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

R5: 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).

R5: 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.

R5: Procedure.focus (new:Reference(Patient,Group,RelatedPerson,Practitioner,Organization,CareTeam,PractitionerRole,Specimen))

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

R5: Procedure.occurrence[x] additional types (string, Age, Range, Timing)

Element Procedure.occurrence[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.occurrence[x] do not cover the following types: Age, Range, string, Timing. 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. This indicates when the procedure actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this Procedure is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds.

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.

R5: Procedure.recorded (new:dateTime)

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

R5: 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).

R5: Procedure.reported[x] (new:boolean, Reference(Patient,RelatedPerson,Practitioner,PractitionerRole,Organization))

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

R5: Procedure.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport), CodeableReference(http://hl7.org/fhir/StructureDefinition/DocumentReference))

Element Procedure.reason is mapped to FHIR STU3 element Procedure.notDoneReason as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonCode as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonReference as SourceIsBroaderThanTarget. The mappings for Procedure.reason do not cover the following types: CodeableReference. Use Procedure.reason.concept when a code sufficiently describes the reason. Use Procedure.reason.reference when referencing a resource, which allows more information to be conveyed, such as onset date. For a single Procedure.reason, if both Procedure.reason.concept and Procedure.reason.reference are present, they are expected to be consistent with each other.

R5: Procedure.used additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Device), CodeableReference(http://hl7.org/fhir/StructureDefinition/Medication), CodeableReference(http://hl7.org/fhir/StructureDefinition/Substance), CodeableReference(http://hl7.org/fhir/StructureDefinition/BiologicallyDerivedProduct))

Element Procedure.used is mapped to FHIR STU3 element Procedure.usedReference as SourceIsBroaderThanTarget. Element Procedure.used is mapped to FHIR STU3 element Procedure.usedCode as SourceIsBroaderThanTarget. The mappings for Procedure.used do not cover the following types: CodeableReference. For devices actually implanted or removed, use Procedure.focalDevice.manipulated.

R5: Procedure.supportingInfo (new:Reference(Resource))

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

An Extension

R5: 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.

An Extension

R5: Procedure.subject

Element Procedure.subject is mapped to FHIR STU3 element Procedure.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Procedure.subject with unmapped reference targets: Device, Group, Location, Organization, Patient, Practitioner.

R5: 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).

R5: 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.

R5: Procedure.focus (new:Reference(Patient,Group,RelatedPerson,Practitioner,Organization,CareTeam,PractitionerRole,Specimen))

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

R5: Procedure.occurrence[x] additional types (string, Age, Range, Timing)

Element Procedure.occurrence[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.occurrence[x] do not cover the following types: Age, Range, string, Timing. 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. This indicates when the procedure actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this Procedure is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds.

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.

R5: Procedure.recorded (new:dateTime)

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

R5: 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).

R5: Procedure.reported[x] (new:boolean, Reference(Patient,RelatedPerson,Practitioner,PractitionerRole,Organization))

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

R5: Procedure.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport), CodeableReference(http://hl7.org/fhir/StructureDefinition/DocumentReference))

Element Procedure.reason is mapped to FHIR STU3 element Procedure.notDoneReason as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonCode as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonReference as SourceIsBroaderThanTarget. The mappings for Procedure.reason do not cover the following types: CodeableReference. Use Procedure.reason.concept when a code sufficiently describes the reason. Use Procedure.reason.reference when referencing a resource, which allows more information to be conveyed, such as onset date. For a single Procedure.reason, if both Procedure.reason.concept and Procedure.reason.reference are present, they are expected to be consistent with each other.

R5: Procedure.used additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Device), CodeableReference(http://hl7.org/fhir/StructureDefinition/Medication), CodeableReference(http://hl7.org/fhir/StructureDefinition/Substance), CodeableReference(http://hl7.org/fhir/StructureDefinition/BiologicallyDerivedProduct))

Element Procedure.used is mapped to FHIR STU3 element Procedure.usedReference as SourceIsBroaderThanTarget. Element Procedure.used is mapped to FHIR STU3 element Procedure.usedCode as SourceIsBroaderThanTarget. The mappings for Procedure.used do not cover the following types: CodeableReference. For devices actually implanted or removed, use Procedure.focalDevice.manipulated.

