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 Procedure - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-Procedure resource profile.

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

0. Procedure
Definition

Root concept of the ProcedureTransfer information model. This root concept contains all data elements of the ProcedureTransfer information model.

ShortProcedure
Alternate NamesVerrichting
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:procedureMethod
    Slice NameprocedureMethod
    TypeExtension(method) (Extension Type: CodeableConcept)
    6. Procedure.extension:procedureMethod.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    Definition

    The method or technique that was used to perform the procedure, e.g. approach, lavage, pressuring, ets.

    ShortProcedureMethod
    BindingUnless not suitable, these codes SHALL be taken from VerrichtingMethodeCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.4--20171231000000)

    VerrichtingMethodeCodelijst

    Alternate NamesVerrichtingMethode
    8. Procedure.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    10. Procedure.basedOn
    SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • type @ $this.resolve()
    • 12. Procedure.basedOn:request
      Slice Namerequest
      Definition

      The ProcedureRequest that contains the details of the request for this procedure, including the requester information located at ProcedureRequest.requester.

      ShortProcedureRequest
      Comments

      The ProcedureRequest resource is used to capture the healthcare provider who requested the procedure as stated in the HCIM Procedure.

      TypeReference(HCIM ProcedureRequest)
      14. Procedure.category
      Definition

      A code that classifies the procedure for searching, sorting and display purposes. In the Basisgegevenset Zorg (BGZ) use case, this is use to search and retrieve Surgical Procedures.

      Control1..?
      Example<br/><b>Example of category code</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "387713003", "display" : "Surgical procedure" }] }
      16. Procedure.code
      Definition

      The name of the procedure.

      As of 1 January 2013, all procedures in the primary process have to be documented with CBV codes. To meet this requirement, the DHD procedure thesaurus (CBV procedures set) is used to code procedures. It is possible that in addition to the CBV procedures set, the NIC will be used for nurse procedures and that a “coded value set” will be introduced for paramedic procedures.

      ShortProcedureType
      Alternate NamesVerrichtingType
      18. 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
      • 20. Procedure.code.coding:VerrichtingTypeCodelijst
        Slice NameVerrichtingTypeCodelijst
        Definition

        DHD procedure thesaurus

        ShortProcedureType
        BindingUnless not suitable, these codes SHALL be taken from VerrichtingTypeCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.2--20171231000000)

        The name of the procedure using the Verrichtingenthesaurus DHD.

        Alternate NamesVerrichtingType
        22. Procedure.subject
        TypeReference(Group, nl-core-patient)
        24. Procedure.performedPeriod:performedPeriod
        Slice NameperformedPeriod
        TypePeriod
        26. Procedure.performedPeriod:performedPeriod.start
        Definition

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

        ShortProcedureStartDate
        Alternate NamesVerrichtingStartDatum
        28. Procedure.performedPeriod:performedPeriod.end
        Definition

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

        ShortProcedureEndDate
        Alternate NamesVerrichtingEindDatum
        30. Procedure.performer
        Definition

        The healthcare professional that carried out the procedure. The healthcare center (location) where the procedure was or is carried out.

        ShortHealthProfessional | Location::HealthcareProvider
        Comments

        Note: Procedure.location could have been used for mapping the Location::HealthcareProvider. In most anticipated cases this would lead to an empty Location resource except for Location.managingOrganization. For efficiency the mapping has thus been done here. Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

        Alternate NamesUitgevoerdDoor, Locatie
        32. Procedure.performer.role
        34. 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
        • 36. 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
          38. Procedure.performer.actor
          TypeReference(nl-core-practitioner, nl-core-organization)
          40. 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
          • 42. Procedure.performer.actor.extension:practitionerRole
            Slice NamepractitionerRole
            Control0..1
            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
            44. Procedure.reasonReference
            Definition

            The indication is the reason for the procedure.

            ShortIndication
            TypeReference(HCIM Problem)
            Alternate NamesIndicatie
            46. Procedure.bodySite
            Definition

            Anatomical location which is the focus of the procedure.

