This page is part of the International Patient Summary Implementation Guide (v0.3.0: STU 1 (FHIR R4) Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions
JSON Format: StructureDefinition-Procedure-uv-ips
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{ "resourceType" : "StructureDefinition", "id" : "Procedure-uv-ips", "meta" : { "lastUpdated" : "2018-02-20T06:54:56.053-05:00" }, "text" : { "status" : "generated", "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">This profile represents the constraints applied to the Procedure resource by the IPS project, which specifies an entry of the History of Procedure for the international patient summary based on the FHIR standard R4.</div>" }, "url" : "http://hl7.org/fhir/uv/ips/StructureDefinition/Procedure-uv-ips", "version" : "0.3.0", "name" : "ProcedureUvIps", "title" : "Procedure (IPS)", "status" : "draft", "date" : "2017-10-27T07:43:30-04:00", "description" : "This profile represents the constraints applied to the Procedure resource by the IPS project, which specifies an entry of the History of Procedure for the international patient summary based on the FHIR standard R4.", "jurisdiction" : [ { "coding" : [ { "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" } ] } ], "fhirVersion" : "4.0.0", "mapping" : [ { "identity" : "workflow", "uri" : "http://hl7.org/fhir/workflow", "name" : "Workflow Pattern" }, { "identity" : "rim", "uri" : "http://hl7.org/v3", "name" : "RIM Mapping" }, { "identity" : "w5", "uri" : "http://hl7.org/fhir/fivews", "name" : "FiveWs Pattern Mapping" }, { "identity" : "v2", "uri" : "http://hl7.org/v2", "name" : "HL7 v2 Mapping" } ], "kind" : "resource", "abstract" : false, "type" : "Procedure", "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Procedure", "derivation" : "constraint", "snapshot" : { "element" : [ { "id" : "Procedure", "path" : "Procedure", "short" : "An action that is being or was performed on a patient", "definition" : "An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure", "min" : 0, "max" : "*" }, "constraint" : [ { "key" : "dom-2", "severity" : "error", "human" : "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression" : "contained.contained.empty()", "xpath" : "not(parent::f:contained and f:contained)", "source" : "DomainResource" }, { "key" : "dom-4", "severity" : "error", "human" : "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression" : "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath" : "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source" : "DomainResource" }, { "key" : "dom-3", "severity" : "error", "human" : "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression" : "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath" : "not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source" : "DomainResource" }, { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean" : true }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown" : "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key" : "dom-6", "severity" : "warning", "human" : "A resource should have narrative for robust management", "expression" : "text.div.exists()", "xpath" : "exists(f:text/h:div)", "source" : "DomainResource" }, { "key" : "dom-5", "severity" : "error", "human" : "If a resource is contained in another resource, it SHALL NOT have a security label", "expression" : "contained.meta.security.empty()", "xpath" : "not(exists(f:contained/*/f:meta/f:security))", "source" : "DomainResource" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "Entity. Role, or Act" }, { "identity" : "workflow", "map" : "Event" }, { "identity" : "rim", "map" : "Procedure[moodCode=EVN]" } ] }, { "id" : "Procedure.id", "path" : "Procedure.id", "short" : "Logical id of this artifact", "definition" : "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment" : "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "id" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta", "path" : "Procedure.meta", "short" : "Metadata about the resource", "definition" : "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.meta", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Meta" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta.id", "path" : "Procedure.meta.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.meta.extension", "path" : "Procedure.meta.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.meta.versionId", "path" : "Procedure.meta.versionId", "short" : "Version specific identifier", "definition" : "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.", "comment" : "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.versionId", "min" : 0, "max" : "1" }, "type" : [ { "code" : "id" } ], "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta.lastUpdated", "path" : "Procedure.meta.lastUpdated", "short" : "When the resource version last changed", "definition" : "When the resource last changed - e.g. when the version changed.", "comment" : "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.lastUpdated", "min" : 0, "max" : "1" }, "type" : [ { "code" : "instant" } ], "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta.source", "path" : "Procedure.meta.source", "short" : "Identifies where the resource comes from", "definition" : "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.", "comment" : "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.", "min" : 0, "max" : "1", "base" : { "path" : "Meta.source", "min" : 0, "max" : "1" }, "type" : [ { "code" : "uri" } ], "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta.profile", "path" : "Procedure.meta.profile", "short" : "Profiles this resource claims to conform to", "definition" : "A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).", "comment" : "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.profile", "min" : 0, "max" : "*" }, "type" : [ { "code" : "canonical", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ] } ], "fixedCanonical" : "http://hl7.org/fhir/uv/ips/StructureDefinition/Procedure-uv-ips", "mustSupport" : true, "isModifier" : false, "isSummary" : true }, { "id" : "Procedure.meta.security", "path" : "Procedure.meta.security", "short" : "Security Labels applied to this resource", "definition" : "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.", "comment" : "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.security", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Coding" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "SecurityLabels" }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean" : true } ], "strength" : "extensible", "description" : "Security Labels from the Healthcare Privacy and Security Classification System.", "valueSet" : "http://hl7.org/fhir/ValueSet/security-labels" } }, { "id" : "Procedure.meta.tag", "path" : "Procedure.meta.tag", "short" : "Tags applied to this resource", "definition" : "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.", "comment" : "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.", "min" : 0, "max" : "*", "base" : { "path" : "Meta.tag", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Coding" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Tags" } ], "strength" : "example", "description" : "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\".", "valueSet" : "http://hl7.org/fhir/ValueSet/common-tags" } }, { "id" : "Procedure.implicitRules", "path" : "Procedure.implicitRules", "short" : "A set of rules under which this content was created", "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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment" : "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.", "min" : 0, "max" : "1", "base" : { "path" : "Resource.implicitRules", "min" : 0, "max" : "1" }, "type" : [ { "code" : "uri" } ], "isModifier" : true, "isModifierReason" : "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary" : true }, { "id" : "Procedure.language", "path" : "Procedure.language", "short" : "Language of the resource content", "definition" : "The base language in which the resource is written.", "comment" : "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).", "min" : 0, "max" : "1", "base" : { "path" : "Resource.language", "min" : 0, "max" : "1" }, "type" : [ { "code" : "code" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical" : "http://hl7.org/fhir/ValueSet/all-languages" }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "Language" }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean" : true } ], "strength" : "preferred", "description" : "A human language.", "valueSet" : "http://hl7.org/fhir/ValueSet/languages" } }, { "id" : "Procedure.text", "path" : "Procedure.text", "short" : "Text summary of the resource, for human interpretation", "definition" : "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment" : "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias" : [ "narrative", "html", "xhtml", "display" ], "min" : 0, "max" : "1", "base" : { "path" : "DomainResource.text", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Narrative" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "Act.text?" } ] }, { "id" : "Procedure.contained", "path" : "Procedure.contained", "short" : "Contained, inline Resources", "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.", "comment" : "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias" : [ "inline resources", "anonymous resources", "contained resources" ], "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.contained", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Resource" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.extension", "path" : "Procedure.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.modifierExtension", "path" : "Procedure.modifierExtension", "short" : "Extensions that cannot be ignored", "definition" : "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "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.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "DomainResource.modifierExtension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.identifier", "path" : "Procedure.identifier", "short" : "External Identifiers for this procedure", "definition" : "Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.", "comment" : "This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.", "requirements" : "Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.identifier", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Identifier" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.identifier" }, { "identity" : "w5", "map" : "FiveWs.identifier" }, { "identity" : "v2", "map" : "Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4" }, { "identity" : "rim", "map" : ".id" } ] }, { "id" : "Procedure.instantiatesCanonical", "path" : "Procedure.instantiatesCanonical", "short" : "Instantiates FHIR protocol or definition", "definition" : "The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.instantiatesCanonical", "min" : 0, "max" : "*" }, "type" : [ { "code" : "canonical", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/PlanDefinition", "http://hl7.org/fhir/StructureDefinition/ActivityDefinition", "http://hl7.org/fhir/StructureDefinition/Measure", "http://hl7.org/fhir/StructureDefinition/OperationDefinition", "http://hl7.org/fhir/StructureDefinition/Questionnaire" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.instantiatesCanonical" }, { "identity" : "rim", "map" : ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id" : "Procedure.instantiatesUri", "path" : "Procedure.instantiatesUri", "short" : "Instantiates external protocol or definition", "definition" : "The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.", "comment" : "This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.instantiatesUri", "min" : 0, "max" : "*" }, "type" : [ { "code" : "uri" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.instantiatesUri" }, { "identity" : "rim", "map" : ".outboundRelationship[typeCode=DEFN].target" } ] }, { "id" : "Procedure.basedOn", "path" : "Procedure.basedOn", "short" : "A request for this procedure", "definition" : "A reference to a resource that contains details of the request for this procedure.", "alias" : [ "fulfills" ], "min" : 0, "max" : "*", "base" : { "path" : "Procedure.basedOn", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/CarePlan", "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.basedOn" }, { "identity" : "rim", "map" : ".outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code" } ] }, { "id" : "Procedure.partOf", "path" : "Procedure.partOf", "short" : "Part of referenced event", "definition" : "A larger event of which this particular procedure is a component or step.", "comment" : "The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).", "alias" : [ "container" ], "min" : 0, "max" : "*", "base" : { "path" : "Procedure.partOf", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Procedure", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/MedicationAdministration" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.partOf" }, { "identity" : "rim", "map" : ".inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]" } ] }, { "id" : "Procedure.status", "path" : "Procedure.status", "short" : "preparation | in-progress | not-done | suspended | aborted | completed | entered-in-error | unknown", "definition" : "A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.", "comment" : "The \"unknown\" code is not to be used to convey other statuses. The \"unknown\" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.