The zib Procedure is mapped both to this ServiceRequest profile and a profile on Procedure (http://nictiz.nl/fhir/StructureDefinition/nl-core-Procedure-event) to align with the intention of FHIR. All past procedures are covered using this Procedure resource, while all future procedures, including the advised procedures, are covered in the ServiceRequest resource. Both resources contain the zib mappings.

The zib mapping contains a known cardinality difference (0..* versus 0..1). The zib will be aligned in a future version with the cardinality of FHIR, therefore this profile pre-adopts the 0..1 cardinality for the requester.

A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

The zib Procedure is mapped both to this ServiceRequest profile and a profile on Procedure (http://nictiz.nl/fhir/StructureDefinition/nl-core-Procedure-event) to align with the intention of FHIR. All past procedures are covered using this Procedure resource, while all future procedures, including the advised procedures, are covered in the ServiceRequest resource. Both resources contain the zib mappings.

The planned and performed procedures can be linked using Procedure.basedOn.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

This element is implictly mapped to the zib concepts ProcedureStartDate (NL-CM:14.1.2) and ProcedureEndDate (NL-CM:14.1.3). Unless the status is explicitly recorded, the following guidance applies:

• When the ProcedureStartDate is in the future, .status will usually be set to active.
• When the ProcedureStartDate is in the past, .status will usually be set to completed.
• When ProcedureEndDate is in the past, .status will usually be set to completed.
• When a system is unable to infer the status from the ProcedureStartDate and ProcedureEndDate , .status will be set to unknown. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the ProcedureRequest.

The status of the order.

The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

The status of a service order.

Unless intent is explicitly recorded and a more appropriate code is known, the value can be set to order because a Procedure should authorize an action for a patient, pharmacist, professional administrator et cetera.

Whether the request is a proposal, plan, an original order or a reflex order.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

The kind of service request.

Set this to true if the record is saying that the service/procedure should NOT be performed.

In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

Codified order entry details which are based on order context.

• value @ $this

The method or technique that will be used to perform the procedure, e.g. approach, lavage, pressuring, etc.

Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

The date/time at which the requested service should occur.

• type @ $this

The date/time at which the requested service should occur.

The (desired) start date (and if possible start time) of the procedure. A ‘vague’ date, such as only the year, is permitted.

The date/time at which the requested service should occur.

If the zib Procedure concerns a procedure performed over a period, ServiceRequest.occurencePeriod.start and ServiceRequest.occurencePeriod.end are used to represent zib concepts ProcedureStartDate and ProcedureEndDate. For instantaneous or very short lasting procedures, ServiceRequest.occurrenceDateTime is used for ProcedureStartDate (ProcedureEndDate doesn't have a meaning in this case; ProcedureStartDate is the moment the procedure is performed).

The healthcare provider who requested the procedure.

The individual who initiated the request and has responsibility for its activation.

The zib mapping contains a known cardinality difference (0..* versus 0..1). The zib will be aligned in a future version with the cardinality of FHIR, therefore this profile pre-adopts the 0..1 cardinality for the requester.

Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: a PractitionerRole resource (instance of nl-core-HealthProfessional-PractitionerRole) and a Practitioner resource (instance of nl-core-HealthProfessional-Practitioner). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance.

In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the zib-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.

This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

The healthcare provider who carried out or will carry out the procedure. In most cases, only the medical specialty is entered, and not the name of the healthcare provider.

The desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.

If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. This deviates from the zib definition where multiple references to the zib Healthprofessional should be interperted as all the performers of the procedure. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

The healthcare center where the procedure was, is or or will be carried out.

A reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.

The indication is the reason for the procedure.

Indicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in supportingInfo.

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

Localisation on/in the body.

Anatomic location where the procedure should be performed. This is the target site.

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

A record of a request for service such as diagnostic investigations, treatments, or operations to be performed.

The zib Procedure is mapped both to this ServiceRequest profile and a profile on Procedure (http://nictiz.nl/fhir/StructureDefinition/nl-core-Procedure-event) to align with the intention of FHIR. All past procedures are covered using this Procedure resource, while all future procedures, including the advised procedures, are covered in the ServiceRequest resource. Both resources contain the zib mappings.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Identifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.

The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Plan/proposal/order fulfilled by this request.

