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 TreatmentDirective - Detailed Descriptions

Active as of 2024-04-09

Definitions for the zib-TreatmentDirective resource profile.

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

0. Consent
ShortTreatmentDirective
Alternate NamesBehandelAanwijzing
Invariantshcim-treatmentdirective-1: extension.additionalSources may only be used for AdvanceDirective references in addition to first reference in .source[x] (extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/consent-additionalSources').empty() or source.exists())
2. Consent.extension
SlicingThis element introduces a set of slices on Consent.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Consent.extension:verification
    Slice Nameverification
    TypeExtension(HCIM TreatmentDirective Verification) (Complex Extension)
    6. Consent.extension:verification.extension:Verified
    Slice NameVerified
    ShortVerified
    Control1..1
    Alternate NamesGeverifieerd
    8. Consent.extension:verification.extension:VerifiedWith
    Slice NameVerifiedWith
    ShortVerifiedWith
    Alternate NamesGeverifieerdBij
    10. Consent.extension:verification.extension:VerifiedWith.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    BindingUnless not suitable, these codes SHALL be taken from GeverifieerdBijCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000)

    The person with whom the treatment instruction was discussed and verified.

    12. Consent.extension:verification.extension:VerificationDate
    Slice NameVerificationDate
    ShortVerificationDate
    Control0..1
    Alternate NamesVerificatieDatum
    14. Consent.extension:comment
    Slice Namecomment
    Definition

    Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).

    Control0..1
    TypeExtension(Comment) (Extension Type: string)
    16. Consent.extension:treatment
    Slice Nametreatment
    Definition

    The medical treatment to which the treatment instruction applies.

    ShortTreatment
    TypeExtension(HCIM TreatmentDirective Treatment) (Extension Type: CodeableConcept)
    Alternate NamesBehandeling
    18. Consent.extension:treatment.valueCodeableConcept:valueCodeableConcept
    Slice NamevalueCodeableConcept
    BindingUnless not suitable, these codes SHALL be taken from BehandelingCodelijst
    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.1--20171231000000)

    The medical treatment to which the treatment instruction applies.

    20. Consent.extension:additionalSources
    Slice NameadditionalSources
    Comments

    The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using this extension.

    TypeExtension(Consent additionalSource) (Extension Type: Choice of: Attachment, Identifier, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse))
    22. Consent.extension:additionalSources.value[x]
    Definition

    A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.

    ShortAdvanceDirective
    TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    24. Consent.modifierExtension
    SlicingThis element introduces a set of slices on Consent.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 26. Consent.modifierExtension:treatmentPermitted
      Slice NametreatmentPermitted
      Definition

      Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

      ShortTreatmentPermitted
      Comments

      If the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of NL-CM:2.1.5 Restrictions is expected under Consent.except.

      Control1..1
      TypeExtension(HCIM TreatmentDirective TreatmentPermitted) (Extension Type: CodeableConcept)
      Alternate NamesBehandelingToegestaan
      28. Consent.modifierExtension:treatmentPermitted.valueCodeableConcept:valueCodeableConcept
      Slice NamevalueCodeableConcept
      BindingUnless not suitable, these codes SHALL be taken from BehandelingToegestaanCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000)

      Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

      30. Consent.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      32. Consent.status
      Comments

      The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is "active" unless stated otherwise.

      34. Consent.category
      Control1..?
      36. Consent.category.coding
      Control1..?
      SlicingThis element introduces a set of slices on Consent.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • value @ code
      • 38. Consent.category.coding:treatmentDirective
        Slice NametreatmentDirective
        Definition

        Category snomed code used for indexing/retrieval of TreatmentDirective.

        Control1..1
        40. Consent.category.coding:treatmentDirective.system
        Control1..?
        Fixed Valuehttp://snomed.info/sct
        42. Consent.category.coding:treatmentDirective.code
        Control1..?
        Fixed Value11291000146105
        44. Consent.category.coding:treatmentDirective.display
        Default ValueTreatment instructions (record artifact)
        46. Consent.patient
        TypeReference(nl-core-patient)
        48. Consent.period
        50. Consent.period.start
        Definition

        Date on which the treatment instruction went into effect. A ‘vague’ date, such as only the year, is permitted.

        ShortStartDate
        Alternate NamesBeginDatum
        52. Consent.period.end
        Definition

        Date on which the treatment instruction ends. A ‘vague’ date, such as only the year, is permitted.

        ShortEndDate
        Alternate NamesEindDatum
        54. Consent.dateTime
        56. Consent.consentingParty
        TypeReference(nl-core-relatedperson, nl-core-organization, nl-core-patient, nl-core-practitioner)
        58. Consent.consentingParty.extension
        SlicingThis element introduces a set of slices on Consent.consentingParty.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 60. Consent.consentingParty.extension:practitionerRole
          Slice NamepractitionerRole
          Control0..1
          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
          62. Consent.actor
          64. Consent.actor.reference
          TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
          66. Consent.actor.reference.extension
          SlicingThis element introduces a set of slices on Consent.actor.reference.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 68. Consent.actor.reference.extension:practitionerRole
            Slice NamepractitionerRole
            Control0..1
            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
            70. Consent.organization
            TypeReference(nl-core-organization)
            72. Consent.source[x]
            Definition

            A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.

            ShortAdvanceDirective
            Comments

            The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using the additionalSources extension.

            TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Alternate NamesWilsverklaring
            74. Consent.policy
            76. Consent.policy.uri
            Example<br/><b>General Dutch Law</b>:http://wetten.overheid.nl/
            78. Consent.except
            Comments

            If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR.

            80. Consent.except.extension
            SlicingThis element introduces a set of slices on Consent.except.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 82. Consent.except.extension:restrictions
              Slice Namerestrictions
              Definition

              The restrictions or specific circumstances that apply to a certain treatment.