\n\nThis element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.", "min" : 1, "max" : "1", "base" : { "path" : "Procedure.status", "min" : 1, "max" : "1" }, "type" : [ { "code" : "code" } ], "mustSupport" : true, "isModifier" : true, "isModifierReason" : "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid", "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureStatus" } ], "strength" : "required", "description" : "A code specifying the state of the procedure.", "valueSet" : "http://hl7.org/fhir/ValueSet/event-status|4.0.0" }, "mapping" : [ { "identity" : "workflow", "map" : "Event.status" }, { "identity" : "w5", "map" : "FiveWs.status" }, { "identity" : "rim", "map" : "statusCode" } ] }, { "id" : "Procedure.statusReason", "path" : "Procedure.statusReason", "short" : "Reason for current status", "definition" : "Captures the reason for the current state of the procedure.", "comment" : "This is generally only used for \"exception\" statuses such as \"not-done\", \"suspended\" or \"aborted\". The reason for performing the event at all is captured in reasonCode, not here.", "alias" : [ "Suspended Reason", "Cancelled Reason" ], "min" : 0, "max" : "1", "base" : { "path" : "Procedure.statusReason", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureNegationReason" } ], "strength" : "example", "description" : "A code that identifies the reason a procedure was not performed.", "valueSet" : "http://hl7.org/fhir/ValueSet/procedure-not-performed-reason" }, "mapping" : [ { "identity" : "workflow", "map" : "Event.statusReason" }, { "identity" : "rim", "map" : ".reason.Observation.value" } ] }, { "id" : "Procedure.category", "path" : "Procedure.category", "short" : "Classification of the procedure", "definition" : "A code that classifies the procedure for searching, sorting and display purposes (e.g. \"Surgical Procedure\").", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.category", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureCategory" } ], "strength" : "example", "description" : "A code that classifies a procedure for searching, sorting and display purposes.", "valueSet" : "http://hl7.org/fhir/ValueSet/procedure-category" }, "mapping" : [ { "identity" : "w5", "map" : "FiveWs.class" }, { "identity" : "rim", "map" : ".outboundRelationship[typeCode=\"COMP].target[classCode=\"LIST\", moodCode=\"EVN\"].code" } ] }, { "id" : "Procedure.code", "path" : "Procedure.code", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "coding.system" } ], "description" : "Discriminated by code system", "rules" : "open" }, "short" : "Concept - reference to a terminology or just text", "definition" : "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.", "comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements" : "0..1 to account for primarily narrative only resources.", "min" : 1, "max" : "1", "base" : { "path" : "Procedure.code", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureCode" } ], "strength" : "preferred", "valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips" }, "mapping" : [ { "identity" : "rim", "map" : "n/a" }, { "identity" : "v2", "map" : "CE/CNE/CWE" }, { "identity" : "rim", "map" : "CD" }, { "identity" : "orim", "map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure", "path" : "Procedure.code", "sliceName" : "absentOrUnknownProcedure", "short" : "Code for absent problem or for unknown procedure", "definition" : "Code representing the statement \"absent problem\" or the statement \"procedures unknown\"", "comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "requirements" : "0..1 to account for primarily narrative only resources.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.code", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "condition" : [ "ele-1" ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" } ], "mustSupport" : true, "isModifier" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "absentOrUnknownProcedure" } ], "strength" : "required", "description" : "A code to identify absent or unknown procedures", "valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-procedures-uv-ips" }, "mapping" : [ { "identity" : "rim", "map" : "n/a" }, { "identity" : "v2", "map" : "CE/CNE/CWE" }, { "identity" : "rim", "map" : "CD" }, { "identity" : "orim", "map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.id", "path" : "Procedure.code.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.extension", "path" : "Procedure.code.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding", "path" : "Procedure.code.coding", "short" : "A reference to a code defined by a terminology system", "definition" : "A reference to a code defined by a terminology system.", "comment" : "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.", "requirements" : "Allows for alternative encodings within a code system, and translations to other code systems.", "min" : 1, "max" : "1", "base" : { "path" : "CodeableConcept.coding", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Coding", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/Coding-uv-ips" ] } ], "condition" : [ "ele-1" ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" } ], "mustSupport" : true, "isModifier" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" }, { "identity" : "v2", "map" : "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" }, { "identity" : "rim", "map" : "CV" }, { "identity" : "orim", "map" : "fhir:Coding rdfs:subClassOf dt:CDCoding" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.id", "path" : "Procedure.code.coding.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.extension", "path" : "Procedure.code.coding.