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 ProcedureRequest - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-ProcedureRequest resource profile.

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

0. ProcedureRequest
2. ProcedureRequest.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
4. ProcedureRequest.status
6. ProcedureRequest.status.extension
SlicingThis element introduces a set of slices on ProcedureRequest.status.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. ProcedureRequest.status.extension:orderStatus
    Slice NameorderStatus
    Definition

    The status of the order.

    ShortOrderStatus
    Control0..1
    TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
    Alternate NamesOrderStatus
    10. ProcedureRequest.status.extension:orderStatus.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    BindingUnless not suitable, these codes SHALL be taken from OrderStatusCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.16.1.2--20171231000000)

    The status of the order.

    12. ProcedureRequest.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
    14. ProcedureRequest.code.coding
    SlicingThis element introduces a set of slices on ProcedureRequest.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 16. ProcedureRequest.code.coding:VerrichtingTypeCodelijst
      Slice NameVerrichtingTypeCodelijst
      Definition

      DHD procedure thesaurus

      ShortProcedureType
      Control0..1
      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 NamesVerrichtingTypeCodelijst
      18. ProcedureRequest.subject
      TypeReference(nl-core-patient, Group, nl-core-location, HCIM MedicalDevice Product)
      20. ProcedureRequest.context
      TypeReference(HCIM Encounter, EpisodeOfCare)
      22. ProcedureRequest.occurrence[x]
      [x] NoteSee Choice of Data Types for further information about how to use [x]
      SlicingThis element introduces a set of slices on ProcedureRequest.occurrence[x]. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 24. ProcedureRequest.occurrence[x]:occurrenceDateTime
        Slice NameoccurrenceDateTime
        TypedateTime
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        26. ProcedureRequest.occurrence[x]:occurrencePeriod
        Slice NameoccurrencePeriod
        TypePeriod
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        28. ProcedureRequest.occurrence[x]:occurrencePeriod.start
        Definition

        Planned or requested date. Clinical reminders can be used to indicate from when the procedure can take place. A vague date (such as only the month and year) is permitted.

        ShortStartDate
        Alternate NamesBeginDatum, VerrichtingStartDatum, ActieStartDatumTijd
        30. ProcedureRequest.occurrence[x]:occurrencePeriod.end
        Definition

        The planned end date of the procedure can be included as well if needed. Depending on the type of procedure, this can also be used to indicate before which time it has to have been completed.

        ShortEndDate
        Alternate NamesEindDatum, ActieEindDatumTijd, VerrichtingEindDatum
        32. ProcedureRequest.occurrence[x]:occurrenceTiming
        Slice NameoccurrenceTiming
        TypeTiming
        [x] NoteSee Choice of Data Types for further information about how to use [x]
        34. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat
        36. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.frequency
        Definition

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

        ShortFrequency
        Alternate NamesFrequentie
        38. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.period
        Definition

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

        ShortInterval
        Alternate NamesInterval
        40. ProcedureRequest.requester
        42. ProcedureRequest.requester.agent
        ShortRequestedBy
        TypeReference(HCIM MedicalDevice Product, nl-core-practitioner, nl-core-organization)
        Alternate NamesAangevraagdDoor
        44. ProcedureRequest.requester.agent.extension
        SlicingThis element introduces a set of slices on ProcedureRequest.requester.agent.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 46. ProcedureRequest.requester.agent.extension:practitionerRole
          Slice NamepractitionerRole
          Control0..1
          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
          48. ProcedureRequest.performerType
          50. ProcedureRequest.performerType.coding
          SlicingThis element introduces a set of slices on ProcedureRequest.performerType.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ system
          • 52. ProcedureRequest.performerType.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
            54. ProcedureRequest.performer
            Definition

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

            ShortCarriedOutBy
            Comments

            Note: Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

            TypeReference(nl-core-practitioner, nl-core-organization, nl-core-patient, HCIM MedicalDevice Product, nl-core-relatedperson, nl-core-healthcareservice)
            Alternate NamesUitgevoerdDoor, Locatie
            56. ProcedureRequest.performer.extension
            SlicingThis element introduces a set of slices on ProcedureRequest.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 58. ProcedureRequest.performer.extension:practitionerRole
              Slice NamepractitionerRole
              Control0..1
              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
              60. ProcedureRequest.reasonReference
              Definition

              The indication is the reason for the procedure.