R5: Procedure.supportingInfo (new:Reference(Resource))

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

R5: 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.

R5: 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 R5 element Procedure.basedOn with unmapped reference targets: CarePlan, ServiceRequest.

R5: Procedure.partOf

Element Procedure.partOf is mapped to FHIR STU3 element Procedure.partOf as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Procedure.partOf with unmapped reference targets: MedicationAdministration, Observation, Procedure. 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).

R5: Procedure.subject

Element Procedure.subject is mapped to FHIR STU3 element Procedure.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Procedure.subject with unmapped reference targets: Device, Group, Location, Organization, Patient, Practitioner.

R5: Procedure.encounter additional types from child elements (display, identifier, reference, type)

Element Procedure.encounter is mapped to FHIR STU3 element Procedure.context as SourceIsBroaderThanTarget. The mappings for Procedure.encounter 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 R5 element Procedure.encounter with unmapped reference targets: Encounter. 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.

R5: Procedure.performer.period (new:Period)

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

R5: 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 R5 element Procedure.performer.actor with unmapped reference targets: CareTeam, Device, HealthcareService, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.

R5: Procedure.performer.onBehalfOf additional types from child elements (display, identifier, reference, type)

Element Procedure.performer.onBehalfOf is mapped to FHIR STU3 element Procedure.performer.onBehalfOf as SourceIsBroaderThanTarget. The mappings for Procedure.performer.onBehalfOf 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 R5 element Procedure.performer.onBehalfOf with unmapped reference targets: Organization. Organization, Patient, RelatedPerson, Device, CareTeam, and HealthcareService can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

R5: Procedure.location additional types from child elements (display, identifier, reference, type)

Element Procedure.location is mapped to FHIR STU3 element Procedure.location as SourceIsBroaderThanTarget. The mappings for Procedure.location 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 R5 element Procedure.location with unmapped reference targets: Location.

R5: 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 R5 element Procedure.report with unmapped reference targets: Composition, DiagnosticReport, 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.

R5: Procedure.complication additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition)) additional types from child elements (reference)

Element Procedure.complication is mapped to FHIR STU3 element Procedure.complication as SourceIsBroaderThanTarget. The mappings for Procedure.complication do not cover the following types: CodeableReference. The mappings for Procedure.complication do not cover the following types based on type expansion: reference. If complications are only expressed by the narrative text, they can be captured using the CodeableReference.concept.text.

R5: Procedure.focalDevice.manipulated additional types from child elements (display, identifier, reference, type)

Element Procedure.focalDevice.manipulated is mapped to FHIR STU3 element Procedure.focalDevice.manipulated as SourceIsBroaderThanTarget. The mappings for Procedure.focalDevice.manipulated 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 R5 element Procedure.focalDevice.manipulated with unmapped reference targets: Device.

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).

Unless not suitable, these codes SHALL be taken from Common Languages
(extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)

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

R5: 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).

R5: 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.

R5: Procedure.focus (new:Reference(Patient,Group,RelatedPerson,Practitioner,Organization,CareTeam,PractitionerRole,Specimen))

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

R5: Procedure.occurrence[x] additional types (string, Age, Range, Timing)

Element Procedure.occurrence[x] is mapped to FHIR STU3 element Procedure.performed[x] as SourceIsBroaderThanTarget. The mappings for Procedure.occurrence[x] do not cover the following types: Age, Range, string, Timing. 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. This indicates when the procedure actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this Procedure is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds.

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.

R5: Procedure.recorded (new:dateTime)

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

R5: 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).

R5: Procedure.reported[x] (new:boolean, Reference(Patient,RelatedPerson,Practitioner,PractitionerRole,Organization))

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

R5: Procedure.reason additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition), CodeableReference(http://hl7.org/fhir/StructureDefinition/Observation), CodeableReference(http://hl7.org/fhir/StructureDefinition/Procedure), CodeableReference(http://hl7.org/fhir/StructureDefinition/DiagnosticReport), CodeableReference(http://hl7.org/fhir/StructureDefinition/DocumentReference))

Element Procedure.reason is mapped to FHIR STU3 element Procedure.notDoneReason as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonCode as SourceIsBroaderThanTarget. Element Procedure.reason is mapped to FHIR STU3 element Procedure.reasonReference as SourceIsBroaderThanTarget. The mappings for Procedure.reason do not cover the following types: CodeableReference. Use Procedure.reason.concept when a code sufficiently describes the reason. Use Procedure.reason.reference when referencing a resource, which allows more information to be conveyed, such as onset date. For a single Procedure.reason, if both Procedure.reason.concept and Procedure.reason.reference are present, they are expected to be consistent with each other.

