Nictiz FHIR NL STU3 Zib2017
1.3.15 - CI Build

Nictiz FHIR NL STU3 Zib2017 - Local Development build (v1.3.15) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Zib NursingIntervention - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-NursingIntervention resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Procedure
ShortNursingIntervention
Alternate NamesVerpleegkundigeInterventie
2. Procedure.extension
SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Procedure.extension:TreatmentObjective
    Slice NameTreatmentObjective
    Definition

    The description of the treatment goal that the intervention decision is based on.

    ShortTreatment objective
    Control0..1
    TypeExtension(pertains to goal) (Extension Type: Reference(Goal))
    Alternate NamesBehandeldoel
    6. Procedure.extension:TreatmentObjective.url
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/goal-pertainsToGoal
    8. Procedure.extension:TreatmentObjective.valueReference:valueReference
    Slice NamevalueReference
    TypeReference(HCIM TreatmentObjective)
    10. Procedure.extension:Frequency
    Slice NameFrequency
    Definition

    The frequency describes how often and in which period certain procedures are carried out, e.g. 3x a day.

    ShortFrequency
    TypeExtension(schedule) (Extension Type: Timing)
    Alternate NamesFrequentie
    12. Procedure.extension:Frequency.url
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/procedure-schedule
    14. Procedure.extension:Interval
    Slice NameInterval
    Definition

    Interval indicates the time between planned procedures. When entering an interval, the focus is on the time between the consecutive procedures, such as in the treatment of a wound, for example. The exact times are of lesser importance.

    Control0..1
    TypeExtension(HCIM NursingIntervention Interval) (Extension Type: Quantity)
    16. Procedure.extension:Instruction
    Slice NameInstruction
    Definition

    Instructions for performing the nursing action. This is particularly at issue when the action is performed by the patient himself or by a caregiver.

    ShortInstruction
    Control0..1
    TypeExtension(Comment) (Extension Type: string)
    Alternate NamesInstructie
    18. Procedure.extension:Requester
    Slice NameRequester
    Definition

    The health professional who requested the nursing intervention. If desired, only the requester’s specialty can be entered.

    ShortRequester
    TypeExtension(HCIM NursingIntervention Requester) (Extension Type: Reference(nl-core-practitionerrole, nl-core-practitioner))
    Alternate NamesAanvrager
    20. Procedure.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    22. Procedure.category
    Control1..?
    24. Procedure.category.coding
    SlicingThis element introduces a set of slices on Procedure.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • 26. Procedure.category.coding:nursingInterventionCode
      Slice NamenursingInterventionCode
      Definition

      Category snomed code used for indexing/retrieval of the HCIM NursingIntervention.

      ShortNursingInterventionCode
      28. Procedure.category.coding:nursingInterventionCode.system
      Fixed Valuehttp://snomed.info/sct
      30. Procedure.category.coding:nursingInterventionCode.code
      Fixed Value9632001
      32. Procedure.category.coding:nursingInterventionCode.display
      Default ValueNursing procedure (procedure)
      34. Procedure.code
      Definition

      A nursing intervention is a treatment carried out by a nurse based on an expert opinion and clinical knowledge for the benefit of the person requesting healthcare. The intervention is targeted towards a certain problem (diagnosis) and has a predetermined healthcare result.

      ShortIntervention
      Control1..?
      Alternate NamesInterventie
      36. Procedure.code.coding
      SlicingThis element introduces a set of slices on Procedure.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 38. Procedure.code.coding:interventionNICCodelist
        Slice NameinterventionNICCodelist
        BindingUnless not suitable, these codes SHALL be taken from InterventieNICCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.2--20171231000000)

        NIC - All Values

        40. Procedure.code.coding:interventionSnomedCodelist
        Slice NameinterventionSnomedCodelist
        BindingUnless not suitable, these codes SHALL be taken from InterventieSnomedCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.4--20171231000000)

        SNOMED CT - SNOMED CT: <<71388002 | procedure |

        42. Procedure.subject
        TypeReference(nl-core-patient, Group)
        44. Procedure.performedPeriod:performedPeriod
        Slice NameperformedPeriod
        TypePeriod
        46. Procedure.performedPeriod:performedPeriod.start
        Definition

        The start date (and if possible start time) of the procedure. The concept offers the option to indicate the start of the period of a series of repeating procedures.

        ShortProcedureStartDateTime
        Alternate NamesActieStartDatumTijd
        48. Procedure.performedPeriod:performedPeriod.end
        Definition

        The end date (and if possible end time) of the procedure. The concept offers the option to indicate the end of the period of a series of repeating procedures.

        ShortProcedureEndDateTime
        Alternate NamesActieEindDatumTijd
        50. Procedure.performer
        Definition

        The person carrying out the nursing procedure.

        ShortPerformer
        Control0..1
        Alternate NamesUitvoerder
        52. Procedure.performer.role
        54. Procedure.performer.role.coding
        SlicingThis element introduces a set of slices on Procedure.performer.role.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ system
        • 56. Procedure.performer.role.coding:healthProfessionalRole
          Slice NamehealthProfessionalRole
          Definition

          The role the healthcare provider fulfils in the healthcare process. For healthcare providers, this could be for example main practitioner, referrer or general practitioner.

          ShortHealthProfessionalRole
          BindingUnless not suitable, these codes SHALL be taken from ZorgverlenerRolCodelijst
          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.17.1.5--20171231000000)
          Alternate NamesZorgverlenerRol
          58. Procedure.performer.actor
          Definition

          The person carrying out the nursing procedure.

          ShortThe reference to the performer
          TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson)
          60. Procedure.performer.actor.extension
          SlicingThis element introduces a set of slices on Procedure.performer.actor.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 62. Procedure.performer.actor.extension:practitionerRole
            Slice NamepractitionerRole
            Control0..1
            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
            64. Procedure.reasonReference
            Definition

            The nursing-related problem (indication) providing cause for the intervention.