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.system", "path" : "Procedure.code.coding.system", "short" : "Identity of the terminology system", "definition" : "The identification of the code system that defines the meaning of the symbol in the code.", "comment" : "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 reference to some definition that establishes the system clearly and unambiguously.", "requirements" : "Need to be unambiguous about the source of the definition of the symbol.", "min" : 1, "max" : "1", "base" : { "path" : "Coding.system", "min" : 0, "max" : "1" }, "type" : [ { "code" : "uri" } ], "fixedUri" : "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips", "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "C*E.3" }, { "identity" : "rim", "map" : "./codeSystem" }, { "identity" : "orim", "map" : "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.version", "path" : "Procedure.code.coding.version", "short" : "Version of the system - if relevant", "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.", "comment" : "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.", "min" : 0, "max" : "1", "base" : { "path" : "Coding.version", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "C*E.7" }, { "identity" : "rim", "map" : "./codeSystemVersion" }, { "identity" : "orim", "map" : "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.code", "path" : "Procedure.code.coding.code", "short" : "Symbol in syntax defined by the system", "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).", "requirements" : "Need to refer to a particular code in the system.", "min" : 0, "max" : "1", "base" : { "path" : "Coding.code", "min" : 0, "max" : "1" }, "type" : [ { "code" : "code" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "C*E.1" }, { "identity" : "rim", "map" : "./code" }, { "identity" : "orim", "map" : "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.display", "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true } ], "path" : "Procedure.code.coding.display", "short" : "Representation defined by the system", "definition" : "A representation of the meaning of the code in the system, following the rules of the system.", "requirements" : "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.", "min" : 0, "max" : "1", "base" : { "path" : "Coding.display", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "C*E.2 - but note this is not well followed" }, { "identity" : "rim", "map" : "CV.displayName" }, { "identity" : "orim", "map" : "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.display.id", "path" : "Procedure.code.coding.display.id", "representation" : [ "xmlAttr" ], "short" : "xml:id (or equivalent in JSON)", "definition" : "unique id for the element within a resource (for internal references)", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.display.extension", "path" : "Procedure.code.coding.display.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : false }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.display.extension:translation", "path" : "Procedure.code.coding.display.extension", "sliceName" : "translation", "short" : "Language Translation (Localization)", "definition" : "Language translation from base language of resource to another language.", "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension", "profile" : [ "http://hl7.org/fhir/StructureDefinition/translation" ] } ], "condition" : [ "ele-1" ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" }, { "key" : "ext-1", "severity" : "error", "human" : "Must have either extensions or value[x], not both", "expression" : "extension.exists() != value.exists()", "xpath" : "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source" : "Extension" } ], "mustSupport" : true, "isModifier" : false, "mapping" : [ { "identity" : "rim", "map" : "ST.translation" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.display.value", "path" : "Procedure.code.coding.display.value", "representation" : [ "xmlAttr" ], "short" : "Primitive value for string", "definition" : "The actual value", "min" : 0, "max" : "1", "base" : { "path" : "string.value", "min" : 0, "max" : "1" }, "type" : [ { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/regex", "valueString" : "[ \\r\\n\\t\\S]+" } ], "_code" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString" : "string" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString" : "xsd:string" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString" : "xsd:string" } ] } } ], "maxLength" : 1048576, "isModifier" : false, "isSummary" : false }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.userSelected", "path" : "Procedure.code.coding.userSelected", "short" : "If this coding was chosen directly by the user", "definition" : "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).", "comment" : "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.", "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.", "min" : 0, "max" : "1", "base" : { "path" : "Coding.userSelected", "min" : 0, "max" : "1" }, "type" : [ { "code" : "boolean" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "Sometimes implied by being first" }, { "identity" : "rim", "map" : "CD.codingRationale" }, { "identity" : "orim", "map" : "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]" } ] }, { "id" : "Procedure.code:absentOrUnknownProcedure.text", "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true } ], "path" : "Procedure.code.text", "short" : "Plain text representation of the concept", "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.", "comment" : "Very often the text is the same as a displayName of one of the codings.", "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.", "min" : 0, "max" : "1", "base" : { "path" : "CodeableConcept.text", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "v2", "map" : "C*E.9. But note many systems use C*E.2 for this" }, { "identity" : "rim", "map" : "./originalText[mediaType/code=\"text/plain\"]/data" }, { "identity" : "orim", "map" : "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" } ] }, { "id" : "Procedure.subject", "path" : "Procedure.subject", "short" : "Who the procedure was performed on", "definition" : "The person on which the procedure was performed.", "alias" : [ "patient" ], "min" : 1, "max" : "1", "base" : { "path" : "Procedure.subject", "min" : 1, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/Patient-uv-ips" ] } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.subject" }, { "identity" : "w5", "map" : "FiveWs.subject[x]" }, { "identity" : "v2", "map" : "PID-3" }, { "identity" : "rim", "map" : ".participation[typeCode=SBJ].role" }, { "identity" : "w5", "map" : "FiveWs.subject" } ] }, { "id" : "Procedure.subject.id", "path" : "Procedure.subject.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.subject.extension", "path" : "Procedure.subject.