              ShortRestrictions
              TypeExtension(HCIM TreatmentDirective Restrictions) (Extension Type: string)
              Alternate NamesBeperkingen
              84. Consent.except.type
              Comments

              If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of this element SHALL be "deny"

              86. Consent.except.actor
              88. Consent.except.actor.reference
              TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
              90. Consent.except.actor.reference.extension
              SlicingThis element introduces a set of slices on Consent.except.actor.reference.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 92. Consent.except.actor.reference.extension:practitionerRole
                Slice NamepractitionerRole
                Control0..1
                TypeExtension(PractitionerRole Reference) (Extension Type: Reference)

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

                0. Consent
                Definition

                A record of a healthcare consumer’s policy choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.

                ShortTreatmentDirectiveA healthcare consumer's policy choices to permits or denies recipients or roles to perform actions for specific purposes and periods of time
                Comments

                Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.

                Control0..*
                Alternate NamesBehandelAanwijzing
                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())
                ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
                hcim-treatmentdirective-1: extension.additionalSources may only be used for AdvanceDirective references in addition to first reference in .source[x] (extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/consent-additionalSources').empty() or source.exists())
                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())
                ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
                2. Consent.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. Consent.extension
                Definition

                An Extension


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

                ShortExtensionAdditional Content defined by implementations
                Comments

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

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

                  Container of the Verification concept. This container contains all data elements of the Verification concept.

                  ShortVerification
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(HCIM TreatmentDirective Verification) (Complex Extension)
                  Is Modifierfalse
                  Alternate NamesVerificatie
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  8. Consent.extension:verification.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.

                  Control10..*
                  TypeExtension
                  Alternate Namesextensions, user content
                  SlicingThis element introduces a set of slices on Consent.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 10. Consent.extension:verification.extension:Verified
                    Slice NameVerified
                    Definition

                    An Extension

                    ShortVerifiedAdditional Content defined by implementations
                    Control10..1*
                    TypeExtension
                    Alternate NamesGeverifieerd
                    12. Consent.extension:verification.extension:Verified.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 ValueVerified
                    14. Consent.extension:verification.extension:Verified.value[x]
                    Definition

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

                    ShortValue of extension
                    Control0..1
                    Typeboolean, 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, base64Binary, Signature, unsignedInt, time, Timing, decimal, 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
                    SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                    • type @ $this
                    • 16. Consent.extension:verification.extension:Verified.value[x]:valueBoolean
                      Slice NamevalueBoolean
                      Definition

                      Indication of the fact that the treatment instruction has been verified with the patient, the patient’s family and/or the patient's authorized representative.


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

                      ShortVerifiedValue of extension
                      Control0..1
                      Typeboolean, 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, base64Binary, Signature, unsignedInt, time, Timing, decimal, 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
                      Alternate NamesGeverifieerd
                      18. Consent.extension:verification.extension:VerifiedWith
                      Slice NameVerifiedWith
                      Definition

                      An Extension

                      ShortVerifiedWithAdditional Content defined by implementations
                      Control0..*
                      TypeExtension
                      Alternate NamesGeverifieerdBij
                      20. Consent.extension:verification.extension:VerifiedWith.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 ValueVerifiedWith
                      22. Consent.extension:verification.extension:VerifiedWith.value[x]
                      Definition

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

                      ShortValue of extension
                      Control0..1
                      TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                      • type @ $this
                      • 24. Consent.extension:verification.extension:VerifiedWith.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
                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from For codes, see GeverifieerdBijCodelijst
                        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000)

                        The person with whom the treatment instruction was discussed and verified.

                        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]
                        26. Consent.extension:verification.extension:VerificationDate
                        Slice NameVerificationDate
                        Definition

                        An Extension

                        ShortVerificationDateAdditional Content defined by implementations
                        Control0..1*
                        TypeExtension
                        Alternate NamesVerificatieDatum
                        28. Consent.extension:verification.extension:VerificationDate.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 ValueVerificationDate
                        30. Consent.extension:verification.extension:VerificationDate.value[x]
                        Definition

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

                        ShortValue of extension
                        Control0..1
                        TypedateTime, date, 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, 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
                        SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 32. Consent.extension:verification.extension:VerificationDate.value[x]:valueDateTime
                          Slice NamevalueDateTime
                          Definition

                          Date on which the verification with the patient, the patient’s family and/or the patient's authorized representative took place.


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

                          ShortVerificationDateValue of extension
                          Control0..1
                          TypedateTime, date, 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, 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
                          Alternate NamesVerificatieDatum
                          34. Consent.extension:verification.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/zib-TreatmentDirective-Verification
                          36. Consent.extension:verification.value[x]
                          Definition

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

                          ShortValue of extension
                          Control0..01
                          TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          38. Consent.extension:comment
                          Slice Namecomment
                          Definition

                          Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).

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

                          The medical treatment to which the treatment instruction applies.

                          ShortTreatment
                          Control0..*
                          This element is affected by the following invariants: ele-1
                          TypeExtension(HCIM TreatmentDirective Treatment) (Extension Type: CodeableConcept)
                          Alternate NamesBehandeling
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          42. Consent.extension:treatment.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/zib-TreatmentDirective-Treatment
                          44. Consent.extension:treatment.value[x]
                          Definition

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

                          ShortValue of extension
                          Control0..1
                          TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                          SlicingThis element introduces a set of slices on Consent.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 46. Consent.extension:treatment.value[x]:valueCodeableConcept
                            Slice NamevalueCodeableConcept
                            Definition

                            The medical treatment to which the treatment instruction applies.


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

                            ShortTreatmentValue of extension
                            Control0..1
                            BindingUnless not suitable, these codes SHALL be taken from For codes, see BehandelingCodelijst
                            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.1--20171231000000)

                            The medical treatment to which the treatment instruction applies.

                            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]
                            Alternate NamesBehandeling
                            48. Consent.extension:additionalSources
                            Slice NameadditionalSources
                            Definition

                            An Extension

                            ShortExtension
                            Comments

                            The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using this extension.

                            Control0..*
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Consent additionalSource) (Extension Type: Choice of: Attachment, Identifier, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse))
                            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())
                            50. Consent.extension:additionalSources.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/consent-additionalSources
                            52. Consent.extension:additionalSources.value[x]
                            Definition

                            A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.