              ShortIndication
              TypeReference(HCIM Problem, Observation)
              Alternate NamesIndicatie
              62. ProcedureRequest.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

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

              0. ProcedureRequest
              Definition

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

              ShortA request for a procedure or diagnostic to be performed
              Control0..*
              Alternate Namesdiagnostic request
              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())
              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())
              2. ProcedureRequest.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. ProcedureRequest.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
              6. ProcedureRequest.identifier
              Definition

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

              ShortIdentifiers assigned to this order
              Comments

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

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Summarytrue
              8. ProcedureRequest.status
              Definition

              The status of the order.

              Shortdraft | active | suspended | completed | entered-in-error | cancelled
              Comments

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

              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 RequestStatushttp://hl7.org/fhir/ValueSet/request-status
              (required to http://hl7.org/fhir/ValueSet/request-status)

              The status of a procedure or diagnostic order.

              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
              10. ProcedureRequest.status.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 ProcedureRequest.status.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 12. ProcedureRequest.status.extension:orderStatus
                Slice NameorderStatus
                Definition

                The status of the order.

                ShortOrderStatus
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., OrderStatus
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                14. ProcedureRequest.status.extension:orderStatus.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/code-specification
                16. ProcedureRequest.status.extension:orderStatus.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
                Control10..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 ProcedureRequest.status.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 18. ProcedureRequest.status.extension:orderStatus.value[x]:valueCodeableConcept
                  Slice NamevalueCodeableConcept
                  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
                  Control10..1
                  BindingUnless not suitable, these codes SHALL be taken from For codes, see OrderStatusCodelijst
                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.16.1.2--20171231000000)

                  The status of the order.

                  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]
                  20. ProcedureRequest.intent
                  Definition

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

                  Shortproposal | plan | order +
                  Comments

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

                  Control1..1
                  BindingThe codes SHALL be taken from RequestIntenthttp://hl7.org/fhir/ValueSet/request-intent
                  (required to http://hl7.org/fhir/ValueSet/request-intent)

                  The kind of procedure or diagnostic request

                  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. ProcedureRequest.doNotPerform
                  Definition

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

                  ShortTrue if procedure should not be performed
                  Comments

                  This element is labeled as a modifier because it indicates that a procedure shouldn't happen, instead of a request for it to happen. In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ProcedureRequest.code and ProcedureRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

                  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
                  Requirements

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

                  Default Valuefalse
                  24. ProcedureRequest.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.


                  A code that identifies a particular procedure, diagnostic investigation, or panel of investigations, that have been requested.

                  ShortProcedureTypeWhat is being requested/ordered
                  Comments

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

                  Control1..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)

                  Codes for tests/services that can be performed by procedure or diagnostic services. For laboratory, LOINC is (preferred)[http://hl7.org/fhir/STU3/terminologies.html#preferred] and a valueset using LOINC Order codes is available here.

                  TypeCodeableConcept
                  Summarytrue
                  Alternate NamesVerrichtingType
                  26. ProcedureRequest.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 ProcedureRequest.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ system
                  • 28. ProcedureRequest.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..1*
                    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 NamesVerrichtingTypeCodelijst
                    30. ProcedureRequest.subject
                    Definition

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

                    ShortIndividual the service is ordered for
                    Control1..1
                    TypeReference(nl-core-patient, Group, nl-core-location, HCIM MedicalDevice Product, Patient, Location, Device)
                    Summarytrue
                    32. ProcedureRequest.context
                    Definition

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

                    ShortEncounter or Episode during which request was created
                    Control0..1
                    TypeReference(HCIM Encounter, EpisodeOfCare, Encounter)
                    Summarytrue
                    Alternate Namesencounter
                    34. ProcedureRequest.occurrence[x]
                    Definition

                    The date/time at which the diagnostic testing should occur.

                    ShortWhen procedure should occur
                    Control0..1
                    TypeChoice of: dateTime, Period, Timing
                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    Alternate Namesschedule
                    SlicingThis element introduces a set of slices on ProcedureRequest.occurrence[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 36. ProcedureRequest.occurrence[x]:occurrenceDateTime
                      Slice NameoccurrenceDateTime
                      Definition

                      The date/time at which the diagnostic testing should occur.

                      ShortWhen procedure should occur
                      Control0..1
                      TypedateTime, Period, Timing
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Alternate Namesschedule
                      38. ProcedureRequest.occurrence[x]:occurrencePeriod
                      Slice NameoccurrencePeriod
                      Definition

                      The date/time at which the diagnostic testing should occur.