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.subject.reference", "path" : "Procedure.subject.reference", "short" : "Literal reference, Relative, internal or absolute URL", "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.", "comment" : "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.", "min" : 1, "max" : "1", "base" : { "path" : "Reference.reference", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "condition" : [ "ref-1" ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.subject.type", "path" : "Procedure.subject.type", "short" : "Type the reference refers to (e.g. \"Patient\")", "definition" : "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).", "comment" : "This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.type", "min" : 0, "max" : "1" }, "type" : [ { "code" : "uri" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "FHIRResourceTypeExt" } ], "strength" : "extensible", "description" : "Aa resource (or, for logical models, the URI of the logical model).", "valueSet" : "http://hl7.org/fhir/ValueSet/resource-types" }, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.subject.identifier", "path" : "Procedure.subject.identifier", "short" : "Logical reference, when literal reference is not known", "definition" : "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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.", "comment" : "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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).", "min" : 0, "max" : "1", "base" : { "path" : "Reference.identifier", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Identifier" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "rim", "map" : ".identifier" } ] }, { "id" : "Procedure.subject.display", "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable", "valueBoolean" : true } ], "path" : "Procedure.subject.display", "short" : "Text alternative for the resource", "definition" : "Plain text narrative that identifies the resource in addition to the resource reference.", "comment" : "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.", "min" : 0, "max" : "1", "base" : { "path" : "Reference.display", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.encounter", "path" : "Procedure.encounter", "short" : "Encounter created as part of", "definition" : "The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.", "comment" : "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.encounter", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.context" }, { "identity" : "w5", "map" : "FiveWs.context" }, { "identity" : "v2", "map" : "PV1-19" }, { "identity" : "rim", "map" : ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" } ] }, { "id" : "Procedure.performed[x]", "path" : "Procedure.performed[x]", "short" : "When the procedure was performed", "definition" : "Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.", "comment" : "Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.", "min" : 1, "max" : "1", "base" : { "path" : "Procedure.performed[x]", "min" : 0, "max" : "1" }, "type" : [ { "code" : "dateTime" }, { "code" : "Period" }, { "code" : "string" }, { "code" : "Age" }, { "code" : "Range" } ], "mustSupport" : true, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.occurrence[x]" }, { "identity" : "w5", "map" : "FiveWs.done[x]" }, { "identity" : "v2", "map" : "OBR-7" }, { "identity" : "rim", "map" : ".effectiveTime" } ] }, { "id" : "Procedure.performed[x].id", "path" : "Procedure.performed[x].id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "_code" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type", "valueString" : "string" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type", "valueString" : "xsd:string" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type", "valueString" : "xsd:string" } ] } } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.performed[x].extension", "path" : "Procedure.performed[x].extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.performed[x].extension:data-absent-reason", "path" : "Procedure.performed[x].extension", "sliceName" : "data-absent-reason", "short" : "performed[x] absence reason", "definition" : "Provides a reason why the performed is missing.", "min" : 0, "max" : "1", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension", "profile" : [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason" ] } ], "mustSupport" : true, "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "ANY.nullFlavor" } ] }, { "id" : "Procedure.performed[x].extension:data-absent-reason.id", "path" : "Procedure.performed[x].extension.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.performed[x].extension:data-absent-reason.extension", "path" : "Procedure.performed[x].extension.extension", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "url" } ], "description" : "Extensions are always sliced by (at least) url", "rules" : "open" }, "short" : "Extension", "definition" : "An Extension", "min" : 0, "max" : "0", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false }, { "id" : "Procedure.performed[x].extension:data-absent-reason.url", "path" : "Procedure.performed[x].extension.url", "representation" : [ "xmlAttr" ], "short" : "identifies the meaning of the extension", "definition" : "Source of the definition for the extension code - a logical name or a URL.", "comment" : "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.", "min" : 1, "max" : "1", "base" : { "path" : "Extension.url", "min" : 1, "max" : "1" }, "type" : [ { "code" : "uri" } ], "fixedUri" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.performed[x].extension:data-absent-reason.valueCode", "path" : "Procedure.performed[x].extension.valueCode", "short" : "Value of extension", "definition" : "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).", "min" : 0, "max" : "1", "base" : { "path" : "Extension.value[x]", "min" : 0, "max" : "1" }, "type" : [ { "code" : "code" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "DataAbsentReason" }, { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding", "valueBoolean" : true } ], "strength" : "required", "description" : "Used to specify why the normally expected content of the data element is missing.", "valueSet" : "http://hl7.org/fhir/ValueSet/data-absent-reason|4.0.0" }, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.recorder", "path" : "Procedure.recorder", "short" : "Who recorded the procedure", "definition" : "Individual who recorded the record and takes responsibility for its content.