Release 5 Preview #1

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V2-0078.cs.xml

Vocabulary Work GroupMaturity Level: N/AStandards Status: Informative

Raw XML (canonical form + also see XML Format Specification)

HL7-defined code system of concepts which specify a categorical assessment of an observation value. Notes: This is being communicated in v2.x in OBX-8 (Observation Interpretation), in v3 in ObservationInterpretation (CWE) in R1 (Representative Realm) and in FHIR in Observation.interpretation.

<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="v2-0078"/> 
  <meta> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> 
  </meta> 
  <language value="en"/> 
  <text> 
    <status value="additional"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p> Interpretation Codes</p> 

      <table class="grid">
        <tr> 
          <td> 
            <b> Code</b> 
          </td> 
          <td> 
            <b> Description</b> 
          </td> 
          <td> 
            <b> Comment</b> 
          </td> 
          <td> 
            <b> Version</b> 
          </td> 
        </tr> 
        <tr> 
          <td> &lt;
            <a name=".60"> </a> 
          </td> 
          <td> Off scale low</td> 
          <td> The result is below the minimum detection limit (the test procedure or equipment is the
               limiting factor).
Synonyms: Below analytical limit, low off scale</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> &gt;
            <a name=".62"> </a> 
          </td> 
          <td> Off scale high</td> 
          <td> The result is above the maximum quantifiable limit (the test procedure or equipment is
               the limiting factor).
Synonyms: Above analytical limit, high off scale</td> 
          <td> added v2.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> A
            <a name="A"> </a> 
          </td> 
          <td> Abnormal</td> 
          <td> The result or observation value is outside the reference range or expected norm (as defined
               for the respective test procedure).
Note: Typically applies to non-numeric results.</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> AA
            <a name="AA"> </a> 
          </td> 
          <td> Critically abnormal</td> 
          <td> The result or observation value is outside a reference range or expected norm at a level
               at which immediate action should be considered for patient safety (as defined for the
               respective test procedure).
[Note: Typically applies to non-numeric results.  Analogous to critical/panic limits for
               numeric results.]</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> AC
            <a name="AC"> </a> 
          </td> 
          <td> Anti-complementary substances present</td> 
          <td> Deprecated</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> B
            <a name="B"> </a> 
          </td> 
          <td> Better</td> 
          <td> The current result or observation value has improved compared to the previous result or
               observation value (the change is significant as defined in the respective test procedure).
Note: This can be applied to quantitative or qualitative observations.</td> 
          <td> added v2.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> D
            <a name="D"> </a> 
          </td> 
          <td> Significant change down</td> 
          <td> The current result has decreased from the previous result for a quantitative observation
               (the change is significant as defined in the respective test procedure).</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> DET
            <a name="DET"> </a> 
          </td> 
          <td> Detected</td> 
          <td> The measurement of the specified component / analyte, organism or clinical sign above
               the limit of detection of the performed test or procedure.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> H
            <a name="H"> </a> 
          </td> 
          <td> High</td> 
          <td> The result for a quantitative observation is above the upper limit of the reference range
               (as defined for the respective test procedure).
Synonym: Above high normal</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> HH
            <a name="HH"> </a> 
          </td> 
          <td> Critically high</td> 
          <td> The result for a quantitative observation is above a reference level at which immediate
               action should be considered for patient safety (as defined for the respective test procedure).
Synonym: Above upper panic limits</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> HM
            <a name="HM"> </a> 
          </td> 
          <td> Hold for Medical Review</td> 
          <td> Deprecated</td> 
          <td> added v2.8, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> HU
            <a name="HU"> </a> 
          </td> 
          <td> Very high</td> 
          <td> Significantly high: A test result that is significantly higher than the reference (normal)
               or therapeutic interval, but has not reached the critically high value and might need
               special attention, as defined by the laboratory or the clinician.

Note: This level is situated between ‘H’ and ‘HH’.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> I
            <a name="I"> </a> 
          </td> 
          <td> Intermediate</td> 
          <td> Bacterial strain inhibited in vitro by a
concentration of an antimicrobial agent that is associated with
uncertain therapeutic effect.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
              Harmonized_Terminolo.htm)
Projects: ISO 20776-1, ISO 20776-2

Note 1: Bacterial strains are categorized as intermediate by applying the appropriate
               breakpoints in a defined phenotypic test system.

Note 2: This class of susceptibility implies that an infection due to the
isolate can be appropriately treated in body sites where the drugs are physiologically
               concentrated or when a high dosage of drug can be used.

Note 3: This class also indicates a “buffer zone,� to prevent small, uncontrolled, technical
               factors from causing major discrepancies in interpretations.