                      ShortWhen procedure should occur
                      Control0..1
                      TypePeriod, dateTime, Timing
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Summarytrue
                      Alternate Namesschedule
                      40. ProcedureRequest.occurrence[x]:occurrencePeriod.start
                      Definition

                      Planned or requested date. Clinical reminders can be used to indicate from when the procedure can take place. A vague date (such as only the month and year) is permitted.


                      The start of the period. The boundary is inclusive.

                      ShortStartDateStarting time with inclusive boundary
                      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 NamesBeginDatum, VerrichtingStartDatum, ActieStartDatumTijd
                      42. ProcedureRequest.occurrence[x]:occurrencePeriod.end
                      Definition

                      The planned end date of the procedure can be included as well if needed. Depending on the type of procedure, this can also be used to indicate before which time it has to have been completed.


                      The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                      ShortEndDateEnd time with inclusive boundary, if not ongoing
                      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 NamesEindDatum, ActieEindDatumTijd, VerrichtingEindDatum
                      Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                      44. ProcedureRequest.occurrence[x]:occurrenceTiming
                      Slice NameoccurrenceTiming
                      Definition

                      The date/time at which the diagnostic testing should occur.

                      ShortWhen procedure should occur
                      Control0..1
                      TypeTiming, dateTime, Period
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Summarytrue
                      Alternate Namesschedule
                      46. ProcedureRequest.requester
                      Definition

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

                      ShortWho/what is requesting procedure or diagnostic
                      Comments

                      This not the dispatcher, but rather who is the authorizer.

                      Control0..1
                      TypeBackboneElement
                      Summarytrue
                      Alternate Namesauthor, orderer
                      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()))
                      48. ProcedureRequest.requester.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
                      50. ProcedureRequest.requester.agent
                      Definition

                      The device, practitioner or organization who initiated the request.

                      ShortRequestedByIndividual making the request
                      Control1..1
                      TypeReference(HCIM MedicalDevice Product, nl-core-practitioner, nl-core-organization, Device, Practitioner, Organization)
                      Summarytrue
                      Alternate NamesAangevraagdDoor
                      52. ProcedureRequest.requester.agent.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 ProcedureRequest.requester.agent.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 54. ProcedureRequest.requester.agent.extension:practitionerRole
                        Slice NamepractitionerRole
                        Definition

                        Optional Extension Element - found in all resources.

                        ShortOptional Extensions Element
                        Control0..1
                        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                        56. ProcedureRequest.performer
                        Definition

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


                        The desired perfomer for doing the diagnostic testing. For example, the surgeon, dermatopathologist, endoscopist, etc.

                        ShortCarriedOutByRequested perfomer
                        Comments

                        Note: Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'


                        If needed, use an extension for listing alternative performers and/or roles and/or preference.

                        Control0..1
                        TypeReference(nl-core-practitioner, nl-core-organization, nl-core-patient, HCIM MedicalDevice Product, nl-core-relatedperson, nl-core-healthcareservice, Practitioner, Organization, Patient, Device, RelatedPerson, HealthcareService)
                        Summarytrue
                        Alternate NamesUitgevoerdDoor, Locatie
                        58. ProcedureRequest.performer.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 ProcedureRequest.performer.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 60. ProcedureRequest.performer.extension:practitionerRole
                          Slice NamepractitionerRole
                          Definition

                          Optional Extension Element - found in all resources.

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

                          The indication is the reason for the procedure.


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

                          ShortIndicationExplanation/Justification for test
                          Comments

                          This may be used to decide how the diagnostic investigation will be performed, or even if it will be performed at all. Use CodeableConcept text element if the data is free (uncoded) text as shown in the CT Scan example.

                          Control0..*
                          TypeReference(HCIM Problem, Observation, Condition)
                          Summarytrue
                          Alternate NamesIndicatie
                          64. ProcedureRequest.bodySite
                          Definition

                          Anatomical location which is the focus of the procedure.


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

                          ShortProcedureAnatomicalLocationLocation on Body
                          Comments

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

                          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
                          Requirements

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

                          Alternate Nameslocation, VerrichtingAnatomischeLocatie

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

                          0. ProcedureRequest
                          Definition

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

                          ShortA request for a procedure or diagnostic to be performed
                          Control0..*
                          Alternate Namesdiagnostic request
                          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())
                          2. ProcedureRequest.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. ProcedureRequest.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. ProcedureRequest.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. ProcedureRequest.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. ProcedureRequest.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. ProcedureRequest.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. ProcedureRequest.extension
                          Definition

                          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.