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

                            ShortAdvanceDirectiveValue of extension
                            Control0..1
                            TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse), date, dateTime, Meta, code, string, Address, integer, oid, Count, instant, ContactPoint, HumanName, Money, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                            54. Consent.modifierExtension
                            Definition

                            An Extension


                            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.

                            ShortExtensionExtensions 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
                            SlicingThis element introduces a set of slices on Consent.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 56. Consent.modifierExtension:treatmentPermitted
                              Slice NametreatmentPermitted
                              Definition

                              Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                              ShortTreatmentPermitted
                              Comments

                              If the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of NL-CM:2.1.5 Restrictions is expected under Consent.except.

                              Control1..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(HCIM TreatmentDirective TreatmentPermitted) (Extension Type: CodeableConcept)
                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                              Alternate NamesBehandelingToegestaan
                              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())
                              58. Consent.modifierExtension:treatmentPermitted.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/zib-TreatmentDirective-TreatmentPermitted
                              60. Consent.modifierExtension:treatmentPermitted.value[x]
                              Definition

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

                              ShortValue of extension
                              Control0..1
                              TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                              SlicingThis element introduces a set of slices on Consent.modifierExtension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                              • type @ $this
                              • 62. Consent.modifierExtension:treatmentPermitted.value[x]:valueCodeableConcept
                                Slice NamevalueCodeableConcept
                                Definition

                                Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.


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

                                ShortTreatmentPermittedValue of extension
                                Control0..1
                                BindingUnless not suitable, these codes SHALL be taken from For codes, see BehandelingToegestaanCodelijst
                                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000)

                                Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                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]
                                Alternate NamesBehandelingToegestaan
                                64. Consent.identifier
                                Definition

                                Unique identifier for this copy of the Consent Statement.

                                ShortIdentifier for this record (external references)
                                Comments

                                This identifier is identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.

                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..1
                                TypeIdentifier
                                Summarytrue
                                Example<br/><b>General</b>:{ "system" : "urn:ietf:rfc:3986", "value" : "Local eCMS identifier" }
                                66. Consent.status
                                Definition

                                Indicates the current state of this consent.

                                Shortdraft | proposed | active | rejected | inactive | entered-in-error
                                Comments

                                The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is "active" unless stated otherwise.


                                This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the Consent as not currently valid.

                                Control1..1
                                BindingThe codes SHALL be taken from ConsentStatehttp://hl7.org/fhir/ValueSet/consent-state-codes
                                (required to http://hl7.org/fhir/ValueSet/consent-state-codes)

                                Indicates the state of the consent

                                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
                                Requirements

                                The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

                                68. Consent.category
                                Definition

                                A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

                                ShortClassification of the consent statement - for indexing/retrieval
                                Control10..*
                                BindingFor example codes, see Consent Category Codeshttp://hl7.org/fhir/ValueSet/consent-category
                                (example to http://hl7.org/fhir/ValueSet/consent-category)

                                A classification of the type of consents found in a consent statement

                                TypeCodeableConcept
                                Summarytrue
                                70. Consent.category.coding
                                Definition

                                A reference to a code defined by a terminology system.

                                ShortCode defined by a terminology system
                                Comments

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

                                Control10..*
                                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 Consent.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • value @ code
                                • 72. Consent.category.coding:treatmentDirective
                                  Slice NametreatmentDirective
                                  Definition

                                  Category snomed code used for indexing/retrieval of TreatmentDirective.


                                  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.

                                  Control10..1*
                                  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.

                                  74. Consent.category.coding:treatmentDirective.system
                                  Definition

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

                                  ShortIdentity of the terminology system
                                  Comments

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

                                  Control10..1
                                  Typeuri
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

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

                                  Fixed Valuehttp://snomed.info/sct
                                  76. Consent.category.coding:treatmentDirective.code
                                  Definition

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

                                  ShortSymbol in syntax defined by the system
                                  Control10..1
                                  Typecode
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  Requirements

                                  Need to refer to a particular code in the system.

                                  Fixed Value11291000146105
                                  78. Consent.category.coding:treatmentDirective.display
                                  Definition

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

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

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

                                  80. Consent.patient
                                  Definition

                                  The patient/healthcare consumer to whom this consent applies.

                                  ShortWho the consent applies to
                                  Comments

                                  Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.

                                  Control1..1
                                  TypeReference(nl-core-patient, Patient)
                                  Summarytrue
                                  82. Consent.dateTime
                                  Definition

                                  When this Consent was issued / created / indexed.

                                  ShortWhen this Consent was created or indexed
                                  Comments

                                  This is not the time of the original consent, but the time that this statement was made or derived.

                                  Control0..1
                                  TypedateTime
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  84. Consent.consentingParty
                                  Definition

                                  Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.

                                  ShortWho is agreeing to the policy and exceptions
                                  Comments

                                  Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.

                                  Control0..*
                                  TypeReference(nl-core-relatedperson, nl-core-organization, nl-core-patient, nl-core-practitioner, Organization, Patient, Practitioner, RelatedPerson)
                                  Summarytrue
                                  Alternate Namesconsentor
                                  86. Consent.consentingParty.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 Consent.consentingParty.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 88. Consent.consentingParty.extension:practitionerRole
                                    Slice NamepractitionerRole
                                    Definition

                                    Optional Extension Element - found in all resources.

                                    ShortOptional Extensions Element
                                    Control0..1
                                    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                    90. Consent.organization
                                    Definition

                                    The organization that manages the consent, and the framework within which it is executed.

                                    ShortCustodian of the consent
                                    Control0..*
                                    TypeReference(nl-core-organization, Organization)
                                    Summarytrue
                                    Alternate Namescustodian
                                    92. Consent.source[x]
                                    Definition

                                    A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.


                                    The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.

                                    ShortAdvanceDirectiveSource from which this consent is taken
                                    Comments

                                    The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using the additionalSources extension.


                                    The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.

                                    Control0..1
                                    TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse, Consent)
                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                    Summarytrue
                                    Alternate NamesWilsverklaring
                                    94. Consent.except
                                    Definition

                                    An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

                                    ShortAdditional rule - addition or removal of permissions
                                    Comments

                                    If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR.

