer Boundary
The signed-discharge service must lock and recheck the current stay, case, assessment/source revision, MAR obligations, required documents, policy and time window. It must commit the signed discharge, terminal case/encounter transition, stay release and source-bed cleaning atomically. A browser boolean or uploaded PDF is not proof. Failed signing, stale evidence or missing required sources must leave active care unchanged. Financial clearance is a separate source.
Required Validation Evidence
- Map every report field to its signed source and target profile element.
- Run an official HL7 FHIR validator with the pinned ABDM package against synthetic signed day-care and admitted-patient bundles. Retain the command, package versions, source commit and OperationOutcome. Resolve all errors and explicitly review warnings; hash-shape unit tests are not profile validation.
- Test missing required identity/encounter, invalid codes, broken references, malformed narrative, unsigned source and stale source rejection.
- Compare PDF and FHIR meaning, medication details, author and version.
- Test authorized amendments, denied access, audit failure and exact retries.
- Verify consent, care-context linkage and encrypted ABDM sandbox transfer separately. A valid bundle is not network certification or clinical approval.
- Record named clinical, Integration and QA acceptance before activation.
Current Gap
The existing builder supplies four narrative sections. Its tests check bundle shape, document type and reference resolution. This work has not established profile-validator evidence, signed Hospital source binding, complete structured mapping or a day-care encounter lifecycle. Treat them as programme U8 release blockers, not as already compliant functionality.