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

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

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

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

An Extension

R4: Procedure.instantiatesCanonical (new:canonical(PlanDefinition,ActivityDefinition,Measure,OperationDefinition,Questionnaire))

Element Procedure.instantiatesCanonical has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.instantiatesUri (new:uri)

Element Procedure.instantiatesUri has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

R4: Procedure.performed[x] additional types (string, Age, Range)

Element Procedure.performed[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.performed[x] do not cover the following types: Age, Range, string. The target context Procedure.performed[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Procedure. 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.

R4: Procedure.recorder (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.recorder has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.recorder has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.asserter (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.asserter has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.asserter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: Procedure.status additional codes

Element Procedure.status is mapped to FHIR STU3 element Procedure.status as RelatedTo. Element Procedure.status is mapped to FHIR STU3 element Procedure.notDone as SourceIsBroaderThanTarget. The mappings for Procedure.status do not allow expression of the necessary codes, per the bindings on the source and target. The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

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

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

The codes SHALL be taken from EventStatus http://hl7.org/fhir/ValueSet/event-status|3.0.2
(required to http://hl7.org/fhir/ValueSet/event-status|3.0.2)

A code specifying the state of the procedure.

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

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

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

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

R4: Procedure.instantiatesCanonical (new:canonical(PlanDefinition,ActivityDefinition,Measure,OperationDefinition,Questionnaire))

Element Procedure.instantiatesCanonical has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.instantiatesUri (new:uri)

Element Procedure.instantiatesUri has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

R4: Procedure.performed[x] additional types (string, Age, Range)

Element Procedure.performed[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.performed[x] do not cover the following types: Age, Range, string. The target context Procedure.performed[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Procedure. 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.

R4: Procedure.recorder (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.recorder has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.recorder has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.asserter (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.asserter has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.asserter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.status additional codes

Element Procedure.status is mapped to FHIR STU3 element Procedure.status as RelatedTo. Element Procedure.status is mapped to FHIR STU3 element Procedure.notDone as SourceIsBroaderThanTarget. The mappings for Procedure.status do not allow expression of the necessary codes, per the bindings on the source and target. The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

R4: Procedure.basedOn additional types from child elements (display, identifier, reference, type)

Element Procedure.basedOn is mapped to FHIR STU3 element Procedure.basedOn as SourceIsBroaderThanTarget. The mappings for Procedure.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.basedOn with unmapped reference targets: ServiceRequest.

R4: Procedure.performer.actor

Element Procedure.performer.actor is mapped to FHIR STU3 element Procedure.performer.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.performer.actor with unmapped reference targets: PractitionerRole.

R4: Procedure.reasonReference

Element Procedure.reasonReference is mapped to FHIR STU3 element Procedure.reasonReference as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.reasonReference with unmapped reference targets: DiagnosticReport, DocumentReference, Procedure. 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). 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.

R4: Procedure.report

Element Procedure.report is mapped to FHIR STU3 element Procedure.report as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.report with unmapped reference targets: Composition, DocumentReference. 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.

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

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

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

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

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

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

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

The base language in which the resource is written.

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).

A human language.

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

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.

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.

An Extension

R4: Procedure.instantiatesCanonical (new:canonical(PlanDefinition,ActivityDefinition,Measure,OperationDefinition,Questionnaire))

Element Procedure.instantiatesCanonical has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesCanonical has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.instantiatesUri (new:uri)

Element Procedure.instantiatesUri has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.instantiatesUri has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element). This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

R4: Procedure.performed[x] additional types (string, Age, Range)

Element Procedure.performed[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.performed[x] do not cover the following types: Age, Range, string. The target context Procedure.performed[x] is a choice-type element and cannot directly hold extensions. The context is moved up to parent element Procedure. 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.

R4: Procedure.recorder (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.recorder has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.recorder has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

R4: Procedure.asserter (new:Reference(Patient,RelatedPerson,Practitioner,PractitionerRole))

Element Procedure.asserter has a context of Procedure based on following the parent source element upwards and mapping to Procedure. Element Procedure.asserter has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).

An Extension

R4: Procedure.status additional codes

Element Procedure.status is mapped to FHIR STU3 element Procedure.status as RelatedTo. Element Procedure.status is mapped to FHIR STU3 element Procedure.notDone as SourceIsBroaderThanTarget. The mappings for Procedure.status do not allow expression of the necessary codes, per the bindings on the source and target. The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

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

Need to allow connection to a wider workflow.

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

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

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

An Extension

R4: Procedure.basedOn additional types from child elements (display, identifier, reference, type)

Element Procedure.basedOn is mapped to FHIR STU3 element Procedure.basedOn as SourceIsBroaderThanTarget. The mappings for Procedure.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.basedOn with unmapped reference targets: ServiceRequest.

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.

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.

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

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

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

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

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

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.

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

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

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

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

The codes SHALL be taken from EventStatus
(required to http://hl7.org/fhir/ValueSet/event-status|3.0.2)

A code specifying the state of the procedure.

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

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

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

A code indicating why the procedure was not performed.

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

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

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

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

A code to identify a specific procedure .

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

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

The encounter during which the procedure was performed.

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

Limited to 'real' people rather than equipment.

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

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

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.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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.

For example: surgeon, anaethetist, endoscopist.

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

The practitioner who was involved in the procedure.

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

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

An Extension

R4: Procedure.performer.actor

Element Procedure.performer.actor is mapped to FHIR STU3 element Procedure.performer.actor as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.performer.actor with unmapped reference targets: PractitionerRole.

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.

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.

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

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

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

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

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

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.

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

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

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

Ties a procedure to where the records are likely kept.

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

A code that identifies the reason a procedure is required.

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

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

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

An Extension

R4: Procedure.reasonReference

Element Procedure.reasonReference is mapped to FHIR STU3 element Procedure.reasonReference as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.reasonReference with unmapped reference targets: DiagnosticReport, DocumentReference, Procedure. 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). 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.

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.

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.

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

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

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

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

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

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.

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

Codes describing anatomical locations. May include laterality.

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

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

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

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

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.

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

An Extension

R4: Procedure.report

Element Procedure.report is mapped to FHIR STU3 element Procedure.report as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R4 element Procedure.report with unmapped reference targets: Composition, DocumentReference. 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.

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.

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.

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

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

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

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

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

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.

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.

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

Codes describing complications that resulted from a procedure.

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

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

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

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

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

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.

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

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

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.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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.

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

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

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

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

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

Used for tracking contamination, etc.

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

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

Codes describing items used during a procedure