                          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
                          16. ProcedureRequest.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
                          18. ProcedureRequest.identifier
                          Definition

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

                          ShortIdentifiers assigned to this order
                          Comments

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

                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control0..*
                          TypeIdentifier
                          Summarytrue
                          20. ProcedureRequest.definition
                          Definition

                          Protocol or definition followed by this request.

                          ShortProtocol or definition
                          Control0..*
                          TypeReference(ActivityDefinition, PlanDefinition)
                          Summarytrue
                          Alternate Namesprotocol
                          22. ProcedureRequest.basedOn
                          Definition

                          Plan/proposal/order fulfilled by this request.

                          ShortWhat request fulfills
                          Control0..*
                          TypeReference(Resource)
                          Summarytrue
                          Alternate Namesfulfills
                          24. ProcedureRequest.replaces
                          Definition

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

                          ShortWhat request replaces
                          Control0..*
                          TypeReference(Resource)
                          Summarytrue
                          26. ProcedureRequest.requisition
                          Definition

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

                          ShortComposite Request ID
                          Comments

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

                          Control0..1
                          TypeIdentifier
                          Summarytrue
                          Requirements

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

                          Alternate NamesgrouperId, groupIdentifier
                          28. ProcedureRequest.status
                          Definition

                          The status of the order.

                          Shortdraft | active | suspended | completed | entered-in-error | cancelled
                          Comments

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

                          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 RequestStatus
                          (required to http://hl7.org/fhir/ValueSet/request-status)

                          The status of a procedure or diagnostic order.

                          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
                          30. ProcedureRequest.status.id
                          Definition

                          unique id for the element within a resource (for internal references)

                          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.
                          32. ProcedureRequest.status.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..*
                          TypeExtension
                          SlicingThis element introduces a set of slices on ProcedureRequest.status.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 34. ProcedureRequest.status.extension:orderStatus
                            Slice NameorderStatus
                            Definition

                            The status of the order.

                            ShortOrderStatus
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(HCIM extension code-specification) (Extension Type: CodeableConcept)
                            Alternate NamesBevat de specifieke code conform de zib, bij een FHIR-element die een verplichte koppeling heeft met een bepaalde FHIR waardelijst of een FHIR element die niet gecodeerd is gedefinieerd, terwijl de zib dit wel doet., OrderStatus
                            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())
                            36. ProcedureRequest.status.extension:orderStatus.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.
                            38. ProcedureRequest.status.extension:orderStatus.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 ProcedureRequest.status.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 40. ProcedureRequest.status.extension:orderStatus.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/code-specification
                              42. ProcedureRequest.status.extension:orderStatus.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
                              Control1..1
                              TypeCodeableConcept
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              SlicingThis element introduces a set of slices on ProcedureRequest.status.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                              • type @ $this
                              • 44. ProcedureRequest.status.extension:orderStatus.value[x]:valueCodeableConcept
                                Slice NamevalueCodeableConcept
                                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
                                Control1..1
                                BindingUnless not suitable, these codes SHALL be taken from OrderStatusCodelijst
                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.16.1.2--20171231000000)

                                The status of the order.

                                TypeCodeableConcept
                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                46. ProcedureRequest.status.value
                                Definition

                                Primitive value for code

                                ShortPrimitive value for code
                                Control0..1
                                Typecode
                                XML FormatIn the XML format, this property is represented as an attribute.
                                48. ProcedureRequest.intent
                                Definition

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

                                Shortproposal | plan | order +
                                Comments

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

                                Control1..1
                                BindingThe codes SHALL be taken from RequestIntent
                                (required to http://hl7.org/fhir/ValueSet/request-intent)

                                The kind of procedure or diagnostic request

                                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
                                50. ProcedureRequest.priority
                                Definition

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

                                Shortroutine | urgent | asap | stat
                                Control0..1
                                BindingThe codes SHALL be taken from RequestPriority
                                (required to http://hl7.org/fhir/ValueSet/request-priority)

                                Identifies the level of importance to be assigned to actioning the request

                                Typecode
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Meaning if MissingIf missing, this task should be performed with normal priority
                                52. ProcedureRequest.doNotPerform
                                Definition

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

                                ShortTrue if procedure should not be performed
                                Comments

                                This element is labeled as a modifier because it indicates that a procedure shouldn't happen, instead of a request for it to happen. In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ProcedureRequest.code and ProcedureRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

                                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
                                Requirements

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

                                Default Valuefalse
                                54. ProcedureRequest.category
                                Definition

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

                                ShortClassification of procedure
                                Comments

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

                                Control0..*
                                BindingFor example codes, see Procedure Category Codes (SNOMED CT)
                                (example to http://hl7.org/fhir/ValueSet/procedure-category)

                                Classification of the procedure

                                TypeCodeableConcept
                                Summarytrue
                                Requirements

                                Used for filtering what procedure request are retrieved and displayed.