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.recorder", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "w5", "map" : "FiveWs.author" }, { "identity" : "rim", "map" : ".participation[typeCode=AUT].role" } ] }, { "id" : "Procedure.asserter", "path" : "Procedure.asserter", "short" : "Person who asserts this procedure", "definition" : "Individual who is making the procedure statement.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.asserter", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole" ] } ], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "w5", "map" : "FiveWs.source" }, { "identity" : "rim", "map" : ".participation[typeCode=INF].role" } ] }, { "id" : "Procedure.performer", "path" : "Procedure.performer", "short" : "The people who performed the procedure", "definition" : "Limited to \"real\" people rather than equipment.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.performer", "min" : 0, "max" : "*" }, "type" : [ { "code" : "BackboneElement" } ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" } ], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.performer" }, { "identity" : "rim", "map" : ".participation[typeCode=PRF]" } ] }, { "id" : "Procedure.performer.id", "path" : "Procedure.performer.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.performer.extension", "path" : "Procedure.performer.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.performer.modifierExtension", "path" : "Procedure.performer.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "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.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).", "alias" : [ "extensions", "user content", "modifiers" ], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.performer.function", "path" : "Procedure.performer.function", "short" : "Type of performance", "definition" : "Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.", "requirements" : "Allows disambiguation of the types of involvement of different performers.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.performer.function", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedurePerformerRole" } ], "strength" : "example", "description" : "A code that identifies the role of a performer of the procedure.", "valueSet" : "http://hl7.org/fhir/ValueSet/performer-role" }, "mapping" : [ { "identity" : "workflow", "map" : "Event.performer.function" }, { "identity" : "v2", "map" : "Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25" }, { "identity" : "rim", "map" : ".functionCode" } ] }, { "id" : "Procedure.performer.actor", "path" : "Procedure.performer.actor", "short" : "The reference to the practitioner", "definition" : "The practitioner who was involved in the procedure.", "requirements" : "A reference to Device supports use cases, such as pacemakers.", "min" : 1, "max" : "1", "base" : { "path" : "Procedure.performer.actor", "min" : 1, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/uv/ips/StructureDefinition/Device-observer-uv-ips", "http://hl7.org/fhir/uv/ips/StructureDefinition/Practitioner-uv-ips", "http://hl7.org/fhir/uv/ips/StructureDefinition/Organization-observation-uv-ips" ] } ], "mustSupport" : false, "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.performer.actor" }, { "identity" : "w5", "map" : "FiveWs.actor" }, { "identity" : "v2", "map" : "ORC-19/PRT-5" }, { "identity" : "rim", "map" : ".role" } ] }, { "id" : "Procedure.performer.onBehalfOf", "path" : "Procedure.performer.onBehalfOf", "short" : "Organization the device or practitioner was acting for", "definition" : "The organization the device or practitioner was acting on behalf of.", "requirements" : "Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.performer.onBehalfOf", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/Organization-observation-uv-ips" ] } ], "mustSupport" : false, "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".scoper" } ] }, { "id" : "Procedure.location", "path" : "Procedure.location", "short" : "Where the procedure happened", "definition" : "The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.", "requirements" : "Ties a procedure to where the records are likely kept.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.location", "min" : 0, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Location" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "w5", "map" : "FiveWs.where[x]" }, { "identity" : "rim", "map" : ".participation[typeCode=LOC].role[classCode=SDLOC]" } ] }, { "id" : "Procedure.reasonCode", "path" : "Procedure.reasonCode", "short" : "Coded reason procedure performed", "definition" : "The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.", "comment" : "Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.reasonCode", "min" : 0, "max" : "*" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureReason" } ], "strength" : "example", "description" : "A code that identifies the reason a procedure is required.", "valueSet" : "http://hl7.org/fhir/ValueSet/procedure-reason" }, "mapping" : [ { "identity" : "workflow", "map" : "Event.reasonCode" }, { "identity" : "w5", "map" : "FiveWs.why[x]" }, { "identity" : "rim", "map" : ".reasonCode" } ] }, { "id" : "Procedure.reasonReference", "path" : "Procedure.reasonReference", "short" : "The justification that the procedure was performed", "definition" : "The justification of why the procedure was performed.", "comment" : "It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). \nUse Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.reasonReference", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Condition", "http://hl7.org/fhir/StructureDefinition/Observation", "http://hl7.org/fhir/StructureDefinition/Procedure", "http://hl7.org/fhir/StructureDefinition/DiagnosticReport", "http://hl7.org/fhir/StructureDefinition/DocumentReference" ] } ], "isModifier" : false, "isSummary" : true, "mapping" : [ { "identity" : "workflow", "map" : "Event.reasonReference" }, { "identity" : "w5", "map" : "FiveWs.why[x]" }, { "identity" : "rim", "map" : ".reasonCode" } ] }, { "id" : "Procedure.bodySite", "path" : "Procedure.bodySite", "short" : "Concept - reference to a terminology or just text", "definition" : "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.", "comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.bodySite", "min" : 0, "max" : "*" }, "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "condition" : [ "ele-1" ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" } ], "mustSupport" : true, "isModifier" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "BodySite" } ], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/body-site" }, "mapping" : [ { "identity" : "rim", "map" : "n/a" }, { "identity" : "v2", "map" : "CE/CNE/CWE" }, { "identity" : "rim", "map" : "CD" }, { "identity" : "orim", "map" : "fhir:CodeableConcept rdfs:subClassOf dt:CD" } ] }, { "id" : "Procedure.outcome", "path" : "Procedure.outcome", "short" : "The result of procedure", "definition" : "The outcome of the procedure - did it resolve the reasons for the procedure being performed?", "comment" : "If outcome contains narrative text only, it can be captured using the CodeableConcept.text.