The request takes the place of the referenced completed or terminated request(s).

A shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

This element is implictly mapped to the zib concepts ProcedureStartDate (NL-CM:14.1.2) and ProcedureEndDate (NL-CM:14.1.3). Unless the status is explicitly recorded, the following guidance applies:

The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

Unless intent is explicitly recorded and a more appropriate code is known, the value can be set to order because a Procedure should authorize an action for a patient, pharmacist, professional administrator et cetera.

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

A code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").

There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

Used for filtering what service request are retrieved and displayed.

Indicates how quickly the ServiceRequest should be addressed with respect to other requests.

Set this to true if the record is saying that the service/procedure should NOT be performed.

In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

The name of the procedure. Choices are the DHD procedure thesaurus, the procedures file (CBV), the Care activities file (NZa), the Dutch Mental Health and Addiction Care procedures list (GGZ) and the procedures list of the Dutch College of General Practitioners (NHG).

Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

Additional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

• value @ $this

The method or technique that will be used to perform the procedure, e.g. approach, lavage, pressuring, etc.

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

An amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).

When ordering a service the number of service items may need to be specified separately from the the service item.

On whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).

An encounter that provides additional information about the healthcare context in which this request is made.

The date/time at which the requested service should occur.

• type @ $this

The date/time at which the requested service should occur.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

The (desired) start date (and if possible start time) of the procedure. A ‘vague’ date, such as only the year, is permitted. The element offers the option to indicate the start of the period of a series of related procedures.

If the zib Procedure concerns a procedure performed over a period, ServiceRequest.occurencePeriod.start and ServiceRequest.occurencePeriod.end are used to represent zib concepts ProcedureStartDate and ProcedureEndDate. For instantaneous or very short lasting procedures, ServiceRequest.occurrenceDateTime is used for ProcedureStartDate (ProcedureEndDate doesn't have a meaning in this case; ProcedureStartDate is the moment the procedure is performed).

The end date (and if possible end time) of the procedure. A ‘vague’ date, such as only the year, is permitted. The element offers the option to indicate the end of the period of a series of related procedures. The end date element is only used for a procedures that takes some time and is then always applied. If the procedure still continues, the value is left empty.

If the zib Procedure concerns a procedure performed over a period, ServiceRequest.occurencePeriod.start and ServiceRequest.occurencePeriod.end are used to represent zib concepts ProcedureStartDate and ProcedureEndDate. For instantaneous or very short lasting procedures, ServiceRequest.occurrenceDateTime is used for ProcedureStartDate (ProcedureEndDate doesn't have a meaning in this case; ProcedureStartDate is the moment the procedure is performed).

The (desired) start date (and if possible start time) of the procedure. A ‘vague’ date, such as only the year, is permitted.

If the zib Procedure concerns a procedure performed over a period, ServiceRequest.occurencePeriod.start and ServiceRequest.occurencePeriod.end are used to represent zib concepts ProcedureStartDate and ProcedureEndDate. For instantaneous or very short lasting procedures, ServiceRequest.occurrenceDateTime is used for ProcedureStartDate (ProcedureEndDate doesn't have a meaning in this case; ProcedureStartDate is the moment the procedure is performed).

If a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.

When the request transitioned to being actionable.

The healthcare provider who requested the procedure.

The zib mapping contains a known cardinality difference (0..* versus 0..1). The zib will be aligned in a future version with the cardinality of FHIR, therefore this profile pre-adopts the 0..1 cardinality for the requester.

Desired type of performer for doing the requested service.

This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.

The healthcare provider who carried out or will carry out the procedure. In most cases, only the medical specialty is entered, and not the name of the healthcare provider.

If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. This deviates from the zib definition where multiple references to the zib Healthprofessional should be interperted as all the performers of the procedure. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

The preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.

The healthcare center where the procedure was, is or or will be carried out.

An explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supportingInfo.

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

The indication is the reason for the procedure.

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.

Additional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.

To represent information about how the services are to be delivered use the instructions element.

One or more specimens that the laboratory procedure will use.

Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

Localisation on/in the body.

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

Any other notes and comments made about the service request. For example, internal billing notes.

Instructions in terms that are understood by the patient or consumer.

Key events in the history of the request.

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.