            ShortIndication
            TypeReference(HCIM Problem, Observation)
            Alternate NamesIndicatie
            66. Procedure.report
            TypeReference(HCIM TextResult)
            68. Procedure.note
            70. Procedure.note.text
            Definition

            Comment on the nursing intervention.

            ShortComment
            Alternate NamesToelichting
            72. Procedure.usedReference
            74. Procedure.usedReference.extension
            SlicingThis element introduces a set of slices on Procedure.usedReference.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 76. Procedure.usedReference.extension:MedicalDevice
              Slice NameMedicalDevice
              Definition

              Description of the materials used for the nursing procedure, such as bandages.

              ShortMedical device
              TypeExtension(MedicalDevice extension) (Extension Type: Reference)

              Guidance on how to interpret the contents of this table can be found here

              0. Procedure
              Definition

              An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy.

              ShortNursingInterventionAn action that is being or was performed on a patient
              Control0..*
              Alternate NamesVerpleegkundigeInterventie
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
              pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
              dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
              pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
              2. Procedure.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

              ShortA set of rules under which this content was created
              Comments

              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.

              This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

              Control0..1
              Typeuri
              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              4. Procedure.extension
              Definition

              An Extension


              May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

              ShortExtensionAdditional Content defined by implementations
              Comments

              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.

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 6. Procedure.extension:TreatmentObjective
                Slice NameTreatmentObjective
                Definition

                The description of the treatment goal that the intervention decision is based on.

                ShortTreatment objective
                Comments

                This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(pertains to goal) (Extension Type: Reference(Goal))
                Alternate NamesBehandeldoel
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                8. Procedure.extension:TreatmentObjective.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/goal-pertainsToGoal
                10. Procedure.extension:TreatmentObjective.valueReference:valueReference
                Slice NamevalueReference
                Definition

                Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                ShortValue of extension
                Control0..1
                TypeReference(HCIM TreatmentObjective), date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
                12. Procedure.extension:Frequency
                Slice NameFrequency
                Definition

                The frequency describes how often and in which period certain procedures are carried out, e.g. 3x a day.

                ShortFrequency
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(schedule) (Extension Type: Timing)
                Alternate NamesFrequentie
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                14. Procedure.extension:Frequency.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/procedure-schedule
                16. Procedure.extension:Interval
                Slice NameInterval
                Definition

                Interval indicates the time between planned procedures. When entering an interval, the focus is on the time between the consecutive procedures, such as in the treatment of a wound, for example. The exact times are of lesser importance.

                ShortInterval
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM NursingIntervention Interval) (Extension Type: Quantity)
                Alternate NamesInterval
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                18. Procedure.extension:Instruction
                Slice NameInstruction
                Definition

                Instructions for performing the nursing action. This is particularly at issue when the action is performed by the patient himself or by a caregiver.

                ShortInstruction
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(Comment) (Extension Type: string)
                Alternate NamesToelichting, Instructie
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                20. Procedure.extension:Requester
                Slice NameRequester
                Definition

                The health professional who requested the nursing intervention. If desired, only the requester’s specialty can be entered.

                ShortRequester
                Control0..*
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM NursingIntervention Requester) (Extension Type: Reference(nl-core-practitionerrole, nl-core-practitioner))
                Alternate NamesAanvrager
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                22. Procedure.modifierExtension
                Definition

                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. Usually modifier elements provide negation or qualification. In order 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.

                ShortExtensions that cannot be ignored
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Alternate Namesextensions, user content
                24. Procedure.identifier
                Definition

                This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

                ShortExternal Identifiers for this procedure
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                TypeIdentifier
                Summarytrue
                Requirements

                Need to allow connection to a wider workflow.

                26. Procedure.status
                Definition

                A code specifying the state of the procedure. Generally this will be in-progress or completed state.

                Shortpreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
                Comments

                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 procedure.

                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status
                (required to http://hl7.org/fhir/ValueSet/event-status)

                A code specifying the state of the procedure.

                Typecode
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                28. Procedure.notDone
                Definition

                Set this to true if the record is saying that the procedure was NOT performed.

                ShortTrue if procedure was not performed as scheduled
                Comments

                If true, it means the procedure did not occur as described. Typically it would be accompanied by attributes describing the type of activity. It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period). Specifying additional information such as performer, outcome, etc. is generally inappropriate. For example, it's not that useful to say "There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome" as it implies that there could have been an appendectomy done at any other time, by any other clinician or with any other outcome.

                This element is labeled as a modifier because it indicates that a procedure didn't happen.

                Control0..1
                Typeboolean
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Default Valuefalse
                30. Procedure.category
                Definition

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

                ShortClassification of the procedure
                Control10..1
                BindingFor example codes, see Procedure Category Codes (SNOMED CT)http://hl7.org/fhir/ValueSet/procedure-category
                (example to http://hl7.org/fhir/ValueSet/procedure-category)

                A code that classifies a procedure for searching, sorting and display purposes.

                TypeCodeableConcept
                Summarytrue
                32. Procedure.category.coding
                Definition

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                Control0..*
                TypeCoding
                Summarytrue
                Requirements

                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                SlicingThis element introduces a set of slices on Procedure.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ code
                • 34. Procedure.category.coding:nursingInterventionCode
                  Slice NamenursingInterventionCode
                  Definition

                  Category snomed code used for indexing/retrieval of the HCIM NursingIntervention.


                  A reference to a code defined by a terminology system.

                  ShortNursingInterventionCodeCode defined by a terminology system
                  Comments

                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                  Control0..*
                  TypeCoding
                  Summarytrue
                  Requirements

                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                  36. Procedure.category.coding:nursingInterventionCode.system
                  Definition

                  The identification of the code system that defines the meaning of the symbol in the code.