            ShortProcedureAnatomicalLocation
            BindingUnless not suitable, these codes SHALL be taken from VerrichtingAnatomischeLocatieCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.1--20171231000000)

            Anatomical location which is the focus of the procedure.

            Alternate NamesVerrichtingAnatomischeLocatie
            48. Procedure.bodySite.extension
            SlicingThis element introduces a set of slices on Procedure.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 50. Procedure.bodySite.extension:ProcedureLaterality
              Slice NameProcedureLaterality
              Definition

              Laterality adds information about body side to the anatomic location, e.g. left

              ShortProcedureLaterality
              Control0..1
              TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
              52. Procedure.bodySite.extension:ProcedureLaterality.valueCodeableConcept:valueCodeableConcept
              Slice NamevalueCodeableConcept
              BindingUnless not suitable, these codes SHALL be taken from VerrichtingLateraliteitCodelijst
              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.3--20171231000000)

              ProcedureLateralityCodelist

              54. Procedure.report
              Definition

              Any report resulting from the procedure.

              Comments

              Note that the HCIM TextResultForTransfer-v1.2 has this relationship reversed, so the relationship goes from report to procedure.

              TypeReference(HCIM TextResult)
              56. Procedure.focalDevice
              58. Procedure.focalDevice.manipulated
              Definition

              The product, the placing of which in or on the body is the purpose of the procedure, for example placing an implant.

              ShortMedicalDevice
              TypeReference(HCIM MedicalDevice Product)
              Alternate NamesMedischHulpmiddel

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

              0. Procedure
              Definition

              Root concept of the ProcedureTransfer information model. This root concept contains all data elements of the ProcedureTransfer information model.


              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.

              ShortProcedureAn action that is being or was performed on a patient
              Control0..*
              Alternate NamesVerrichting
              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:procedureMethod
                Slice NameprocedureMethod
                Definition

                The method used to perform this procedure.

                ShortThe method used to perform the procedure
                Comments

                Improve definition. Add mappings.

                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(method) (Extension Type: CodeableConcept)
                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:procedureMethod.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-method
                10. Procedure.extension:procedureMethod.valueCodeableConcept:valueCodeableConcept
                Slice NamevalueCodeableConcept
                Definition

                The method or technique that was used to perform the procedure, e.g. approach, lavage, pressuring, ets.


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

                ShortProcedureMethodValue of extension
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from For codes, see VerrichtingMethodeCodelijst
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.4--20171231000000)

                VerrichtingMethodeCodelijst

                TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                Alternate NamesVerrichtingMethode
                12. 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
                14. 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.

                16. 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
                SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • type @ $this.resolve()
                • 18. Procedure.basedOn:request
                  Slice Namerequest
                  Definition

                  The ProcedureRequest that contains the details of the request for this procedure, including the requester information located at ProcedureRequest.requester.


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

                  ShortProcedureRequestA request for this procedure
                  Comments

                  The ProcedureRequest resource is used to capture the healthcare provider who requested the procedure as stated in the HCIM Procedure.

                  Control0..*
                  TypeReference(HCIM ProcedureRequest, CarePlan, ProcedureRequest, ReferralRequest)
                  Summarytrue
                  Alternate Namesfulfills
                  20. 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
                  22. 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
                  24. Procedure.category
                  Definition

                  A code that classifies the procedure for searching, sorting and display purposes. In the Basisgegevenset Zorg (BGZ) use case, this is use to search and retrieve Surgical Procedures.


                  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
                  Example<br/><b>Example of category code</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "387713003", "display" : "Surgical procedure" }] }
                  26. Procedure.code
                  Definition

                  The name of the procedure.

                  As of 1 January 2013, all procedures in the primary process have to be documented with CBV codes. To meet this requirement, the DHD procedure thesaurus (CBV procedures set) is used to code procedures. It is possible that in addition to the CBV procedures set, the NIC will be used for nurse procedures and that a “coded value set” will be introduced for paramedic procedures.