                                56. ProcedureRequest.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
                                Comments

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

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

                                Codes for tests/services that can be performed by procedure or diagnostic services. For laboratory, LOINC is (preferred)[http://hl7.org/fhir/STU3/terminologies.html#preferred] and a valueset using LOINC Order codes is available here.

                                TypeCodeableConcept
                                Summarytrue
                                Alternate NamesVerrichtingType
                                58. ProcedureRequest.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.
                                60. ProcedureRequest.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 ProcedureRequest.code.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 62. ProcedureRequest.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 ProcedureRequest.code.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ system
                                  • 64. ProcedureRequest.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..1
                                    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 NamesVerrichtingTypeCodelijst
                                    66. ProcedureRequest.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.

                                    68. ProcedureRequest.subject
                                    Definition

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

                                    ShortIndividual the service is ordered for
                                    Control1..1
                                    TypeReference(nl-core-patient, Group, nl-core-location, HCIM MedicalDevice Product)
                                    Summarytrue
                                    70. ProcedureRequest.context
                                    Definition

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

                                    ShortEncounter or Episode during which request was created
                                    Control0..1
                                    TypeReference(HCIM Encounter, EpisodeOfCare)
                                    Summarytrue
                                    Alternate Namesencounter
                                    72. ProcedureRequest.occurrence[x]
                                    Definition

                                    The date/time at which the diagnostic testing should occur.

                                    ShortWhen procedure should occur
                                    Control0..1
                                    TypeChoice of: dateTime, Period, Timing
                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Alternate Namesschedule
                                    SlicingThis element introduces a set of slices on ProcedureRequest.occurrence[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 74. ProcedureRequest.occurrence[x]:occurrenceDateTime
                                      Slice NameoccurrenceDateTime
                                      Definition

                                      The date/time at which the diagnostic testing should occur.

                                      ShortWhen procedure should occur
                                      Control0..1
                                      TypedateTime
                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Summarytrue
                                      Alternate Namesschedule
                                      76. ProcedureRequest.occurrence[x]:occurrencePeriod
                                      Slice NameoccurrencePeriod
                                      Definition

                                      The date/time at which the diagnostic testing should occur.

                                      ShortWhen procedure should occur
                                      Control0..1
                                      TypePeriod
                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                      Summarytrue
                                      Alternate Namesschedule
                                      78. ProcedureRequest.occurrence[x]:occurrencePeriod.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.
                                      80. ProcedureRequest.occurrence[x]:occurrencePeriod.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 ProcedureRequest.occurrence[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 82. ProcedureRequest.occurrence[x]:occurrencePeriod.start
                                        Definition

                                        Planned or requested date. Clinical reminders can be used to indicate from when the procedure can take place. A vague date (such as only the month and year) is permitted.

                                        ShortStartDate
                                        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 NamesBeginDatum, VerrichtingStartDatum, ActieStartDatumTijd
                                        84. ProcedureRequest.occurrence[x]:occurrencePeriod.end
                                        Definition

                                        The planned end date of the procedure can be included as well if needed. Depending on the type of procedure, this can also be used to indicate before which time it has to have been completed.

                                        ShortEndDate
                                        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 NamesEindDatum, ActieEindDatumTijd, VerrichtingEindDatum
                                        Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                        86. ProcedureRequest.occurrence[x]:occurrenceTiming
                                        Slice NameoccurrenceTiming
                                        Definition

                                        The date/time at which the diagnostic testing should occur.

                                        ShortWhen procedure should occur
                                        Control0..1
                                        TypeTiming
                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                        Summarytrue
                                        Alternate Namesschedule
                                        88. ProcedureRequest.occurrence[x]:occurrenceTiming.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.
                                        90. ProcedureRequest.occurrence[x]:occurrenceTiming.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 ProcedureRequest.occurrence[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 92. ProcedureRequest.occurrence[x]:occurrenceTiming.event
                                          Definition

                                          Identifies specific times when the event occurs.

                                          ShortWhen the event occurs
                                          Control0..*
                                          TypedateTime
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Summarytrue
                                          Requirements

                                          In an MAR, for instance, you need to take a general specification, and turn it into a precise specification.

                                          94. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat
                                          Definition

                                          A set of rules that describe when the event is scheduled.