                                    Control0..*
                                    TypeBackboneElement
                                    Summarytrue
                                    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()))
                                    96. Consent.except.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 Consent.except.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 98. Consent.except.extension:restrictions
                                      Slice Namerestrictions
                                      Definition

                                      The restrictions or specific circumstances that apply to a certain treatment.

                                      ShortRestrictions
                                      Control0..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(HCIM TreatmentDirective Restrictions) (Extension Type: string)
                                      Alternate NamesBeperkingen
                                      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())
                                      100. Consent.except.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
                                      102. Consent.except.type
                                      Definition

                                      Action to take - permit or deny - when the exception conditions are met.

                                      Shortdeny | permit
                                      Comments

                                      If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of this element SHALL be "deny"

                                      Control1..1
                                      BindingThe codes SHALL be taken from ConsentExceptTypehttp://hl7.org/fhir/ValueSet/consent-except-type
                                      (required to http://hl7.org/fhir/ValueSet/consent-except-type)

                                      How an exception statement is applied, such as adding additional consent or removing consent

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

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

                                      0. Consent
                                      Definition

                                      A record of a healthcare consumer’s policy choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.

                                      ShortTreatmentDirective
                                      Comments

                                      Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.

                                      Control0..*
                                      Alternate NamesBehandelAanwijzing
                                      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())
                                      ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
                                      hcim-treatmentdirective-1: extension.additionalSources may only be used for AdvanceDirective references in addition to first reference in .source[x] (extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/consent-additionalSources').empty() or source.exists())
                                      2. Consent.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. Consent.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. Consent.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. Consent.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. Consent.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. Consent.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. Consent.extension
                                      Definition

                                      An Extension

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

                                        Container of the Verification concept. This container contains all data elements of the Verification concept.

                                        ShortVerification
                                        Control0..*
                                        This element is affected by the following invariants: ele-1
                                        TypeExtension(HCIM TreatmentDirective Verification) (Complex Extension)
                                        Is Modifierfalse
                                        Alternate NamesVerificatie
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        18. Consent.extension:verification.id
                                        Definition

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

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

                                        An Extension

                                        ShortExtension
                                        Control1..*
                                        TypeExtension
                                        SlicingThis element introduces a set of slices on Consent.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 22. Consent.extension:verification.extension:Verified
                                          Slice NameVerified
                                          Definition

                                          An Extension

                                          ShortVerified
                                          Control1..1
                                          TypeExtension
                                          Alternate NamesGeverifieerd
                                          24. Consent.extension:verification.extension:Verified.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.
                                          26. Consent.extension:verification.extension:Verified.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 Consent.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 28. Consent.extension:verification.extension:Verified.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 ValueVerified
                                            30. Consent.extension:verification.extension:Verified.value[x]
                                            Definition

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

                                            ShortValue of extension
                                            Control0..1
                                            Typeboolean
                                            [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
                                            SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                            • type @ $this
                                            • 32. Consent.extension:verification.extension:Verified.value[x]:valueBoolean
                                              Slice NamevalueBoolean
                                              Definition

                                              Indication of the fact that the treatment instruction has been verified with the patient, the patient’s family and/or the patient's authorized representative.

                                              ShortVerified
                                              Control0..1
                                              Typeboolean
                                              [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
                                              Alternate NamesGeverifieerd
                                              34. Consent.extension:verification.extension:VerifiedWith
                                              Slice NameVerifiedWith
                                              Definition

                                              An Extension

                                              ShortVerifiedWith
                                              Control0..*
                                              TypeExtension
                                              Alternate NamesGeverifieerdBij
                                              36. Consent.extension:verification.extension:VerifiedWith.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. Consent.extension:verification.extension:VerifiedWith.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 Consent.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 40. Consent.extension:verification.extension:VerifiedWith.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 ValueVerifiedWith
                                                42. Consent.extension:verification.extension:VerifiedWith.value[x]
                                                Definition

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

                                                ShortValue of extension
                                                Control0..1
                                                TypeCodeableConcept
                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                • type @ $this
                                                • 44. Consent.extension:verification.extension:VerifiedWith.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
                                                  Control0..1
                                                  BindingUnless not suitable, these codes SHALL be taken from GeverifieerdBijCodelijst
                                                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000)

                                                  The person with whom the treatment instruction was discussed and verified.

                                                  TypeCodeableConcept
                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                  46. Consent.extension:verification.extension:VerificationDate
                                                  Slice NameVerificationDate
                                                  Definition

                                                  An Extension

                                                  ShortVerificationDate
                                                  Control0..1
                                                  TypeExtension
                                                  Alternate NamesVerificatieDatum
                                                  48. Consent.extension:verification.extension:VerificationDate.id
                                                  Definition

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

                                                  Shortxml:id (or equivalent in JSON)
                                                  Control0..1
                                                  Typestring
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  50. Consent.extension:verification.extension:VerificationDate.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 Consent.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 52. Consent.extension:verification.extension:VerificationDate.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 ValueVerificationDate
                                                    54. Consent.extension:verification.extension:VerificationDate.value[x]
                                                    Definition

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

                                                    ShortValue of extension
                                                    Control0..1
                                                    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
                                                    SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                    • type @ $this
                                                    • 56. Consent.extension:verification.extension:VerificationDate.value[x]:valueDateTime
                                                      Slice NamevalueDateTime
                                                      Definition

                                                      Date on which the verification with the patient, the patient’s family and/or the patient's authorized representative took place.

                                                      ShortVerificationDate
                                                      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
                                                      Alternate NamesVerificatieDatum
                                                      58. Consent.extension:verification.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/zib-TreatmentDirective-Verification
                                                      60. Consent.extension:verification.value[x]
                                                      Definition

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

                                                      ShortValue of extension
                                                      Control0..0
                                                      TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      62. Consent.extension:comment
                                                      Slice Namecomment
                                                      Definition

                                                      Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).

                                                      ShortComment
                                                      Control0..1
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(Comment) (Extension Type: string)
                                                      Alternate NamesToelichting
                                                      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())
                                                      64. Consent.extension:treatment
                                                      Slice Nametreatment
                                                      Definition

                                                      The medical treatment to which the treatment instruction applies.