                  ShortIdentity of the terminology system
                  Comments

                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                  Control0..1
                  Typeuri
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be unambiguous about the source of the definition of the symbol.

                  Fixed Valuehttp://snomed.info/sct
                  38. Procedure.category.coding:nursingInterventionCode.code
                  Definition

                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                  ShortSymbol in syntax defined by the system
                  Control0..1
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Fixed Value9632001
                  40. Procedure.category.coding:nursingInterventionCode.display
                  Definition

                  A representation of the meaning of the code in the system, following the rules of the system.

                  ShortRepresentation defined by the system
                  Control0..1
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                  42. Procedure.code
                  Definition

                  A nursing intervention is a treatment carried out by a nurse based on an expert opinion and clinical knowledge for the benefit of the person requesting healthcare. The intervention is targeted towards a certain problem (diagnosis) and has a predetermined healthcare result.


                  The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

                  ShortInterventionIdentification of the procedure
                  Control10..1
                  BindingFor example codes, see Procedure Codes (SNOMED CT)http://hl7.org/fhir/ValueSet/procedure-code
                  (example to http://hl7.org/fhir/ValueSet/procedure-code)

                  A code to identify a specific procedure .

                  TypeCodeableConcept
                  Summarytrue
                  Requirements

                  0..1 to account for primarily narrative only resources.

                  Alternate Namestype, Interventie
                  44. Procedure.code.coding
                  Definition

                  A reference to a code defined by a terminology system.

                  ShortCode defined by a terminology system
                  Comments

                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                  Control0..*
                  TypeCoding
                  Summarytrue
                  Requirements

                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                  SlicingThis element introduces a set of slices on Procedure.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ system
                  • 46. Procedure.code.coding:interventionNICCodelist
                    Slice NameinterventionNICCodelist
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control0..*
                    BindingUnless not suitable, these codes SHALL be taken from For codes, see InterventieNICCodelijst
                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.2--20171231000000)

                    NIC - All Values

                    TypeCoding
                    Summarytrue
                    Requirements

                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                    48. Procedure.code.coding:interventionSnomedCodelist
                    Slice NameinterventionSnomedCodelist
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control0..*
                    BindingUnless not suitable, these codes SHALL be taken from For codes, see InterventieSnomedCodelijst
                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.4--20171231000000)

                    SNOMED CT - SNOMED CT: <<71388002 | procedure |

                    TypeCoding
                    Summarytrue
                    Requirements

                    Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                    50. Procedure.subject
                    Definition

                    The person, animal or group on which the procedure was performed.

                    ShortWho the procedure was performed on
                    Control1..1
                    TypeReference(nl-core-patient, Group, Patient)
                    Summarytrue
                    Alternate Namespatient
                    52. Procedure.performed[x]
                    Definition

                    The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                    ShortDate/Period the procedure was performed
                    Control0..1
                    TypePeriod, dateTime
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Summarytrue
                    SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 54. Procedure.performed[x]:performedPeriod
                      Slice NameperformedPeriod
                      Definition

                      The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                      ShortDate/Period the procedure was performed
                      Control0..1
                      TypePeriod, dateTime
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Summarytrue
                      56. Procedure.performer
                      Definition

                      The person carrying out the nursing procedure.


                      Limited to 'real' people rather than equipment.

                      ShortPerformerThe people who performed the procedure
                      Control0..1*
                      TypeBackboneElement
                      Summarytrue
                      Alternate NamesUitvoerder
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                      ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                      58. Procedure.performer.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

                      ShortExtensions that cannot be ignored
                      Comments

                      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.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                      Summarytrue
                      Alternate Namesextensions, user content, modifiers
                      60. Procedure.performer.actor
                      Definition

                      The person carrying out the nursing procedure.


                      The practitioner who was involved in the procedure.

                      ShortThe reference to the performerThe reference to the practitioner
                      Control1..1
                      TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson, Practitioner, Organization, Patient, RelatedPerson, Device)
                      Summarytrue
                      Requirements

                      A reference to Device supports use cases, such as pacemakers.

                      62. Procedure.performer.actor.extension
                      Definition

                      An Extension


                      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                      ShortExtensionAdditional Content defined by implementations
                      Comments

                      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.

                      Control0..*
                      TypeExtension
                      Alternate Namesextensions, user content
                      SlicingThis element introduces a set of slices on Procedure.performer.actor.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 64. Procedure.performer.actor.extension:practitionerRole
                        Slice NamepractitionerRole
                        Definition

                        Optional Extension Element - found in all resources.

                        ShortOptional Extensions Element
                        Control0..1
                        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                        66. Procedure.reasonReference
                        Definition

                        The nursing-related problem (indication) providing cause for the intervention.


                        The condition that is the reason why the procedure was performed.

                        ShortIndicationCondition that is the reason the procedure performed
                        Comments

                        e.g. endoscopy for dilatation and biopsy, combination diagnosis and therapeutic.

                        Control0..*
                        TypeReference(HCIM Problem, Observation, Condition)
                        Summarytrue
                        Alternate NamesIndicatie
                        68. Procedure.report
                        Definition

                        This could be a histology result, pathology report, surgical report, etc..

                        ShortAny report resulting from the procedure
                        Comments

                        There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

                        Control0..*
                        TypeReference(HCIM TextResult, DiagnosticReport)

                        Guidance on how to interpret the contents of this table can be found here

                        0. Procedure
                        Definition

                        An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy.

                        ShortNursingIntervention
                        Control0..*
                        Alternate NamesVerpleegkundigeInterventie
                        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                        dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
                        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
                        pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
                        2. Procedure.id
                        Definition

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

                        ShortLogical id of this artifact
                        Comments

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

                        Control0..1
                        Typeid
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        4. Procedure.meta
                        Definition

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

                        ShortMetadata about the resource
                        Control0..1
                        TypeMeta
                        Summarytrue
                        6. Procedure.implicitRules
                        Definition

                        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

                        ShortA set of rules under which this content was created
                        Comments

                        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.