                                          ShortWhen the event is to occur
                                          Control0..1
                                          TypeElement
                                          Summarytrue
                                          Requirements

                                          Many timing schedules are determined by regular repetitions.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                          tim-9: If there's an offset, there must be a when (and not C, CM, CD, CV) (offset.empty() or (when.exists() and ((when in ('C' | 'CM' | 'CD' | 'CV')).not())))
                                          tim-5: period SHALL be a non-negative value (period.exists() implies period >= 0)
                                          tim-6: If there's a periodMax, there must be a period (periodMax.empty() or period.exists())
                                          tim-7: If there's a durationMax, there must be a duration (durationMax.empty() or duration.exists())
                                          tim-8: If there's a countMax, there must be a count (countMax.empty() or count.exists())
                                          tim-1: if there's a duration, there needs to be duration units (duration.empty() or durationUnit.exists())
                                          tim-10: If there's a timeOfDay, there cannot be be a when, or vice versa (timeOfDay.empty() or when.empty())
                                          tim-2: if there's a period, there needs to be period units (period.empty() or periodUnit.exists())
                                          tim-4: duration SHALL be a non-negative value (duration.exists() implies duration >= 0)
                                          96. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.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. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.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 ProcedureRequest.occurrence[x].repeat.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 100. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.bounds[x]
                                            Definition

                                            Either a duration for the length of the timing schedule, a range of possible length, or outer bounds for start and/or end limits of the timing schedule.

                                            ShortLength/Range of lengths, or (Start and/or end) limits
                                            Control0..1
                                            TypeChoice of: Duration, Range, Period
                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                            Summarytrue
                                            102. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.count
                                            Definition

                                            A total count of the desired number of repetitions.

                                            ShortNumber of times to repeat
                                            Comments

                                            If you have both bounds and count, then this should be understood as within the bounds period, until count times happens.

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

                                            Repetitions may be limited by end time or total occurrences.

                                            104. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.countMax
                                            Definition

                                            A maximum value for the count of the desired repetitions (e.g. do something 6-8 times).

                                            ShortMaximum number of times to repeat
                                            Control0..1
                                            Typeinteger
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            106. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.duration
                                            Definition

                                            How long this thing happens for when it happens.

                                            ShortHow long when it happens
                                            Comments

                                            For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

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

                                            Some activities are not instantaneous and need to be maintained for a period of time.

                                            108. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.durationMax
                                            Definition

                                            The upper limit of how long this thing happens for when it happens.

                                            ShortHow long when it happens (Max)
                                            Comments

                                            For some events the duration is part of the definition of the event (e.g. IV infusions, where the duration is implicit in the specified quantity and rate). For others, it's part of the timing specification (e.g. exercise).

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

                                            Some activities are not instantaneous and need to be maintained for a period of time.

                                            110. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.durationUnit
                                            Definition

                                            The units of time for the duration, in UCUM units.

                                            Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
                                            Control0..1
                                            BindingThe codes SHALL be taken from UnitsOfTime
                                            (required to http://hl7.org/fhir/ValueSet/units-of-time)

                                            A unit of time (units from UCUM).

                                            Typecode
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            112. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.frequency
                                            Definition

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

                                            ShortFrequency
                                            Control0..1
                                            Typeinteger
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Alternate NamesFrequentie
                                            Default Value1
                                            114. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.frequencyMax
                                            Definition

                                            If present, indicates that the frequency is a range - so to repeat between [frequency] and [frequencyMax] times within the period or period range.

                                            ShortEvent occurs up to frequencyMax times per period
                                            Control0..1
                                            Typeinteger
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            116. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.period
                                            Definition

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

                                            ShortInterval
                                            Control0..1
                                            Typedecimal
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Alternate NamesInterval
                                            118. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.periodMax
                                            Definition

                                            If present, indicates that the period is a range from [period] to [periodMax], allowing expressing concepts such as "do this once every 3-5 days.

                                            ShortUpper limit of period (3-4 hours)
                                            Control0..1
                                            Typedecimal
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            120. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.periodUnit
                                            Definition

                                            The units of time for the period in UCUM units.

                                            Shorts | min | h | d | wk | mo | a - unit of time (UCUM)
                                            Control0..1
                                            BindingThe codes SHALL be taken from UnitsOfTime
                                            (required to http://hl7.org/fhir/ValueSet/units-of-time)

                                            A unit of time (units from UCUM).

                                            Typecode
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            122. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.dayOfWeek
                                            Definition

                                            If one or more days of week is provided, then the action happens only on the specified day(s).