                                                      ShortTreatment
                                                      Control0..*
                                                      This element is affected by the following invariants: ele-1
                                                      TypeExtension(HCIM TreatmentDirective Treatment) (Extension Type: CodeableConcept)
                                                      Alternate NamesBehandeling
                                                      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())
                                                      66. Consent.extension:treatment.id
                                                      Definition

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

                                                      Shortxml:id (or equivalent in JSON)
                                                      Control0..1
                                                      Typestring
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      68. Consent.extension:treatment.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 Consent.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 70. Consent.extension:treatment.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/zib-TreatmentDirective-Treatment
                                                        72. Consent.extension:treatment.value[x]
                                                        Definition

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

                                                        ShortValue of extension
                                                        Control0..1
                                                        TypeCodeableConcept
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        SlicingThis element introduces a set of slices on Consent.extension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                        • type @ $this
                                                        • 74. Consent.extension:treatment.value[x]:valueCodeableConcept
                                                          Slice NamevalueCodeableConcept
                                                          Definition

                                                          The medical treatment to which the treatment instruction applies.

                                                          ShortTreatment
                                                          Control0..1
                                                          BindingUnless not suitable, these codes SHALL be taken from BehandelingCodelijst
                                                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.1--20171231000000)

                                                          The medical treatment to which the treatment instruction applies.

                                                          TypeCodeableConcept
                                                          [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                          Alternate NamesBehandeling
                                                          76. Consent.extension:additionalSources
                                                          Slice NameadditionalSources
                                                          Definition

                                                          An Extension

                                                          ShortExtension
                                                          Comments

                                                          The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using this extension.

                                                          Control0..*
                                                          This element is affected by the following invariants: ele-1
                                                          TypeExtension(Consent additionalSource) (Extension Type: Choice of: Attachment, Identifier, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse))
                                                          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())
                                                          78. Consent.extension:additionalSources.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. Consent.extension:additionalSources.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 Consent.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 82. Consent.extension:additionalSources.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/consent-additionalSources
                                                            84. Consent.extension:additionalSources.value[x]
                                                            Definition

                                                            A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.

                                                            ShortAdvanceDirective
                                                            Control0..1
                                                            TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
                                                            [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                            86. Consent.modifierExtension
                                                            Definition

                                                            An Extension

                                                            ShortExtension
                                                            Control0..*
                                                            TypeExtension
                                                            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                            SlicingThis element introduces a set of slices on Consent.modifierExtension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 88. Consent.modifierExtension:treatmentPermitted
                                                              Slice NametreatmentPermitted
                                                              Definition

                                                              Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                                              ShortTreatmentPermitted
                                                              Comments

                                                              If the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of NL-CM:2.1.5 Restrictions is expected under Consent.except.

                                                              Control1..1
                                                              This element is affected by the following invariants: ele-1
                                                              TypeExtension(HCIM TreatmentDirective TreatmentPermitted) (Extension Type: CodeableConcept)
                                                              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                                              Alternate NamesBehandelingToegestaan
                                                              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())
                                                              90. Consent.modifierExtension:treatmentPermitted.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.
                                                              92. Consent.modifierExtension:treatmentPermitted.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 Consent.modifierExtension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                              • value @ url
                                                              • 94. Consent.modifierExtension:treatmentPermitted.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/zib-TreatmentDirective-TreatmentPermitted
                                                                96. Consent.modifierExtension:treatmentPermitted.value[x]
                                                                Definition

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

                                                                ShortValue of extension
                                                                Control0..1
                                                                TypeCodeableConcept
                                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                SlicingThis element introduces a set of slices on Consent.modifierExtension.value[x]. The slices are unordered and Closed, and can be differentiated using the following discriminators:
                                                                • type @ $this
                                                                • 98. Consent.modifierExtension:treatmentPermitted.value[x]:valueCodeableConcept
                                                                  Slice NamevalueCodeableConcept
                                                                  Definition

                                                                  Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                                                  ShortTreatmentPermitted
                                                                  Control0..1
                                                                  BindingUnless not suitable, these codes SHALL be taken from BehandelingToegestaanCodelijst
                                                                  (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000)

                                                                  Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                                                  TypeCodeableConcept
                                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                  Alternate NamesBehandelingToegestaan
                                                                  100. Consent.identifier
                                                                  Definition

                                                                  Unique identifier for this copy of the Consent Statement.

                                                                  ShortIdentifier for this record (external references)
                                                                  Comments

                                                                  This identifier is identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.

                                                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                                                  Control0..1
                                                                  TypeIdentifier
                                                                  Summarytrue
                                                                  Example<br/><b>General</b>:{ "system" : "urn:ietf:rfc:3986", "value" : "Local eCMS identifier" }
                                                                  102. Consent.status
                                                                  Definition

                                                                  Indicates the current state of this consent.

                                                                  Shortdraft | proposed | active | rejected | inactive | entered-in-error
                                                                  Comments

                                                                  The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is "active" unless stated otherwise.

                                                                  Control1..1
                                                                  BindingThe codes SHALL be taken from ConsentState
                                                                  (required to http://hl7.org/fhir/ValueSet/consent-state-codes)

                                                                  Indicates the state of the consent

                                                                  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
                                                                  Requirements

                                                                  The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

                                                                  104. Consent.category
                                                                  Definition

                                                                  A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

                                                                  ShortClassification of the consent statement - for indexing/retrieval
                                                                  Control1..*
                                                                  BindingFor example codes, see Consent Category Codes
                                                                  (example to http://hl7.org/fhir/ValueSet/consent-category)

                                                                  A classification of the type of consents found in a consent statement

                                                                  TypeCodeableConcept
                                                                  Summarytrue
                                                                  106. Consent.category.id
                                                                  Definition

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

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

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

                                                                  ShortAdditional Content defined by implementations
                                                                  Comments

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

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

                                                                    A reference to a code defined by a terminology system.

                                                                    ShortCode defined by a terminology system
                                                                    Comments

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

                                                                    Control1..*
                                                                    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 Consent.category.coding. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                    • value @ code
                                                                    • 112. Consent.category.coding:treatmentDirective
                                                                      Slice NametreatmentDirective
                                                                      Definition

                                                                      Category snomed code used for indexing/retrieval of TreatmentDirective.