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

                  ShortProcedureTypeIdentification of the procedure
                  Control0..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, VerrichtingType
                  28. 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
                  • 30. Procedure.code.coding:VerrichtingTypeCodelijst
                    Slice NameVerrichtingTypeCodelijst
                    Definition

                    DHD procedure thesaurus


                    A reference to a code defined by a terminology system.

                    ShortProcedureTypeCode 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 VerrichtingTypeCodelijst
                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.2--20171231000000)

                    The name of the procedure using the Verrichtingenthesaurus DHD.

                    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 NamesVerrichtingType
                    32. Procedure.subject
                    Definition

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

                    ShortWho the procedure was performed on
                    Control1..1
                    TypeReference(Group, nl-core-patient, Patient)
                    Summarytrue
                    Alternate Namespatient
                    34. 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
                    • 36. 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
                      38. Procedure.performer
                      Definition

                      The healthcare professional that carried out the procedure. The healthcare center (location) where the procedure was or is carried out.


                      Limited to 'real' people rather than equipment.

                      ShortHealthProfessional | Location::HealthcareProviderThe people who performed the procedure
                      Comments

                      Note: Procedure.location could have been used for mapping the Location::HealthcareProvider. In most anticipated cases this would lead to an empty Location resource except for Location.managingOrganization. For efficiency the mapping has thus been done here. Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

                      Control0..*
                      TypeBackboneElement
                      Summarytrue
                      Alternate NamesUitgevoerdDoor, Locatie
                      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()))
                      40. 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
                      42. Procedure.performer.actor
                      Definition

                      The practitioner who was involved in the procedure.

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

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

                      44. 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
                      • 46. 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)
                        48. Procedure.reasonReference
                        Definition

                        The indication is the reason for the procedure.


                        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, Condition, Observation)
                        Summarytrue
                        Alternate NamesIndicatie
                        50. Procedure.bodySite
                        Definition

                        Anatomical location which is the focus of the procedure.


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

                        ShortProcedureAnatomicalLocationTarget body sites
                        Control0..*
                        BindingUnless not suitable, these codes SHALL be taken from For example codes, see VerrichtingAnatomischeLocatieCodelijsthttp://hl7.org/fhir/ValueSet/body-site
                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.1--20171231000000)

                        Anatomical location which is the focus of the procedure.


                        Codes describing anatomical locations. May include laterality.

                        TypeCodeableConcept
                        Summarytrue
                        Alternate NamesVerrichtingAnatomischeLocatie
                        52. Procedure.bodySite.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.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 54. Procedure.bodySite.extension:ProcedureLaterality
                          Slice NameProcedureLaterality
                          Definition

                          Laterality adds information about body side to the anatomic location, e.g. left

                          ShortProcedureLaterality
                          Control0..1
                          TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
                          56. Procedure.bodySite.extension:ProcedureLaterality.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://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier
                          58. Procedure.bodySite.extension:ProcedureLaterality.value[x]
                          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
                          TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          SlicingThis element introduces a set of slices on Procedure.bodySite.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 60. Procedure.bodySite.extension:ProcedureLaterality.value[x]:valueCodeableConcept
                            Slice NamevalueCodeableConcept
                            Definition

                            Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.


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

                            ShortBodySite qualifierValue of extension
                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from For codes, see VerrichtingLateraliteitCodelijst
                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.3--20171231000000)

                            ProcedureLateralityCodelist

                            TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                            62. Procedure.report
                            Definition

                            Any report resulting from the procedure.


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

                            ShortAny report resulting from the procedure
                            Comments

                            Note that the HCIM TextResultForTransfer-v1.2 has this relationship reversed, so the relationship goes from report to procedure.


                            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

                            Root concept of the ProcedureTransfer information model. This root concept contains all data elements of the ProcedureTransfer information model.

                            ShortProcedure
                            Control0..*
                            Alternate NamesVerrichting
                            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:procedureMethod
                              Slice NameprocedureMethod
                              Definition

                              The method used to perform this procedure.