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.outcome", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureOutcome" } ], "strength" : "example", "description" : "An outcome of a procedure - whether it was resolved or otherwise.", "valueSet" : "http://hl7.org/fhir/ValueSet/procedure-outcome" }, "mapping" : [ { "identity" : "rim", "map" : ".outboundRelationship[typeCode=OUT].target.text" } ] }, { "id" : "Procedure.report", "path" : "Procedure.report", "short" : "Any report resulting from the procedure", "definition" : "This could be a histology result, pathology report, surgical report, etc.", "comment" : "There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.report", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/DiagnosticReport", "http://hl7.org/fhir/StructureDefinition/DocumentReference", "http://hl7.org/fhir/StructureDefinition/Composition" ] } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]" } ] }, { "id" : "Procedure.complication", "path" : "Procedure.complication", "short" : "Complication following the procedure", "definition" : "Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.", "comment" : "If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.complication", "min" : 0, "max" : "*" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureComplication" } ], "strength" : "example", "description" : "Codes describing complications that resulted from a procedure.", "valueSet" : "http://hl7.org/fhir/ValueSet/condition-code" }, "mapping" : [ { "identity" : "rim", "map" : ".outboundRelationship[typeCode=OUTC].target[classCode=OBS, code=\"complication\", moodCode=EVN].value" } ] }, { "id" : "Procedure.complicationDetail", "path" : "Procedure.complicationDetail", "short" : "A condition that is a result of the procedure", "definition" : "Any complications that occurred during the procedure, or in the immediate post-performance period.", "requirements" : "This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.complicationDetail", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Condition" ] } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".outboundRelationship[typeCode=OUTC].target[classCode=OBS, code=\"complication\", moodCode=EVN].value" } ] }, { "id" : "Procedure.followUp", "path" : "Procedure.followUp", "short" : "Instructions for follow up", "definition" : "If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.followUp", "min" : 0, "max" : "*" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureFollowUp" } ], "strength" : "example", "description" : "Specific follow up required for a procedure e.g. removal of sutures.", "valueSet" : "http://hl7.org/fhir/ValueSet/procedure-followup" }, "mapping" : [ { "identity" : "rim", "map" : ".outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code" } ] }, { "id" : "Procedure.note", "path" : "Procedure.note", "short" : "Additional information about the procedure", "definition" : "Any other notes and comments about the procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.note", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Annotation" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "workflow", "map" : "Event.note" }, { "identity" : "v2", "map" : "NTE" }, { "identity" : "rim", "map" : ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value" } ] }, { "id" : "Procedure.focalDevice", "path" : "Procedure.focalDevice", "short" : "Manipulated, implanted, or removed device", "definition" : "A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.focalDevice", "min" : 0, "max" : "*" }, "type" : [ { "code" : "BackboneElement" } ], "constraint" : [ { "key" : "ele-1", "severity" : "error", "human" : "All FHIR elements must have a @value or children", "expression" : "hasValue() or (children().count() > id.count())", "xpath" : "@value|f:*|h:div", "source" : "Element" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".participation[typeCode=DEV].role[classCode=MANU]" } ] }, { "id" : "Procedure.focalDevice.id", "path" : "Procedure.focalDevice.id", "representation" : [ "xmlAttr" ], "short" : "Unique id for inter-element referencing", "definition" : "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min" : 0, "max" : "1", "base" : { "path" : "Element.id", "min" : 0, "max" : "1" }, "type" : [ { "code" : "string" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.focalDevice.extension", "path" : "Procedure.focalDevice.extension", "short" : "Additional content defined by implementations", "definition" : "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment" : "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.", "alias" : [ "extensions", "user content" ], "min" : 0, "max" : "*", "base" : { "path" : "Element.extension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : "n/a" } ] }, { "id" : "Procedure.focalDevice.modifierExtension", "path" : "Procedure.focalDevice.modifierExtension", "short" : "Extensions that cannot be ignored even if unrecognized", "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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment" : "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.", "requirements" : "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).", "alias" : [ "extensions", "user content", "modifiers" ], "min" : 0, "max" : "*", "base" : { "path" : "BackboneElement.modifierExtension", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Extension" } ], "isModifier" : true, "isModifierReason" : "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary" : true, "mapping" : [ { "identity" : "rim", "map" : "N/A" } ] }, { "id" : "Procedure.focalDevice.action", "path" : "Procedure.focalDevice.action", "short" : "Kind of change to device", "definition" : "The kind of change that happened to the device during the procedure.", "min" : 0, "max" : "1", "base" : { "path" : "Procedure.focalDevice.action", "min" : 0, "max" : "1" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "DeviceActionKind" } ], "strength" : "preferred", "description" : "A