                                                                      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.

                                                                      Control1..1
                                                                      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.

                                                                      114. Consent.category.coding:treatmentDirective.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.
                                                                      116. Consent.category.coding:treatmentDirective.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 Consent.category.coding.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 118. Consent.category.coding:treatmentDirective.system
                                                                        Definition

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

                                                                        ShortIdentity of the terminology system
                                                                        Comments

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

                                                                        Control1..1
                                                                        Typeuri
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

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

                                                                        Fixed Valuehttp://snomed.info/sct
                                                                        120. Consent.category.coding:treatmentDirective.version
                                                                        Definition

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

                                                                        ShortVersion of the system - if relevant
                                                                        Comments

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

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

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

                                                                        ShortSymbol in syntax defined by the system
                                                                        Control1..1
                                                                        Typecode
                                                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                        Summarytrue
                                                                        Requirements

                                                                        Need to refer to a particular code in the system.

                                                                        Fixed Value11291000146105
                                                                        124. Consent.category.coding:treatmentDirective.display
                                                                        Definition

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

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

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

                                                                        126. Consent.category.coding:treatmentDirective.userSelected
                                                                        Definition

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

                                                                        ShortIf this coding was chosen directly by the user
                                                                        Comments

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

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

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

                                                                        128. Consent.category.text
                                                                        Definition

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

                                                                        ShortPlain text representation of the concept
                                                                        Comments

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

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

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

                                                                        130. Consent.patient
                                                                        Definition

                                                                        The patient/healthcare consumer to whom this consent applies.

                                                                        ShortWho the consent applies to
                                                                        Comments

                                                                        Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.

                                                                        Control1..1
                                                                        TypeReference(nl-core-patient)
                                                                        Summarytrue
                                                                        132. Consent.period
                                                                        Definition

                                                                        Relevant time or time-period when this Consent is applicable.

                                                                        ShortPeriod that this consent applies
                                                                        Comments

                                                                        This can be a subset of the period of the original statement.

                                                                        Control0..1
                                                                        TypePeriod
                                                                        Summarytrue
                                                                        Meaning if Missingall date ranges included
                                                                        134. Consent.period.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.
                                                                        136. Consent.period.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 Consent.period.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                        • value @ url
                                                                        • 138. Consent.period.start
                                                                          Definition

                                                                          Date on which the treatment instruction went into effect. A ‘vague’ date, such as only the 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
                                                                          140. Consent.period.end
                                                                          Definition

                                                                          Date on which the treatment instruction ends. A ‘vague’ date, such as only the year, is permitted.

                                                                          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
                                                                          Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                                          142. Consent.dateTime
                                                                          Definition

                                                                          When this Consent was issued / created / indexed.

                                                                          ShortWhen this Consent was created or indexed
                                                                          Comments

                                                                          This is not the time of the original consent, but the time that this statement was made or derived.

                                                                          Control0..1
                                                                          TypedateTime
                                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                          Summarytrue
                                                                          144. Consent.consentingParty
                                                                          Definition

                                                                          Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.

                                                                          ShortWho is agreeing to the policy and exceptions
                                                                          Comments

                                                                          Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.

                                                                          Control0..*
                                                                          TypeReference(nl-core-relatedperson, nl-core-organization, nl-core-patient, nl-core-practitioner)
                                                                          Summarytrue
                                                                          Alternate Namesconsentor
                                                                          146. Consent.consentingParty.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. Consent.consentingParty.extension
                                                                          Definition

                                                                          An Extension

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

                                                                            Optional Extension Element - found in all resources.

                                                                            ShortOptional Extensions Element
                                                                            Control0..1
                                                                            TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                                            152. Consent.consentingParty.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. Consent.consentingParty.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. Consent.consentingParty.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. Consent.actor
                                                                            Definition

                                                                            Who or what is controlled by this consent. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                                            ShortWho|what controlled by this consent (or group, by role)
                                                                            Control0..*
                                                                            TypeBackboneElement
                                                                            Summarytrue
                                                                            Meaning if MissingThere is no specific actor associated with the consent
                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                            160. Consent.actor.id
                                                                            Definition

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

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

                                                                            How the individual is involved in the resources content that is described in the consent.

                                                                            ShortHow the actor is involved
                                                                            Control1..1
                                                                            BindingUnless not suitable, these codes SHALL be taken from SecurityRoleType
                                                                            (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

                                                                            How an actor is involved in the consent considerations

                                                                            TypeCodeableConcept
                                                                            168. Consent.actor.reference
                                                                            Definition

                                                                            The resource that identifies the actor. To identify a actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                                            ShortResource for the actor (or group, by role)
                                                                            Control1..1
                                                                            TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                                                                            170. Consent.actor.reference.id
                                                                            Definition

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

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

                                                                            An Extension

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

                                                                              Optional Extension Element - found in all resources.

                                                                              ShortOptional Extensions Element
                                                                              Control0..1
                                                                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                                              176. Consent.actor.reference.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
                                                                              178. Consent.actor.reference.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
                                                                              180. Consent.actor.reference.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
                                                                              182. Consent.action
                                                                              Definition

                                                                              Actions controlled by this consent.

                                                                              ShortActions controlled by this consent
                                                                              Comments

                                                                              Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.

                                                                              Control0..*
                                                                              BindingFor example codes, see Consent Action Codes
                                                                              (example to http://hl7.org/fhir/ValueSet/consent-action)

                                                                              Detailed codes for the consent action.

                                                                              TypeCodeableConcept
                                                                              Summarytrue
                                                                              Meaning if Missingall actions
                                                                              184. Consent.organization
                                                                              Definition

                                                                              The organization that manages the consent, and the framework within which it is executed.

                                                                              ShortCustodian of the consent
                                                                              Control0..*
                                                                              TypeReference(nl-core-organization)
                                                                              Summarytrue
                                                                              Alternate Namescustodian
                                                                              186. Consent.source[x]
                                                                              Definition

                                                                              A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.