                                            Shortmon | tue | wed | thu | fri | sat | sun
                                            Comments

                                            If no days are specified, the action is assumed to happen every day as otherwise specified. The elements frequency and period cannot be used as well as dayOfWeek.

                                            Control0..*
                                            BindingThe codes SHALL be taken from DaysOfWeek
                                            (required to http://hl7.org/fhir/ValueSet/days-of-week)
                                            Typecode
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            124. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.timeOfDay
                                            Definition

                                            Specified time of day for action to take place.

                                            ShortTime of day for action
                                            Comments

                                            When time of day is specified, it is inferred that the action happens every day (as filtered by dayofWeek) on the specified times. The elements when, frequency and period cannot be used as well as timeOfDay.

                                            Control0..*
                                            Typetime
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            126. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.when
                                            Definition

                                            Real world events that the occurrence of the event should be tied to.

                                            ShortRegular life events the event is tied to
                                            Comments

                                            When more than one event is listed, the event is tied to the union of the specified events.

                                            Control0..*
                                            BindingThe codes SHALL be taken from EventTiming
                                            (required to http://hl7.org/fhir/ValueSet/event-timing)

                                            Real world event relating to the schedule.

                                            Typecode
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Requirements

                                            Timings are frequently determined by occurrences such as waking, eating and sleep.

                                            128. ProcedureRequest.occurrence[x]:occurrenceTiming.repeat.offset
                                            Definition

                                            The number of minutes from the event. If the event code does not indicate whether the minutes is before or after the event, then the offset is assumed to be after the event.

                                            ShortMinutes from event (before or after)
                                            Control0..1
                                            TypeunsignedInt
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            130. ProcedureRequest.occurrence[x]:occurrenceTiming.code
                                            Definition

                                            A code for the timing schedule. Some codes such as BID are ubiquitous, but many institutions define their own additional codes. If a code is provided, the code is understood to be a complete statement of whatever is specified in the structured timing data, and either the code or the data may be used to interpret the Timing, with the exception that .repeat.bounds still applies over the code (and is not contained in the code).

                                            ShortBID | TID | QID | AM | PM | QD | QOD | Q4H | Q6H +
                                            Comments

                                            BID etc are defined as 'at institutionally specified times'. For example, an institution may choose that BID is "always at 7am and 6pm". If it is inappropriate for this choice to be made, the code BID should not be used. Instead, a distinct organization-specific code should be used in place of the HL7-defined BID code and/or the a structured representation should be used (in this case, specifying the two event times).

                                            Control0..1
                                            BindingThe codes SHOULD be taken from TimingAbbreviation
                                            (preferred to http://hl7.org/fhir/ValueSet/timing-abbreviation)

                                            Code for a known / defined timing pattern.

                                            TypeCodeableConcept
                                            Summarytrue
                                            132. ProcedureRequest.asNeeded[x]
                                            Definition

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

                                            ShortPreconditions for procedure or diagnostic
                                            Control0..1
                                            BindingFor example codes, see SNOMED CT Medication As Needed Reason Codes
                                            (example to http://hl7.org/fhir/ValueSet/medication-as-needed-reason)

                                            A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

                                            TypeChoice of: boolean, CodeableConcept
                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            134. ProcedureRequest.authoredOn
                                            Definition

                                            When the request transitioned to being actionable.

                                            ShortDate request signed
                                            Control0..1
                                            TypedateTime
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Alternate NamesorderedOn
                                            136. ProcedureRequest.requester
                                            Definition

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

                                            ShortWho/what is requesting procedure or diagnostic
                                            Comments

                                            This not the dispatcher, but rather who is the authorizer.

                                            Control0..1
                                            TypeBackboneElement
                                            Summarytrue
                                            Alternate Namesauthor, orderer
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                            138. ProcedureRequest.requester.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.
                                            140. ProcedureRequest.requester.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
                                            142. ProcedureRequest.requester.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
                                            144. ProcedureRequest.requester.agent
                                            Definition

                                            The device, practitioner or organization who initiated the request.

                                            ShortRequestedBy
                                            Control1..1
                                            TypeReference(HCIM MedicalDevice Product, nl-core-practitioner, nl-core-organization)
                                            Summarytrue
                                            Alternate NamesAangevraagdDoor
                                            146. ProcedureRequest.requester.agent.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.
                                            148. ProcedureRequest.requester.agent.extension
                                            Definition

                                            An Extension

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

                                              Optional Extension Element - found in all resources.