R5: Procedure.used additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Device), CodeableReference(http://hl7.org/fhir/StructureDefinition/Medication), CodeableReference(http://hl7.org/fhir/StructureDefinition/Substance), CodeableReference(http://hl7.org/fhir/StructureDefinition/BiologicallyDerivedProduct))

Element Procedure.used is mapped to FHIR STU3 element Procedure.usedReference as SourceIsBroaderThanTarget. Element Procedure.used is mapped to FHIR STU3 element Procedure.usedCode as SourceIsBroaderThanTarget. The mappings for Procedure.used do not cover the following types: CodeableReference. For devices actually implanted or removed, use Procedure.focalDevice.manipulated.

R5: Procedure.supportingInfo (new:Reference(Resource))

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

An Extension

R5: 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

R5: 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 R5 element Procedure.basedOn with unmapped reference targets: CarePlan, 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.

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

An Extension

R5: Procedure.partOf

Element Procedure.partOf is mapped to FHIR STU3 element Procedure.partOf as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Procedure.partOf with unmapped reference targets: MedicationAdministration, Observation, Procedure. 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).

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 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.

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

An Extension

R5: Procedure.subject

Element Procedure.subject is mapped to FHIR STU3 element Procedure.subject as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element Procedure.subject with unmapped reference targets: Device, Group, Location, Organization, Patient, Practitioner.

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 encounter during which the procedure was performed.

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

An Extension

R5: Procedure.encounter additional types from child elements (display, identifier, reference, type)

Element Procedure.encounter is mapped to FHIR STU3 element Procedure.context as SourceIsBroaderThanTarget. The mappings for Procedure.encounter 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 R5 element Procedure.encounter with unmapped reference targets: Encounter. 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.

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 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.

An Extension

R5: Procedure.performer.period (new:Period)

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

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

R5: 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 R5 element Procedure.performer.actor with unmapped reference targets: CareTeam, Device, HealthcareService, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson.

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.

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

An Extension

R5: Procedure.performer.onBehalfOf additional types from child elements (display, identifier, reference, type)

Element Procedure.performer.onBehalfOf is mapped to FHIR STU3 element Procedure.performer.onBehalfOf as SourceIsBroaderThanTarget. The mappings for Procedure.performer.onBehalfOf 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 R5 element Procedure.performer.onBehalfOf with unmapped reference targets: Organization. Organization, Patient, RelatedPerson, Device, CareTeam, and HealthcareService can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

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 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.

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

An Extension

R5: Procedure.location additional types from child elements (display, identifier, reference, type)

Element Procedure.location is mapped to FHIR STU3 element Procedure.location as SourceIsBroaderThanTarget. The mappings for Procedure.location 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 R5 element Procedure.location with unmapped reference targets: Location.

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 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.

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

R5: 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 R5 element Procedure.report with unmapped reference targets: Composition, DiagnosticReport, 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.

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

An Extension

R5: Procedure.complication additional types (CodeableReference(http://hl7.org/fhir/StructureDefinition/Condition)) additional types from child elements (reference)

Element Procedure.complication is mapped to FHIR STU3 element Procedure.complication as SourceIsBroaderThanTarget. The mappings for Procedure.complication do not cover the following types: CodeableReference. The mappings for Procedure.complication do not cover the following types based on type expansion: reference. If complications are only expressed by the narrative text, they can be captured using the CodeableReference.concept.text.

A reference to a code defined by a terminology system.

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

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

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.

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

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.

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.

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

An Extension

R5: Procedure.focalDevice.manipulated additional types from child elements (display, identifier, reference, type)

Element Procedure.focalDevice.manipulated is mapped to FHIR STU3 element Procedure.focalDevice.manipulated as SourceIsBroaderThanTarget. The mappings for Procedure.focalDevice.manipulated 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 R5 element Procedure.focalDevice.manipulated with unmapped reference targets: Device.

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.

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