                                                                              ShortAdvanceDirective
                                                                              Comments

                                                                              The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using the additionalSources extension.

                                                                              Control0..1
                                                                              TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
                                                                              [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                              Summarytrue
                                                                              Alternate NamesWilsverklaring
                                                                              188. Consent.policy
                                                                              Definition

                                                                              The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

                                                                              ShortPolicies covered by this consent
                                                                              Control0..*
                                                                              TypeBackboneElement
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                              190. Consent.policy.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.
                                                                              192. Consent.policy.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
                                                                              194. Consent.policy.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
                                                                              196. Consent.policy.authority
                                                                              Definition

                                                                              Entity or Organization having regulatory jurisdiction or accountability for  enforcing policies pertaining to Consent Directives.

                                                                              ShortEnforcement source for policy
                                                                              Control0..1
                                                                              This element is affected by the following invariants: ppc-1
                                                                              Typeuri
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              198. Consent.policy.uri
                                                                              Definition

                                                                              The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

                                                                              ShortSpecific policy covered by this consent
                                                                              Comments

                                                                              This element is for discoverability / documentation, and does not modify or qualify the policy rules.

                                                                              Control0..1
                                                                              This element is affected by the following invariants: ppc-1
                                                                              Typeuri
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Example<br/><b>General Dutch Law</b>:http://wetten.overheid.nl/
                                                                              200. Consent.policyRule
                                                                              Definition

                                                                              A referece to the specific computable policy.

                                                                              ShortPolicy that this consents to
                                                                              Comments

                                                                              If the policy reference is not known, the resource cannot be processed. Where the reference is absent, there is no particular policy other than what is expressed directly in the consent resource.

                                                                              Control0..1
                                                                              This element is affected by the following invariants: ppc-1
                                                                              Typeuri
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              Requirements

                                                                              Might be a unique identifier of a policy set in XACML, or other rules engine.

                                                                              202. Consent.securityLabel
                                                                              Definition

                                                                              A set of security labels that define which resources are controlled by this consent. If more than one label is specified, all resources must have all the specified labels.

                                                                              ShortSecurity Labels that define affected resources
                                                                              Comments

                                                                              If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                                              Control0..*
                                                                              BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                                              (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                                                                              Security Labels from the Healthcare Privacy and Security Classification System.

                                                                              TypeCoding
                                                                              Summarytrue
                                                                              204. Consent.purpose
                                                                              Definition

                                                                              The context of the activities a user is taking - why the user is accessing the data - that are controlled by this consent.

                                                                              ShortContext of activities for which the agreement is made
                                                                              Comments

                                                                              This element is for discoverability / documentation, and does not modify or qualify the policy (e.g. the policy itself describes the purposes for which it applies).

                                                                              Control0..*
                                                                              BindingUnless not suitable, these codes SHALL be taken from PurposeOfUse
                                                                              (extensible to http://hl7.org/fhir/ValueSet/v3-PurposeOfUse)

                                                                              What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels

                                                                              TypeCoding
                                                                              Summarytrue
                                                                              206. Consent.dataPeriod
                                                                              Definition

                                                                              Clinical or Operational Relevant period of time that bounds the data controlled by this consent.

                                                                              ShortTimeframe for data controlled by this consent
                                                                              Comments

                                                                              This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.

                                                                              Control0..1
                                                                              TypePeriod
                                                                              Summarytrue
                                                                              208. Consent.data
                                                                              Definition

                                                                              The resources controlled by this consent, if specific resources are referenced.

                                                                              ShortData controlled by this consent
                                                                              Control0..*
                                                                              TypeBackboneElement
                                                                              Summarytrue
                                                                              Meaning if Missingall data
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                              210. Consent.data.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.
                                                                              212. Consent.data.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
                                                                              214. Consent.data.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
                                                                              216. Consent.data.meaning
                                                                              Definition

                                                                              How the resource reference is interpreted when testing consent restrictions.

                                                                              Shortinstance | related | dependents | authoredby
                                                                              Control1..1
                                                                              BindingThe codes SHALL be taken from ConsentDataMeaning
                                                                              (required to http://hl7.org/fhir/ValueSet/consent-data-meaning)

                                                                              How a resource reference is interpreted when testing consent restrictions

                                                                              Typecode
                                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                              Summarytrue
                                                                              218. Consent.data.reference
                                                                              Definition

                                                                              A reference to a specific resource that defines which resources are covered by this consent.

                                                                              ShortThe actual data reference
                                                                              Control1..1
                                                                              TypeReference(Resource)
                                                                              Summarytrue
                                                                              220. Consent.except
                                                                              Definition

                                                                              An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

                                                                              ShortAdditional rule - addition or removal of permissions
                                                                              Comments

                                                                              If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR.

                                                                              Control0..*
                                                                              TypeBackboneElement
                                                                              Summarytrue
                                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                              222. Consent.except.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.
                                                                              224. Consent.except.extension
                                                                              Definition

                                                                              An Extension

                                                                              ShortExtension
                                                                              Control0..*
                                                                              TypeExtension
                                                                              SlicingThis element introduces a set of slices on Consent.except.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                              • value @ url
                                                                              • 226. Consent.except.extension:restrictions
                                                                                Slice Namerestrictions
                                                                                Definition

                                                                                The restrictions or specific circumstances that apply to a certain treatment.

                                                                                ShortRestrictions
                                                                                Control0..*
                                                                                This element is affected by the following invariants: ele-1
                                                                                TypeExtension(HCIM TreatmentDirective Restrictions) (Extension Type: string)
                                                                                Alternate NamesBeperkingen
                                                                                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())
                                                                                228. Consent.except.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
                                                                                230. Consent.except.type
                                                                                Definition

                                                                                Action to take - permit or deny - when the exception conditions are met.

                                                                                Shortdeny | permit
                                                                                Comments

                                                                                If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of this element SHALL be "deny"

                                                                                Control1..1
                                                                                BindingThe codes SHALL be taken from ConsentExceptType
                                                                                (required to http://hl7.org/fhir/ValueSet/consent-except-type)

                                                                                How an exception statement is applied, such as adding additional consent or removing consent

                                                                                Typecode
                                                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                Summarytrue
                                                                                232. Consent.except.period
                                                                                Definition

                                                                                The timeframe in this exception is valid.