                        This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

                        Control0..1
                        Typeuri
                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        8. Procedure.language
                        Definition

                        The base language in which the resource is written.

                        ShortLanguage of the resource content
                        Comments

                        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).

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from Common Languages
                        (extensible to http://hl7.org/fhir/ValueSet/languages)

                        A human language.

                        Additional BindingsPurpose
                        AllLanguagesMax Binding
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        10. Procedure.text
                        Definition

                        A human-readable narrative that contains a summary of the resource, and may 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.

                        ShortText summary of the resource, for human interpretation
                        Comments

                        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 in formation is added later.

                        Control0..1
                        This element is affected by the following invariants: dom-1
                        TypeNarrative
                        Alternate Namesnarrative, html, xhtml, display
                        12. Procedure.contained
                        Definition

                        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.

                        ShortContained, inline Resources
                        Comments

                        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.

                        Control0..*
                        TypeResource
                        Alternate Namesinline resources, anonymous resources, contained resources
                        14. Procedure.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control0..*
                        TypeExtension
                        SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 16. Procedure.extension:TreatmentObjective
                          Slice NameTreatmentObjective
                          Definition

                          The description of the treatment goal that the intervention decision is based on.

                          ShortTreatment objective
                          Comments

                          This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

                          Control0..1
                          This element is affected by the following invariants: ele-1
                          TypeExtension(pertains to goal) (Extension Type: Reference(Goal))
                          Alternate NamesBehandeldoel
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          18. Procedure.extension:TreatmentObjective.id
                          Definition

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

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          20. Procedure.extension:TreatmentObjective.extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                          ShortAdditional Content defined by implementations
                          Comments

                          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.

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 22. Procedure.extension:TreatmentObjective.url
                            Definition

                            Source of the definition for the extension code - a logical name or a URL.

                            Shortidentifies the meaning of the extension
                            Comments

                            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                            Control1..1
                            Typeuri
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/goal-pertainsToGoal
                            24. Procedure.extension:TreatmentObjective.valueReference:valueReference
                            Slice NamevalueReference
                            Definition

                            Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                            ShortValue of extension
                            Control0..1
                            TypeReference(HCIM TreatmentObjective)
                            26. Procedure.extension:Frequency
                            Slice NameFrequency
                            Definition

                            The frequency describes how often and in which period certain procedures are carried out, e.g. 3x a day.

                            ShortFrequency
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(schedule) (Extension Type: Timing)
                            Alternate NamesFrequentie
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            28. Procedure.extension:Frequency.id
                            Definition

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

                            Shortxml:id (or equivalent in JSON)
                            Control0..1
                            Typestring
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            XML FormatIn the XML format, this property is represented as an attribute.
                            30. Procedure.extension:Frequency.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                            ShortAdditional Content defined by implementations
                            Comments

                            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.

                            Control0..*
                            TypeExtension
                            Alternate Namesextensions, user content
                            SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 32. Procedure.extension:Frequency.url
                              Definition

                              Source of the definition for the extension code - a logical name or a URL.

                              Shortidentifies the meaning of the extension
                              Comments

                              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                              Control1..1
                              Typeuri
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/procedure-schedule
                              34. Procedure.extension:Frequency.valueTiming
                              Definition

                              Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

                              ShortValue of extension
                              Control0..1
                              TypeTiming
                              36. Procedure.extension:Interval
                              Slice NameInterval
                              Definition

                              Interval indicates the time between planned procedures. When entering an interval, the focus is on the time between the consecutive procedures, such as in the treatment of a wound, for example. The exact times are of lesser importance.

                              ShortInterval
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM NursingIntervention Interval) (Extension Type: Quantity)
                              Alternate NamesInterval
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              38. Procedure.extension:Instruction
                              Slice NameInstruction
                              Definition

                              Instructions for performing the nursing action. This is particularly at issue when the action is performed by the patient himself or by a caregiver.

                              ShortInstruction
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Comment) (Extension Type: string)
                              Alternate NamesToelichting, Instructie
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              40. Procedure.extension:Requester
                              Slice NameRequester
                              Definition

                              The health professional who requested the nursing intervention. If desired, only the requester’s specialty can be entered.

                              ShortRequester
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM NursingIntervention Requester) (Extension Type: Reference(nl-core-practitionerrole, nl-core-practitioner))
                              Alternate NamesAanvrager
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              42. Procedure.modifierExtension
                              Definition

                              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. Usually modifier elements provide negation or qualification. In order 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.

                              ShortExtensions that cannot be ignored
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              Alternate Namesextensions, user content
                              44. Procedure.identifier
                              Definition

                              This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).

                              ShortExternal Identifiers for this procedure
                              NoteThis is a business identifier, not a resource identifier (see discussion)
                              Control0..*
                              TypeIdentifier
                              Summarytrue
                              Requirements

                              Need to allow connection to a wider workflow.

                              46. Procedure.definition
                              Definition

                              A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this procedure.

                              ShortInstantiates protocol or definition
                              Control0..*
                              TypeReference(PlanDefinition, ActivityDefinition, HealthcareService)
                              Summarytrue
                              48. Procedure.basedOn
                              Definition

                              A reference to a resource that contains details of the request for this procedure.

                              ShortA request for this procedure
                              Control0..*
                              TypeReference(CarePlan, ProcedureRequest, ReferralRequest)
                              Summarytrue
                              Alternate Namesfulfills
                              50. Procedure.partOf
                              Definition

                              A larger event of which this particular procedure is a component or step.

                              ShortPart of referenced event
                              Comments

                              The MedicationAdministration has a partOf reference to Procedure, but this is not a circular reference. For a surgical procedure, the anesthesia related medicationAdministration is part of the procedure. For an IV medication administration, the procedure to insert the IV port is part of the medication administration.

