Concepts/Consent
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A consent records a patient's decision to permit or refuse a category of activity — treatment, research participation, sharing of their information, or a directive about end-of-life care. It is the auditable proof that a choice was made, by or for the patient, before that activity went ahead.
What it represents
In Care's FHIR-aligned model, a consent maps to the Consent resource. Each record answers four questions:
- What is being decided — a category such as treatment, research, privacy of information, or an advance directive like a do-not-resuscitate order
- What was decided — a single decision to permit or deny it
- When it applies — the date it was recorded, plus an optional validity window
- How it was confirmed — who witnessed the decision and how, with any signed form attached alongside
The key thing to understand is that a consent is not a permission setting. It does not grant anyone access to the system. It documents the patient's clinical and legal choice — a fact about the patient's care, not a rule about staff. Who can act in Care is governed separately by the permission model.
Lifecycle
A consent's status mirrors whether its decision is currently in force:
draft → active → inactive
↘ not_done
↘ entered_in_error
- draft — recorded but not yet in force
- active — in force; the decision currently governs the activity
- inactive — no longer in force, for example once its validity window has passed
- not_done — the consent activity never took place
- entered_in_error — recorded by mistake; kept for audit but disregarded
Status is a plain field on the record. Moving a consent to entered_in_error corrects the history without deleting it, and changing status has no automatic side effect elsewhere in the chart — nothing downstream is unlocked or revoked.
Categories
The category names what the patient is deciding about. Care recognises seven:
| Category | What it covers |
|---|---|
| Treatment | Consent to a clinical treatment or procedure |
| Research | Consent to take part in research |
| Patient privacy | Consent to disclose or share the patient's information |
| DNR | A do-not-resuscitate directive |
| Comfort care | A comfort or palliative care directive |
| Advance care directive | A directive about future care while the patient can still decide |
| Advance directive (other) | Any other advance directive |
Every consent carries exactly one decision — permit or deny — so a refusal is captured with the same weight and auditability as an approval. A documented "no" is as much a part of the record as a "yes".
How it connects
A consent is always attached to a single encounter, and the owning patient is reached through that encounter. The encounter is fixed at creation and cannot be moved to a different visit later — this is deliberate, because it preserves when and in what context the decision was made.
Two neighbouring records hang off a consent:
- Documents — a signed consent form or scanned file can be attached, so the paper trail lives beside the structured record
- Verifiers — each verification names the user who confirmed the consent, so a reviewer can later see exactly who witnessed it
Permissions
There is no separate consent permission set. Because a consent always hangs off an encounter, it is governed by the encounter clinical-data permissions, with patient-level clinical-data access also accepted for reads.
| Permission | Description | System Roles |
|---|---|---|
can_write_encounter_clinical_data
|
Create, update, or delete a consent on an encounter, and add or remove its verifications (blocked once the encounter is closed) | Admin, Doctor, Nurse, Facility Admin |
can_view_clinical_data
|
View a patient's clinical record, including their consents | Staff, Doctor, Nurse, Admin, Facility Admin |
can_read_encounter_clinical_data
|
Read consents via the encounter when patient-level clinical-data access is absent | Admin, Doctor, Nurse, Facility Admin |
Roles are granted through organization, facility, or patient memberships, and permissions cascade down the organization tree — a role held higher up applies to the patients and consents beneath it.
FHIR reference
Care's consent aligns with the FHIR Consent resource: its status, category, decision, and validity period map to their FHIR counterparts, modelling a patient's recorded choice to permit or deny a category of activity.
Related
- Concept: Concepts/Patient
- Reference: References/Permission
Wiki: ohcnwiki.tellmey.fyi