                                              ShortOptional Extensions Element
                                              Control0..1
                                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                              152. ProcedureRequest.requester.agent.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
                                              154. ProcedureRequest.requester.agent.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
                                              156. ProcedureRequest.requester.agent.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
                                              158. ProcedureRequest.requester.onBehalfOf
                                              Definition

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

                                              ShortOrganization agent is acting for
                                              Control0..1
                                              TypeReference(Organization)
                                              Summarytrue
                                              Requirements

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

                                              160. ProcedureRequest.performerType
                                              Definition

                                              Desired type of performer for doing the diagnostic testing.

                                              ShortPerformer role
                                              Comments

                                              this is a role, not a participation type. I.e. does not describe the task, but describes the capacity. For example, “compounding pharmacy” or “psychiatrist” or “internal referral”.

                                              Control0..1
                                              BindingFor example codes, see Participant Roles
                                              (example to http://hl7.org/fhir/ValueSet/participant-role)

                                              Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

                                              TypeCodeableConcept
                                              Summarytrue
                                              162. ProcedureRequest.performerType.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.
                                              164. ProcedureRequest.performerType.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 ProcedureRequest.performerType.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 166. ProcedureRequest.performerType.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 ProcedureRequest.performerType.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ system
                                                • 168. ProcedureRequest.performerType.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
                                                  170. ProcedureRequest.performerType.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.

                                                  172. ProcedureRequest.performer
                                                  Definition

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

                                                  ShortCarriedOutBy
                                                  Comments

                                                  Note: Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

                                                  Control0..1
                                                  TypeReference(nl-core-practitioner, nl-core-organization, nl-core-patient, HCIM MedicalDevice Product, nl-core-relatedperson, nl-core-healthcareservice)
                                                  Summarytrue
                                                  Alternate NamesUitgevoerdDoor, Locatie
                                                  174. ProcedureRequest.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.
                                                  176. ProcedureRequest.performer.extension
                                                  Definition

                                                  An Extension

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

                                                    Optional Extension Element - found in all resources.

                                                    ShortOptional Extensions Element
                                                    Control0..1
                                                    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                    180. ProcedureRequest.performer.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
                                                    182. ProcedureRequest.performer.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
                                                    184. ProcedureRequest.performer.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
                                                    186. ProcedureRequest.reasonCode
                                                    Definition

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

                                                    ShortExplanation/Justification for test
                                                    Comments

                                                    This may be used to decide how the diagnostic investigation will be performed, or even if it will be performed at all. Use CodeableConcept text element if the data is free (uncoded) text as shown in the CT Scan example.

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

                                                    Diagnosis or problem codes justifying the reason for requesting the procedure or diagnostic investigation.

                                                    TypeCodeableConcept
                                                    Summarytrue
                                                    188. ProcedureRequest.reasonReference
                                                    Definition

                                                    The indication is the reason for the procedure.

                                                    ShortIndication
                                                    Comments

                                                    This may be used to decide how the diagnostic investigation will be performed, or even if it will be performed at all. Use CodeableConcept text element if the data is free (uncoded) text as shown in the CT Scan example.

                                                    Control0..*
                                                    TypeReference(HCIM Problem, Observation)
                                                    Summarytrue
                                                    Alternate NamesIndicatie
                                                    190. ProcedureRequest.supportingInfo
                                                    Definition

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

                                                    ShortAdditional clinical information
                                                    Control0..*
                                                    TypeReference(Resource)
                                                    Alternate NamesAsk at order entry question, AOE
                                                    192. ProcedureRequest.specimen
                                                    Definition

                                                    One or more specimens that the laboratory procedure will use.

                                                    ShortProcedure Samples
                                                    Comments

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

                                                    Control0..*
                                                    TypeReference(Specimen)
                                                    Summarytrue
                                                    194. ProcedureRequest.bodySite
                                                    Definition

                                                    Anatomical location which is the focus of the procedure.

                                                    ShortProcedureAnatomicalLocation
                                                    Comments

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

                                                    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
                                                    Requirements

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

                                                    Alternate Nameslocation, VerrichtingAnatomischeLocatie
                                                    196. ProcedureRequest.note
                                                    Definition

                                                    Any other notes and comments made about the service request. For example, letting provider know that "patient hates needles" or other provider instructions.

                                                    ShortComments
                                                    Control0..*
                                                    TypeAnnotation
                                                    198. ProcedureRequest.relevantHistory
                                                    Definition

                                                    Key events in the history of the request.

                                                    ShortRequest provenance
                                                    Comments

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

                                                    Control0..*
                                                    TypeReference(Provenance)