                              Control0..*
                              TypeReference(Procedure, Observation, MedicationAdministration)
                              Summarytrue
                              Alternate Namescontainer
                              52. Procedure.status
                              Definition

                              A code specifying the state of the procedure. Generally this will be in-progress or completed state.

                              Shortpreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
                              Comments

                              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 procedure.

                              This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                              Control1..1
                              BindingThe codes SHALL be taken from EventStatus
                              (required to http://hl7.org/fhir/ValueSet/event-status)

                              A code specifying the state of the procedure.

                              Typecode
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              54. Procedure.notDone
                              Definition

                              Set this to true if the record is saying that the procedure was NOT performed.

                              ShortTrue if procedure was not performed as scheduled
                              Comments

                              If true, it means the procedure did not occur as described. Typically it would be accompanied by attributes describing the type of activity. It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period). Specifying additional information such as performer, outcome, etc. is generally inappropriate. For example, it's not that useful to say "There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome" as it implies that there could have been an appendectomy done at any other time, by any other clinician or with any other outcome.

                              This element is labeled as a modifier because it indicates that a procedure didn't happen.

                              Control0..1
                              Typeboolean
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Default Valuefalse
                              56. Procedure.notDoneReason
                              Definition

                              A code indicating why the procedure was not performed.

                              ShortReason procedure was not performed
                              Control0..1
                              This element is affected by the following invariants: pro-1
                              BindingFor example codes, see Procedure Not Performed Reason (SNOMED-CT)
                              (example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

                              A code that identifies the reason a procedure was not performed.

                              TypeCodeableConcept
                              Summarytrue
                              58. Procedure.category
                              Definition

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

                              ShortClassification of the procedure
                              Control1..1
                              BindingFor example codes, see Procedure Category Codes (SNOMED CT)
                              (example to http://hl7.org/fhir/ValueSet/procedure-category)

                              A code that classifies a procedure for searching, sorting and display purposes.

                              TypeCodeableConcept
                              Summarytrue
                              60. Procedure.category.id
                              Definition

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

                              Shortxml:id (or equivalent in JSON)
                              Control0..1
                              Typestring
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              XML FormatIn the XML format, this property is represented as an attribute.
                              62. Procedure.category.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                              ShortAdditional Content defined by implementations
                              Comments

                              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.

                              Control0..*
                              TypeExtension
                              Alternate Namesextensions, user content
                              SlicingThis element introduces a set of slices on Procedure.category.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 64. Procedure.category.coding
                                Definition

                                A reference to a code defined by a terminology system.

                                ShortCode defined by a terminology system
                                Comments

                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                Control0..*
                                TypeCoding
                                Summarytrue
                                Requirements

                                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                SlicingThis element introduces a set of slices on Procedure.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • value @ code
                                • 66. Procedure.category.coding:nursingInterventionCode
                                  Slice NamenursingInterventionCode
                                  Definition

                                  Category snomed code used for indexing/retrieval of the HCIM NursingIntervention.

                                  ShortNursingInterventionCode
                                  Comments

                                  Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                  Control0..*
                                  TypeCoding
                                  Summarytrue
                                  Requirements

                                  Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                  68. Procedure.category.coding:nursingInterventionCode.id
                                  Definition

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

                                  Shortxml:id (or equivalent in JSON)
                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  70. Procedure.category.coding:nursingInterventionCode.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                  ShortAdditional Content defined by implementations
                                  Comments

                                  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.

                                  Control0..*
                                  TypeExtension
                                  Alternate Namesextensions, user content
                                  SlicingThis element introduces a set of slices on Procedure.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 72. Procedure.category.coding:nursingInterventionCode.system
                                    Definition

                                    The identification of the code system that defines the meaning of the symbol in the code.

                                    ShortIdentity of the terminology system
                                    Comments

                                    The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

                                    Control0..1
                                    Typeuri
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to be unambiguous about the source of the definition of the symbol.

                                    Fixed Valuehttp://snomed.info/sct
                                    74. Procedure.category.coding:nursingInterventionCode.version
                                    Definition

                                    The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                                    ShortVersion of the system - if relevant
                                    Comments

                                    Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                                    NoteThis is a business versionId, not a resource version id (see discussion)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    76. Procedure.category.coding:nursingInterventionCode.code
                                    Definition

                                    A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                                    ShortSymbol in syntax defined by the system
                                    Control0..1
                                    Typecode
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to refer to a particular code in the system.

                                    Fixed Value9632001
                                    78. Procedure.category.coding:nursingInterventionCode.display
                                    Definition

                                    A representation of the meaning of the code in the system, following the rules of the system.

                                    ShortRepresentation defined by the system
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                                    80. Procedure.category.coding:nursingInterventionCode.userSelected
                                    Definition

                                    Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

                                    ShortIf this coding was chosen directly by the user
                                    Comments

                                    Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                                    Control0..1
                                    Typeboolean
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

                                    82. Procedure.category.text
                                    Definition

                                    A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                    ShortPlain text representation of the concept
                                    Comments

                                    Very often the text is the same as a displayName of one of the codings.

                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Requirements

                                    The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                    84. Procedure.code
                                    Definition

                                    A nursing intervention is a treatment carried out by a nurse based on an expert opinion and clinical knowledge for the benefit of the person requesting healthcare. The intervention is targeted towards a certain problem (diagnosis) and has a predetermined healthcare result.

                                    ShortIntervention
                                    Control1..1
                                    BindingFor example codes, see Procedure Codes (SNOMED CT)
                                    (example to http://hl7.org/fhir/ValueSet/procedure-code)

                                    A code to identify a specific procedure .

                                    TypeCodeableConcept
                                    Summarytrue
                                    Requirements

                                    0..1 to account for primarily narrative only resources.