kind of change that happened to the device during the procedure.", "valueSet" : "http://hl7.org/fhir/ValueSet/device-action" }, "mapping" : [ { "identity" : "rim", "map" : ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"procedure device action\"].value=:procedure device action codes" } ] }, { "id" : "Procedure.focalDevice.manipulated", "path" : "Procedure.focalDevice.manipulated", "short" : "Device that was changed", "definition" : "The device that was manipulated (changed) during the procedure.", "min" : 1, "max" : "1", "base" : { "path" : "Procedure.focalDevice.manipulated", "min" : 1, "max" : "1" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Device" ] } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".participation[typeCode=DEV].role[classCode=SDLOC]" } ] }, { "id" : "Procedure.usedReference", "path" : "Procedure.usedReference", "short" : "Items used during procedure", "definition" : "Identifies medications, devices and any other substance used as part of the procedure.", "comment" : "For devices actually implanted or removed, use Procedure.device.", "requirements" : "Used for tracking contamination, etc.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.usedReference", "min" : 0, "max" : "*" }, "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Device", "http://hl7.org/fhir/StructureDefinition/Medication", "http://hl7.org/fhir/StructureDefinition/Substance" ] } ], "isModifier" : false, "isSummary" : false, "mapping" : [ { "identity" : "rim", "map" : ".participation[typeCode=DEV].role[classCode=MANU] or\n.participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)" } ] }, { "id" : "Procedure.usedCode", "path" : "Procedure.usedCode", "short" : "Coded items used during the procedure", "definition" : "Identifies coded items that were used as part of the procedure.", "comment" : "For devices actually implanted or removed, use Procedure.device.", "min" : 0, "max" : "*", "base" : { "path" : "Procedure.usedCode", "min" : 0, "max" : "*" }, "type" : [ { "code" : "CodeableConcept" } ], "isModifier" : false, "isSummary" : false, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureUsed" } ], "strength" : "example", "description" : "Codes describing items used during a procedure.", "valueSet" : "http://hl7.org/fhir/ValueSet/device-kind" }, "mapping" : [ { "identity" : "rim", "map" : "participation[typeCode=Dev].role[classCode=MANU]" } ] } ] }, "differential" : { "element" : [ { "id" : "Procedure", "path" : "Procedure", "mustSupport" : true }, { "id" : "Procedure.id", "path" : "Procedure.id", "mustSupport" : true }, { "id" : "Procedure.meta", "path" : "Procedure.meta", "mustSupport" : true }, { "id" : "Procedure.meta.profile", "path" : "Procedure.meta.profile", "fixedCanonical" : "http://hl7.org/fhir/uv/ips/StructureDefinition/Procedure-uv-ips", "mustSupport" : true }, { "id" : "Procedure.status", "path" : "Procedure.status", "mustSupport" : true }, { "id" : "Procedure.code", "path" : "Procedure.code", "slicing" : { "discriminator" : [ { "type" : "value", "path" : "coding.system" } ], "description" : "Discriminated by code system", "rules" : "open" }, "min" : 1, "max" : "1", "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "mustSupport" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "ProcedureCode" } ], "strength" : "preferred", "valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips" } }, { "id" : "Procedure.code:absentOrUnknownProcedure", "path" : "Procedure.code", "sliceName" : "absentOrUnknownProcedure", "short" : "Code for absent problem or for unknown procedure", "definition" : "Code representing the statement \"absent problem\" or the statement \"procedures unknown\"", "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "mustSupport" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "absentOrUnknownProcedure" } ], "strength" : "required", "description" : "A code to identify absent or unknown procedures", "valueSet" : "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-procedures-uv-ips" } }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding", "path" : "Procedure.code.coding", "min" : 1, "max" : "1", "mustSupport" : true }, { "id" : "Procedure.code:absentOrUnknownProcedure.coding.system", "path" : "Procedure.code.coding.system", "min" : 1, "max" : "1", "fixedUri" : "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips", "mustSupport" : true }, { "id" : "Procedure.subject", "path" : "Procedure.subject", "definition" : "The person on which the procedure was performed.", "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/Patient-uv-ips" ] } ], "mustSupport" : true }, { "id" : "Procedure.subject.reference", "path" : "Procedure.subject.reference", "min" : 1, "mustSupport" : true }, { "id" : "Procedure.performed[x]", "path" : "Procedure.performed[x]", "min" : 1, "max" : "1", "mustSupport" : true }, { "id" : "Procedure.performed[x].extension:data-absent-reason", "path" : "Procedure.performed[x].extension", "sliceName" : "data-absent-reason", "short" : "performed[x] absence reason", "definition" : "Provides a reason why the performed is missing.", "max" : "1", "type" : [ { "code" : "Extension", "profile" : [ "http://hl7.org/fhir/StructureDefinition/data-absent-reason" ] } ], "mustSupport" : true }, { "id" : "Procedure.asserter", "path" : "Procedure.asserter", "mustSupport" : false }, { "id" : "Procedure.performer", "path" : "Procedure.performer", "mustSupport" : false }, { "id" : "Procedure.performer.actor", "path" : "Procedure.performer.actor", "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson", "http://hl7.org/fhir/uv/ips/StructureDefinition/Device-observer-uv-ips", "http://hl7.org/fhir/uv/ips/StructureDefinition/Practitioner-uv-ips", "http://hl7.org/fhir/uv/ips/StructureDefinition/Organization-observation-uv-ips" ] } ], "mustSupport" : false }, { "id" : "Procedure.performer.onBehalfOf", "path" : "Procedure.performer.onBehalfOf", "type" : [ { "code" : "Reference", "targetProfile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/Organization-observation-uv-ips" ] } ], "mustSupport" : false }, { "id" : "Procedure.bodySite", "path" : "Procedure.bodySite", "type" : [ { "code" : "CodeableConcept", "profile" : [ "http://hl7.org/fhir/uv/ips/StructureDefinition/CodeableConcept-uv-ips" ] } ], "mustSupport" : true, "binding" : { "extension" : [ { "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString" : "BodySite" } ], "strength" : "example", "valueSet" : "http://hl7.org/fhir/ValueSet/body-site" } } ] } }