                              ShortThe method used to perform the procedure
                              Comments

                              Improve definition. Add mappings.

                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(method) (Extension Type: CodeableConcept)
                              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:procedureMethod.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:procedureMethod.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:procedureMethod.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-method
                                24. Procedure.extension:procedureMethod.valueCodeableConcept:valueCodeableConcept
                                Slice NamevalueCodeableConcept
                                Definition

                                The method or technique that was used to perform the procedure, e.g. approach, lavage, pressuring, ets.

                                ShortProcedureMethod
                                Control0..1
                                BindingUnless not suitable, these codes SHALL be taken from VerrichtingMethodeCodelijst
                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.4--20171231000000)

                                VerrichtingMethodeCodelijst

                                TypeCodeableConcept
                                Alternate NamesVerrichtingMethode
                                26. 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
                                28. 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.

                                30. 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
                                32. 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
                                SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • type @ $this.resolve()
                                • 34. Procedure.basedOn:request
                                  Slice Namerequest
                                  Definition

                                  The ProcedureRequest that contains the details of the request for this procedure, including the requester information located at ProcedureRequest.requester.

                                  ShortProcedureRequest
                                  Comments

                                  The ProcedureRequest resource is used to capture the healthcare provider who requested the procedure as stated in the HCIM Procedure.

                                  Control0..*
                                  TypeReference(HCIM ProcedureRequest)
                                  Summarytrue
                                  Alternate Namesfulfills
                                  36. 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
                                  38. 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
                                  40. 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
                                  42. 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
                                  44. Procedure.category
                                  Definition

                                  A code that classifies the procedure for searching, sorting and display purposes. In the Basisgegevenset Zorg (BGZ) use case, this is use to search and retrieve Surgical Procedures.

                                  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
                                  Example<br/><b>Example of category code</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "387713003", "display" : "Surgical procedure" }] }
                                  46. Procedure.code
                                  Definition

                                  The name of the procedure.

                                  As of 1 January 2013, all procedures in the primary process have to be documented with CBV codes. To meet this requirement, the DHD procedure thesaurus (CBV procedures set) is used to code procedures. It is possible that in addition to the CBV procedures set, the NIC will be used for nurse procedures and that a “coded value set” will be introduced for paramedic procedures.

                                  ShortProcedureType
                                  Control0..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, VerrichtingType
                                  48. 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.
                                  50. 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
                                  • 52. 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
                                    • 54. Procedure.code.coding:VerrichtingTypeCodelijst
                                      Slice NameVerrichtingTypeCodelijst
                                      Definition

                                      DHD procedure thesaurus

                                      ShortProcedureType
                                      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 VerrichtingTypeCodelijst
                                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.2--20171231000000)

                                      The name of the procedure using the Verrichtingenthesaurus DHD.

                                      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 NamesVerrichtingType
                                      56. 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.

                                      58. Procedure.subject
                                      Definition

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

                                      ShortWho the procedure was performed on
                                      Control1..1
                                      TypeReference(Group, nl-core-patient)
                                      Summarytrue
                                      Alternate Namespatient
                                      60. 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
                                      62. 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
                                      • 64. 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
                                        66. 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.
                                        68. 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
                                        • 70. Procedure.performed[x]:performedPeriod.start
                                          Definition

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

                                          ShortProcedureStartDate
                                          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 NamesVerrichtingStartDatum
                                          72. Procedure.performed[x]:performedPeriod.end
                                          Definition

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

                                          ShortProcedureEndDate
                                          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 NamesVerrichtingEindDatum
                                          Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                          74. Procedure.performer
                                          Definition

                                          The healthcare professional that carried out the procedure. The healthcare center (location) where the procedure was or is carried out.