                                    Alternate Namestype, Interventie
                                    86. Procedure.code.id
                                    Definition

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

                                    Shortxml:id (or equivalent in JSON)
                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    88. Procedure.code.extension
                                    Definition

                                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                    ShortAdditional Content defined by implementations
                                    Comments

                                    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.

                                    Control0..*
                                    TypeExtension
                                    Alternate Namesextensions, user content
                                    SlicingThis element introduces a set of slices on Procedure.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 90. Procedure.code.coding
                                      Definition

                                      A reference to a code defined by a terminology system.

                                      ShortCode defined by a terminology system
                                      Comments

                                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                      Control0..*
                                      TypeCoding
                                      Summarytrue
                                      Requirements

                                      Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                      SlicingThis element introduces a set of slices on Procedure.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ system
                                      • 92. Procedure.code.coding:interventionNICCodelist
                                        Slice NameinterventionNICCodelist
                                        Definition

                                        A reference to a code defined by a terminology system.

                                        ShortCode defined by a terminology system
                                        Comments

                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                        Control0..*
                                        BindingUnless not suitable, these codes SHALL be taken from InterventieNICCodelijst
                                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.2--20171231000000)

                                        NIC - All Values

                                        TypeCoding
                                        Summarytrue
                                        Requirements

                                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                        94. Procedure.code.coding:interventionSnomedCodelist
                                        Slice NameinterventionSnomedCodelist
                                        Definition

                                        A reference to a code defined by a terminology system.

                                        ShortCode defined by a terminology system
                                        Comments

                                        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                        Control0..*
                                        BindingUnless not suitable, these codes SHALL be taken from InterventieSnomedCodelijst
                                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.2.4--20171231000000)

                                        SNOMED CT - SNOMED CT: <<71388002 | procedure |

                                        TypeCoding
                                        Summarytrue
                                        Requirements

                                        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                        96. Procedure.code.text
                                        Definition

                                        A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                        ShortPlain text representation of the concept
                                        Comments

                                        Very often the text is the same as a displayName of one of the codings.

                                        Control0..1
                                        Typestring
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Summarytrue
                                        Requirements

                                        The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                        98. Procedure.subject
                                        Definition

                                        The person, animal or group on which the procedure was performed.

                                        ShortWho the procedure was performed on
                                        Control1..1
                                        TypeReference(nl-core-patient, Group)
                                        Summarytrue
                                        Alternate Namespatient
                                        100. Procedure.context
                                        Definition

                                        The encounter during which the procedure was performed.

                                        ShortEncounter or episode associated with the procedure
                                        Control0..1
                                        TypeReference(Encounter, EpisodeOfCare)
                                        Summarytrue
                                        Alternate Namesencounter
                                        102. Procedure.performed[x]
                                        Definition

                                        The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                                        ShortDate/Period the procedure was performed
                                        Control0..1
                                        TypePeriod
                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                        Summarytrue
                                        SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                        • type @ $this
                                        • 104. Procedure.performed[x]:performedPeriod
                                          Slice NameperformedPeriod
                                          Definition

                                          The date(time)/period over which the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                                          ShortDate/Period the procedure was performed
                                          Control0..1
                                          TypePeriod
                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                          Summarytrue
                                          106. Procedure.performed[x]:performedPeriod.id
                                          Definition

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

                                          Shortxml:id (or equivalent in JSON)
                                          Control0..1
                                          Typestring
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          108. Procedure.performed[x]:performedPeriod.extension
                                          Definition

                                          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                          ShortAdditional Content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          SlicingThis element introduces a set of slices on Procedure.performed[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 110. Procedure.performed[x]:performedPeriod.start
                                            Definition

                                            The start date (and if possible start time) of the procedure. The concept offers the option to indicate the start of the period of a series of repeating procedures.

                                            ShortProcedureStartDateTime
                                            Comments

                                            If the low element is missing, the meaning is that the low boundary is not known.

                                            Control0..1
                                            This element is affected by the following invariants: per-1
                                            TypedateTime
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Alternate NamesActieStartDatumTijd
                                            112. Procedure.performed[x]:performedPeriod.end
                                            Definition

                                            The end date (and if possible end time) of the procedure. The concept offers the option to indicate the end of the period of a series of repeating procedures.

                                            ShortProcedureEndDateTime
                                            Comments

                                            The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

                                            Control0..1
                                            This element is affected by the following invariants: per-1
                                            TypedateTime
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Alternate NamesActieEindDatumTijd
                                            Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                            114. Procedure.performer
                                            Definition

                                            The person carrying out the nursing procedure.

                                            ShortPerformer
                                            Control0..1
                                            TypeBackboneElement
                                            Summarytrue
                                            Alternate NamesUitvoerder
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                            116. Procedure.performer.id
                                            Definition

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

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            118. Procedure.performer.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                            ShortAdditional Content defined by implementations
                                            Comments

                                            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.

                                            Control0..*
                                            TypeExtension
                                            Alternate Namesextensions, user content
                                            120. Procedure.performer.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                            ShortExtensions that cannot be ignored
                                            Comments

                                            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.

                                            Control0..*
                                            TypeExtension
                                            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                            Summarytrue
                                            Alternate Namesextensions, user content, modifiers
                                            122. Procedure.performer.role
                                            Definition

                                            For example: surgeon, anaethetist, endoscopist.

                                            ShortThe role the actor was in
                                            Control0..1
                                            BindingFor example codes, see Procedure Performer Role Codes
                                            (example to http://hl7.org/fhir/ValueSet/performer-role)

                                            A code that identifies the role of a performer of the procedure.

                                            TypeCodeableConcept
                                            Summarytrue
                                            124. Procedure.performer.role.id
                                            Definition

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

                                            Shortxml:id (or equivalent in JSON)
                                            Control0..1
                                            Typestring
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            XML FormatIn the XML format, this property is represented as an attribute.
                                            126. Procedure.performer.role.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                            ShortAdditional Content defined by implementations
                                            Comments

                                            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.