                                                                                ShortTimeframe for this exception
                                                                                Control0..1
                                                                                TypePeriod
                                                                                Summarytrue
                                                                                234. Consent.except.actor
                                                                                Definition

                                                                                Who or what is controlled by this Exception. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                                                ShortWho|what controlled by this exception (or group, by role)
                                                                                Control0..*
                                                                                TypeBackboneElement
                                                                                Summarytrue
                                                                                Meaning if MissingThere is no specific actor associated with the exception
                                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                236. Consent.except.actor.id
                                                                                Definition

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

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

                                                                                How the individual is involved in the resources content that is described in the exception.

                                                                                ShortHow the actor is involved
                                                                                Control1..1
                                                                                BindingUnless not suitable, these codes SHALL be taken from SecurityRoleType
                                                                                (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

                                                                                How an actor is involved in the consent considerations

                                                                                TypeCodeableConcept
                                                                                244. Consent.except.actor.reference
                                                                                Definition

                                                                                The resource that identifies the actor. To identify a actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                                                ShortResource for the actor (or group, by role)
                                                                                Control1..1
                                                                                TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                                                                                246. Consent.except.actor.reference.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.
                                                                                248. Consent.except.actor.reference.extension
                                                                                Definition

                                                                                An Extension

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

                                                                                  Optional Extension Element - found in all resources.

                                                                                  ShortOptional Extensions Element
                                                                                  Control0..1
                                                                                  TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                                                  252. Consent.except.actor.reference.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
                                                                                  254. Consent.except.actor.reference.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
                                                                                  256. Consent.except.actor.reference.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
                                                                                  258. Consent.except.action
                                                                                  Definition

                                                                                  Actions controlled by this Exception.

                                                                                  ShortActions controlled by this exception
                                                                                  Comments

                                                                                  Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see Consent Action Codes
                                                                                  (example to http://hl7.org/fhir/ValueSet/consent-action)

                                                                                  Detailed codes for the consent action.

                                                                                  TypeCodeableConcept
                                                                                  Summarytrue
                                                                                  Meaning if Missingall actions
                                                                                  260. Consent.except.securityLabel
                                                                                  Definition

                                                                                  A set of security labels that define which resources are controlled by this exception. If more than one label is specified, all resources must have all the specified labels.

                                                                                  ShortSecurity Labels that define affected resources
                                                                                  Comments

                                                                                  If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                                                  Control0..*
                                                                                  BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                                                                                  Security Labels from the Healthcare Privacy and Security Classification System.

                                                                                  TypeCoding
                                                                                  Summarytrue
                                                                                  262. Consent.except.purpose
                                                                                  Definition

                                                                                  The context of the activities a user is taking - why the user is accessing the data - that are controlled by this exception.

                                                                                  ShortContext of activities covered by this exception
                                                                                  Comments

                                                                                  E.g. if the purpose is 'research', then the operational context must be research, in order for the consent to apply. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                                                  Control0..*
                                                                                  BindingUnless not suitable, these codes SHALL be taken from PurposeOfUse
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/v3-PurposeOfUse)

                                                                                  What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels

                                                                                  TypeCoding
                                                                                  Summarytrue
                                                                                  264. Consent.except.class
                                                                                  Definition

                                                                                  The class of information covered by this exception. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.

                                                                                  Shorte.g. Resource Type, Profile, or CDA etc
                                                                                  Comments

                                                                                  Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.

                                                                                  Control0..*
                                                                                  BindingUnless not suitable, these codes SHALL be taken from Consent Content Class
                                                                                  (extensible to http://hl7.org/fhir/ValueSet/consent-content-class)

                                                                                  The class (type) of information a consent rule covers

                                                                                  TypeCoding
                                                                                  Summarytrue
                                                                                  266. Consent.except.code
                                                                                  Definition

                                                                                  If this code is found in an instance, then the exception applies.

                                                                                  Shorte.g. LOINC or SNOMED CT code, etc in the content
                                                                                  Comments

                                                                                  Typical use of this is a Document code with class = CDA.

                                                                                  Control0..*
                                                                                  BindingFor example codes, see Consent Content Codes
                                                                                  (example to http://hl7.org/fhir/ValueSet/consent-content-code)

                                                                                  If this code is found in an instance, then the exception applies

                                                                                  TypeCoding
                                                                                  Summarytrue
                                                                                  268. Consent.except.dataPeriod
                                                                                  Definition

                                                                                  Clinical or Operational Relevant period of time that bounds the data controlled by this exception.

                                                                                  ShortTimeframe for data controlled by this exception
                                                                                  Comments

                                                                                  This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.

                                                                                  Control0..1
                                                                                  TypePeriod
                                                                                  Summarytrue
                                                                                  270. Consent.except.data
                                                                                  Definition

                                                                                  The resources controlled by this exception, if specific resources are referenced.

                                                                                  ShortData controlled by this exception
                                                                                  Control0..*
                                                                                  TypeBackboneElement
                                                                                  Summarytrue
                                                                                  Meaning if Missingall data
                                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                                                  272. Consent.except.data.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.
                                                                                  274. Consent.except.data.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
                                                                                  276. Consent.except.data.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
                                                                                  278. Consent.except.data.meaning
                                                                                  Definition

                                                                                  How the resource reference is interpreted when testing consent restrictions.

                                                                                  Shortinstance | related | dependents | authoredby
                                                                                  Control1..1
                                                                                  BindingThe codes SHALL be taken from ConsentDataMeaning
                                                                                  (required to http://hl7.org/fhir/ValueSet/consent-data-meaning)

                                                                                  How a resource reference is interpreted when testing consent restrictions

                                                                                  Typecode
                                                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                                  Summarytrue
                                                                                  280. Consent.except.data.reference
                                                                                  Definition

                                                                                  A reference to a specific resource that defines which resources are covered by this consent.

                                                                                  ShortThe actual data reference
                                                                                  Control1..1
                                                                                  TypeReference(Resource)
                                                                                  Summarytrue