                                          ShortHealthProfessional | Location::HealthcareProvider
                                          Comments

                                          Note: Procedure.location could have been used for mapping the Location::HealthcareProvider. In most anticipated cases this would lead to an empty Location resource except for Location.managingOrganization. For efficiency the mapping has thus been done here. Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

                                          Control0..*
                                          TypeBackboneElement
                                          Summarytrue
                                          Alternate NamesUitgevoerdDoor, Locatie
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                          76. 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.
                                          78. 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
                                          80. 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
                                          82. 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
                                          84. 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.
                                          86. 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
                                          • 88. 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
                                            • 90. 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
                                              92. 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.

                                              94. Procedure.performer.actor
                                              Definition

                                              The practitioner who was involved in the procedure.

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

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

                                              96. 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.
                                              98. 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
                                              • 100. 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)
                                                102. 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
                                                104. 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
                                                106. 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
                                                108. 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.

                                                110. 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.

                                                112. 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
                                                114. Procedure.reasonReference
                                                Definition

                                                The indication is the reason for the procedure.

                                                ShortIndication
                                                Comments

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

                                                Control0..*
                                                TypeReference(HCIM Problem)
                                                Summarytrue
                                                Alternate NamesIndicatie
                                                116. Procedure.bodySite
                                                Definition

                                                Anatomical location which is the focus of the procedure.

                                                ShortProcedureAnatomicalLocation
                                                Control0..*
                                                BindingUnless not suitable, these codes SHALL be taken from VerrichtingAnatomischeLocatieCodelijst
                                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.1--20171231000000)

                                                Anatomical location which is the focus of the procedure.

                                                TypeCodeableConcept
                                                Summarytrue
                                                Alternate NamesVerrichtingAnatomischeLocatie
                                                118. Procedure.bodySite.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.
                                                120. Procedure.bodySite.extension
                                                Definition

                                                An Extension

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

                                                  Laterality adds information about body side to the anatomic location, e.g. left

                                                  ShortProcedureLaterality
                                                  Control0..1
                                                  TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
                                                  124. Procedure.bodySite.extension:ProcedureLaterality.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.bodySite.extension:ProcedureLaterality.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.bodySite.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 128. Procedure.bodySite.extension:ProcedureLaterality.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://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier
                                                    130. Procedure.bodySite.extension:ProcedureLaterality.value[x]
                                                    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
                                                    TypeCodeableConcept
                                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                    SlicingThis element introduces a set of slices on Procedure.bodySite.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                    • type @ $this
                                                    • 132. Procedure.bodySite.extension:ProcedureLaterality.value[x]:valueCodeableConcept
                                                      Slice NamevalueCodeableConcept
                                                      Definition

                                                      Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.

                                                      ShortBodySite qualifier
                                                      Control0..1
                                                      BindingUnless not suitable, these codes SHALL be taken from VerrichtingLateraliteitCodelijst
                                                      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.3--20171231000000)

                                                      ProcedureLateralityCodelist

                                                      TypeCodeableConcept
                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                      134. Procedure.bodySite.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.

                                                      136. Procedure.bodySite.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.

                                                      138. 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
                                                      140. Procedure.report
                                                      Definition

                                                      Any report resulting from the procedure.

                                                      ShortAny report resulting from the procedure
                                                      Comments

                                                      Note that the HCIM TextResultForTransfer-v1.2 has this relationship reversed, so the relationship goes from report to procedure.

                                                      Control0..*
                                                      TypeReference(HCIM TextResult)
                                                      142. 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
                                                      144. 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.

                                                      146. 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
                                                      148. Procedure.note
                                                      Definition

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

                                                      ShortAdditional information about the procedure
                                                      Control0..*
                                                      TypeAnnotation
                                                      150. 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()))
                                                      152. 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.
                                                      154. 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
                                                      156. 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
                                                      158. 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
                                                      160. Procedure.focalDevice.manipulated
                                                      Definition

                                                      The product, the placing of which in or on the body is the purpose of the procedure, for example placing an implant.

                                                      ShortMedicalDevice
                                                      Control1..1
                                                      TypeReference(HCIM MedicalDevice Product)
                                                      Alternate NamesMedischHulpmiddel
                                                      162. 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.

                                                      164. 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