                                            Control0..*
                                            TypeExtension
                                            Alternate Namesextensions, user content
                                            SlicingThis element introduces a set of slices on Procedure.performer.role.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 128. Procedure.performer.role.coding
                                              Definition

                                              A reference to a code defined by a terminology system.

                                              ShortCode defined by a terminology system
                                              Comments

                                              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                              Control0..*
                                              TypeCoding
                                              Summarytrue
                                              Requirements

                                              Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                              SlicingThis element introduces a set of slices on Procedure.performer.role.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ system
                                              • 130. Procedure.performer.role.coding:healthProfessionalRole
                                                Slice NamehealthProfessionalRole
                                                Definition

                                                The role the healthcare provider fulfils in the healthcare process. For healthcare providers, this could be for example main practitioner, referrer or general practitioner.

                                                ShortHealthProfessionalRole
                                                Comments

                                                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                                                Control0..*
                                                BindingUnless not suitable, these codes SHALL be taken from ZorgverlenerRolCodelijst
                                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.17.1.5--20171231000000)
                                                TypeCoding
                                                Summarytrue
                                                Requirements

                                                Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

                                                Alternate NamesZorgverlenerRol
                                                132. Procedure.performer.role.text
                                                Definition

                                                A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                                                ShortPlain text representation of the concept
                                                Comments

                                                Very often the text is the same as a displayName of one of the codings.

                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Summarytrue
                                                Requirements

                                                The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

                                                134. Procedure.performer.actor
                                                Definition

                                                The person carrying out the nursing procedure.

                                                ShortThe reference to the performer
                                                Control1..1
                                                TypeReference(nl-core-practitioner, nl-core-patient, nl-core-relatedperson)
                                                Summarytrue
                                                Requirements

                                                A reference to Device supports use cases, such as pacemakers.

                                                136. Procedure.performer.actor.id
                                                Definition

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

                                                Shortxml:id (or equivalent in JSON)
                                                Control0..1
                                                Typestring
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                138. Procedure.performer.actor.extension
                                                Definition

                                                An Extension

                                                ShortExtension
                                                Control0..*
                                                TypeExtension
                                                SlicingThis element introduces a set of slices on Procedure.performer.actor.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 140. Procedure.performer.actor.extension:practitionerRole
                                                  Slice NamepractitionerRole
                                                  Definition

                                                  Optional Extension Element - found in all resources.

                                                  ShortOptional Extensions Element
                                                  Control0..1
                                                  TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                  142. Procedure.performer.actor.reference
                                                  Definition

                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                  ShortLiteral reference, Relative, internal or absolute URL
                                                  Comments

                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                  Control0..1
                                                  This element is affected by the following invariants: ref-1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  144. Procedure.performer.actor.identifier
                                                  Definition

                                                  An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                  ShortLogical reference, when literal reference is not known
                                                  Comments

                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                  Control0..1
                                                  TypeIdentifier
                                                  Summarytrue
                                                  146. Procedure.performer.actor.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  ShortText alternative for the resource
                                                  Comments

                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summarytrue
                                                  148. Procedure.performer.onBehalfOf
                                                  Definition

                                                  The organization the device or practitioner was acting on behalf of.

                                                  ShortOrganization the device or practitioner was acting for
                                                  Control0..1
                                                  TypeReference(Organization)
                                                  Requirements

                                                  Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

                                                  150. Procedure.location
                                                  Definition

                                                  The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.

                                                  ShortWhere the procedure happened
                                                  Control0..1
                                                  TypeReference(Location)
                                                  Summarytrue
                                                  Requirements

                                                  Ties a procedure to where the records are likely kept.

                                                  152. Procedure.reasonCode
                                                  Definition

                                                  The coded reason why the procedure was performed. This may be coded entity of some type, or may simply be present as text.

                                                  ShortCoded reason procedure performed
                                                  Control0..*
                                                  BindingFor example codes, see Procedure Reason Codes
                                                  (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                                                  A code that identifies the reason a procedure is required.

                                                  TypeCodeableConcept
                                                  Summarytrue
                                                  154. Procedure.reasonReference
                                                  Definition

                                                  The nursing-related problem (indication) providing cause for the intervention.

                                                  ShortIndication
                                                  Comments

                                                  e.g. endoscopy for dilatation and biopsy, combination diagnosis and therapeutic.

                                                  Control0..*
                                                  TypeReference(HCIM Problem, Observation)
                                                  Summarytrue
                                                  Alternate NamesIndicatie
                                                  156. Procedure.bodySite
                                                  Definition

                                                  Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

                                                  ShortTarget body sites
                                                  Control0..*
                                                  BindingFor example codes, see SNOMED CT Body Structures
                                                  (example to http://hl7.org/fhir/ValueSet/body-site)

                                                  Codes describing anatomical locations. May include laterality.

                                                  TypeCodeableConcept
                                                  Summarytrue
                                                  158. Procedure.outcome
                                                  Definition

                                                  The outcome of the procedure - did it resolve reasons for the procedure being performed?

                                                  ShortThe result of procedure
                                                  Comments

                                                  If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

                                                  Control0..1
                                                  BindingFor example codes, see Procedure Outcome Codes (SNOMED CT)
                                                  (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

                                                  An outcome of a procedure - whether it was resolved or otherwise.

                                                  TypeCodeableConcept
                                                  Summarytrue
                                                  160. Procedure.report
                                                  Definition

                                                  This could be a histology result, pathology report, surgical report, etc..

                                                  ShortAny report resulting from the procedure
                                                  Comments

                                                  There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

                                                  Control0..*
                                                  TypeReference(HCIM TextResult)
                                                  162. Procedure.complication
                                                  Definition

                                                  Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.

                                                  ShortComplication following the procedure
                                                  Comments

                                                  If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

                                                  Control0..*
                                                  BindingFor example codes, see Condition/Problem/Diagnosis Codes
                                                  (example to http://hl7.org/fhir/ValueSet/condition-code)

                                                  Codes describing complications that resulted from a procedure.

                                                  TypeCodeableConcept
                                                  164. Procedure.complicationDetail
                                                  Definition

                                                  Any complications that occurred during the procedure, or in the immediate post-performance period.

                                                  ShortA condition that is a result of the procedure
                                                  Control0..*
                                                  TypeReference(Condition)
                                                  Requirements

                                                  This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

                                                  166. Procedure.followUp
                                                  Definition

                                                  If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note, or could potentially be more complex in which case the CarePlan resource can be used.

                                                  ShortInstructions for follow up
                                                  Control0..*
                                                  BindingFor example codes, see Procedure Follow up Codes (SNOMED CT)
                                                  (example to http://hl7.org/fhir/ValueSet/procedure-followup)

                                                  Specific follow up required for a procedure e.g. removal of sutures.

                                                  TypeCodeableConcept
                                                  168. Procedure.note
                                                  Definition

                                                  Any other notes about the procedure. E.g. the operative notes.

                                                  ShortAdditional information about the procedure
                                                  Control0..*
                                                  TypeAnnotation
                                                  170. Procedure.note.id
                                                  Definition

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

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  172. Procedure.note.extension
                                                  Definition

                                                  May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                  ShortAdditional Content defined by implementations
                                                  Comments

                                                  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.

                                                  Control0..*
                                                  TypeExtension
                                                  Alternate Namesextensions, user content
                                                  SlicingThis element introduces a set of slices on Procedure.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 174. Procedure.note.author[x]
                                                    Definition

                                                    The individual responsible for making the annotation.

                                                    ShortIndividual responsible for the annotation
                                                    Control0..1
                                                    TypeChoice of: Reference(Practitioner, Patient, RelatedPerson), string
                                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    176. Procedure.note.time
                                                    Definition

                                                    Indicates when this particular annotation was made.

                                                    ShortWhen the annotation was made
                                                    Control0..1
                                                    TypedateTime
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Summarytrue
                                                    178. Procedure.note.text
                                                    Definition

                                                    Comment on the nursing intervention.

                                                    ShortComment
                                                    Control1..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Alternate NamesToelichting
                                                    180. Procedure.focalDevice
                                                    Definition

                                                    A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

                                                    ShortDevice changed in procedure
                                                    Control0..*
                                                    TypeBackboneElement
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                    182. Procedure.focalDevice.id
                                                    Definition

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

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    184. Procedure.focalDevice.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                                                    ShortAdditional Content defined by implementations
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeExtension
                                                    Alternate Namesextensions, user content
                                                    186. Procedure.focalDevice.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.

                                                    ShortExtensions that cannot be ignored
                                                    Comments

                                                    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.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                    Summarytrue
                                                    Alternate Namesextensions, user content, modifiers
                                                    188. Procedure.focalDevice.action
                                                    Definition

                                                    The kind of change that happened to the device during the procedure.

                                                    ShortKind of change to device
                                                    Control0..1
                                                    BindingThe codes SHOULD be taken from Procedure Device Action Codes
                                                    (preferred to http://hl7.org/fhir/ValueSet/device-action)

                                                    A kind of change that happened to the device during the procedure.

                                                    TypeCodeableConcept
                                                    190. Procedure.focalDevice.manipulated
                                                    Definition

                                                    The device that was manipulated (changed) during the procedure.

                                                    ShortDevice that was changed
                                                    Control1..1
                                                    TypeReference(Device)
                                                    192. Procedure.usedReference
                                                    Definition

                                                    Identifies medications, devices and any other substance used as part of the procedure.

                                                    ShortItems used during procedure
                                                    Comments

                                                    For devices actually implanted or removed, use Procedure.device.

                                                    Control0..*
                                                    TypeReference(Device, Medication, Substance)
                                                    Requirements

                                                    Used for tracking contamination, etc.

                                                    194. Procedure.usedReference.id
                                                    Definition

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

                                                    Shortxml:id (or equivalent in JSON)
                                                    Control0..1
                                                    Typestring
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    196. Procedure.usedReference.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control0..*
                                                    TypeExtension
                                                    SlicingThis element introduces a set of slices on Procedure.usedReference.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 198. Procedure.usedReference.extension:MedicalDevice
                                                      Slice NameMedicalDevice
                                                      Definition

                                                      Description of the materials used for the nursing procedure, such as bandages.

                                                      ShortMedical device
                                                      Control0..*
                                                      TypeExtension(MedicalDevice extension) (Extension Type: Reference)
                                                      200. Procedure.usedReference.reference
                                                      Definition

                                                      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                      ShortLiteral reference, Relative, internal or absolute URL
                                                      Comments

                                                      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                      Control0..1
                                                      This element is affected by the following invariants: ref-1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      202. Procedure.usedReference.identifier
                                                      Definition

                                                      An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                      ShortLogical reference, when literal reference is not known
                                                      Comments

                                                      When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                      When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                      Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                      NoteThis is a business identifier, not a resource identifier (see discussion)
                                                      Control0..1
                                                      TypeIdentifier
                                                      Summarytrue
                                                      204. Procedure.usedReference.display
                                                      Definition

                                                      Plain text narrative that identifies the resource in addition to the resource reference.

                                                      ShortText alternative for the resource
                                                      Comments

                                                      This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      206. Procedure.usedCode
                                                      Definition

                                                      Identifies coded items that were used as part of the procedure.

                                                      ShortCoded items used during the procedure
                                                      Comments

                                                      For devices actually implanted or removed, use Procedure.device.

                                                      Control0..*
                                                      BindingFor example codes, see FHIR Device Types
                                                      (example to http://hl7.org/fhir/ValueSet/device-kind)

                                                      Codes describing items used during a procedure

                                                      TypeCodeableConcept