Note 4: These breakpoints can be altered due to changes in circumstances (e.g., changes
               in commonly used drug dosages, emergence of new resistance mechanisms).</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> IE
            <a name="IE"> </a> 
          </td> 
          <td> Insufficient evidence</td> 
          <td> There is insufficient evidence that the species in question is a good target for therapy
               with the drug.  A categorical interpretation is not possible.
Reference: EUCAST

Note: A MIC with “IE� and/or a comment may be reported (without an accompanying S, I or
               R-categorization).</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> IND
            <a name="IND"> </a> 
          </td> 
          <td> Indeterminate</td> 
          <td> The specified component / analyte, organism or clinical sign could neither be declared
               positive / negative or detected / not detected by the performed test or procedure.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> L
            <a name="L"> </a> 
          </td> 
          <td> Low</td> 
          <td> The result for a quantitative observation is below the lower limit of the reference range
               (as defined for the respective test procedure).
Synonym: Below low normal</td> 
          <td> added v2.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> LL
            <a name="LL"> </a> 
          </td> 
          <td> Critically low</td> 
          <td> The result for a quantitative observation is below a reference level at which immediate
               action should be considered for patient safety (as defined for the respective test procedure).
Synonym: Below lower panic limits</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> LU
            <a name="LU"> </a> 
          </td> 
          <td> Very low</td> 
          <td> Significantly low: A test result that is significantly lower than the reference (normal)
               or therapeutic interval, but has not reached the critically low value and might need special
               attention, as defined by the laboratory or the clinician.

Note: This level is situated between ‘L’ and ‘LL’.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> MS
            <a name="MS"> </a> 
          </td> 
          <td> Moderately susceptible. Indicates for microbiology susceptibilities only.</td> 
          <td> Deprecated - CLSI now only supports S, I &amp; R. This information can be found in CLSI
               document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
                Jan 2012.</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> N
            <a name="N"> </a> 
          </td> 
          <td> Normal</td> 
          <td> The result or observation value is within the reference range or expected norm (as defined
               for the respective test procedure).
Note: Applies to numeric or non-numeric results.</td> 
          <td> added v2.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> ND
            <a name="ND"> </a> 
          </td> 
          <td> Not Detected</td> 
          <td> The presence of the specified component / analyte, organism or clinical sign could not
               be determined  within the limit of detection of the performed test or procedure.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> NEG
            <a name="NEG"> </a> 
          </td> 
          <td> Negative</td> 
          <td> An absence finding of the specified component / analyte, organism or clinical sign based
               on the established threshold of the performed test or procedure.
Note: Negative does not necessarily imply the complete absence of the specified item.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> NR
            <a name="NR"> </a> 
          </td> 
          <td> Non-reactive</td> 
          <td> An absence finding used to indicate that the specified component / analyte did not react
               measurably with the reagent.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> NS
            <a name="NS"> </a> 
          </td> 
          <td> Non-susceptible</td> 
          <td> A category used for isolates for which only a susceptible interpretive criterion has been
               designated because of the absence or rare occurrence of resistant strains. Isolates that
               have MICs above or zone diameters below the value indicated for the susceptible breakpoint
               should be reported as non-susceptible.

Synonym: decreased susceptibility

Note 1: An isolate that is interpreted as non-susceptible does not necessarily mean that
               the isolate has a resistance mechanism. It is possible that isolates with MICs above the
               susceptible breakpoint that lack resistance mechanisms may be encountered within the wild-type
               distribution subsequent to the time the susceptible-only breakpoint is set.

Note 2: For strains yielding results in the “nonsusceptible� category, organism identification
               and antimicrobial susceptibility test results should be confirmed.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> null
            <a name="null"> </a> 
          </td> 
          <td> No range defined, or normal ranges don't apply</td> 
          <td> Deprecated</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> OBX
            <a name="OBX"> </a> 
          </td> 
          <td> Interpretation qualifiers in separate OBX segments</td> 
          <td> Deprecated</td> 
          <td> added v2.8, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> POS
            <a name="POS"> </a> 
          </td> 
          <td> Positive</td> 
          <td> A presence finding of the specified component / analyte, organism or clinical sign based
               on the established threshold of the performed test or procedure.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> QCF
            <a name="QCF"> </a> 
          </td> 
          <td> Quality Control Failure</td> 
          <td> Deprecated</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> R
            <a name="R"> </a> 
          </td> 
          <td> Resistant</td> 
          <td> Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that
               is associated with a high likelihood of therapeutic failure.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
              Harmonized_Terminolo.htm)
Projects: ISO 20776-1, ISO 20776-2

Note 1: Bacterial strains are categorized as resistant by applying the appropriate breakpoints
               in a defined phenotypic test system.

Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes
               in commonly used drug dosages, emergence of new resistance mechanisms).</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> RR
            <a name="RR"> </a> 
          </td> 
          <td> Reactive</td> 
          <td> A presence finding used to indicate that the specified component / analyte reacted with
               the reagent above the reliably measurable limit of the performed test.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> S
            <a name="S"> </a> 
          </td> 
          <td> Susceptible</td> 
          <td> Bacterial strain inhibited by in vitro concentration of an antimicrobial agent that is
               associated with a high likelihood of therapeutic success.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
              Harmonized_Terminolo.htm) 
Projects: ISO 20776-1, ISO 20776-2

Synonym (earlier term): Sensitive

Note 1: Bacterial strains are categorized as susceptible by applying the appropriate breakpoints
               in a defined phenotypic system.

Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes
               in commonly used drug dosages, emergence of new resistance mechanisms).</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> SDD
            <a name="SDD"> </a> 
          </td> 
          <td> Susceptible-dose dependent</td> 
          <td> A category that includes isolates with antimicrobial agent minimum inhibitory concentrations
               (MICs) that approach usually attainable blood and tissue levels and for which response
               rates may be lower than for susceptible isolates.
Reference: CLSI document M44-A2 2009 “Method for antifungal disk diffusion susceptibility
               testing of yeasts; approved guideline – second edition� – page 2.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> SYN-R
            <a name="SYN-R"> </a> 
          </td> 
          <td> Synergy - resistant</td> 
          <td> A category for isolates where the bacteria (e.g. enterococci) are not susceptible in vitro
               to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent).
               This is predictive that this combination therapy will not be effective. 

Usage Note: Since the use of penicillin or ampicillin alone often results in treatment
               failure of serious enterococcal or other bacterial infections, combination therapy is
               usually indicated to enhance bactericidal activity. The synergy between a cell wall active
               agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin,
               kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance
               to the aminoglycoside.

Open Issue: The print name of the code is very general and the description is very specific
               to a pair of classes of agents, which may lead to confusion of these concepts in the future
               should other synergies be found.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> SYN-S
            <a name="SYN-S"> </a> 
          </td> 
          <td> Synergy - susceptible</td> 
          <td> A category for isolates where the bacteria (e.g. enterococci) are susceptible in vitro
               to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent).
               This is predictive that this combination therapy will be effective. 

Usage Note: Since the use of penicillin or ampicillin alone often results in treatment
               failure of serious enterococcal or other bacterial infections, combination therapy is
               usually indicated to enhance bactericidal activity. The synergy between a cell wall active
               agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin,
               kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance
               to the aminoglycoside.

Open Issue: The print name of the code is very general and the description is very specific
               to a pair of classes of agents, which may lead to confusion of these concepts in the future
               should other synergies be found.</td> 
          <td> added v2.8.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> TOX
            <a name="TOX"> </a> 
          </td> 
          <td> Cytotoxic substance present</td> 
          <td> Deprecated</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> U
            <a name="U"> </a> 
          </td> 
          <td> Significant change up</td> 
          <td> The current result has increased from the previous result for a quantitative observation
               (the change is significant as defined in the respective test procedure).</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> VS
            <a name="VS"> </a> 
          </td> 
          <td> Very susceptible. Indicates for microbiology susceptibilities only.</td> 
          <td> Deprecated - CLSI now only supports S, I &amp; R. This information can be found in CLSI
               document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
                Jan 2012.</td> 
          <td> from v2.1, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> W
            <a name="W"> </a> 
          </td> 
          <td> Worse</td> 
          <td> The current result or observation value has degraded compared to the previous result or
               observation value (the change is significant as defined in the respective test procedure).
Note: This can be applied to quantitative or qualitative observations.</td> 
          <td> added v2.2, removed after v2.8.2</td> 
        </tr> 
        <tr> 
          <td> WR
            <a name="WR"> </a> 
          </td> 
          <td> Weakly reactive</td> 
          <td> A weighted presence finding used to indicate that the specified component / analyte reacted
               with the reagent, but below the reliably measurable limit of the performed test.</td> 
          <td> added v2.7, removed after v2.8.2</td> 
        </tr> 
      </table> 

    </div> 
  </text> 
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  </extension> 
  <url value="http://terminology.hl7.org/CodeSystem/v2-0078"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.18.31"/> 
  </identifier> 
  <version value="2.9"/> 
  <name value="v2.0078"/> 
  <title value="v2 ABNORMAL FLAGS"/> 
  <status value="active"/> 
  <experimental value="false"/> 
  <publisher value="HL7, Inc"/> 
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    </telecom> 
  </contact> 
  <description value="HL7-defined code system of concepts which specify a categorical assessment of an observation
     value.   
   
   Notes:
   
   This is being communicated in v2.x in OBX-8 (Observation Interpretation), in v3 in
     ObservationInterpretation (CWE) in R1 (Representative Realm) and in FHIR in    Observation.interpret
    ation."/> 
  <content value="complete"/> 
  <property> 
    <code value="status"/> 
    <uri value="http://hl7.org/fhir/concept-properties#status"/> 
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       retired"/> 
    <type value="code"/> 
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  <property> 
    <code value="deprecationDate"/> 
    <uri value="http://hl7.org/fhir/concept-properties#deprecationDate"/> 
    <description value="The date at which a concept was deprecated. Concepts that are deprecated but not inactive
       can still be used, but their use is discouraged"/> 
    <type value="dateTime"/> 
  </property> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result is below the minimum detection limit (the test procedure or equipment is the
         limiting factor).
Synonyms: Below analytical limit, low off scale">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat is onder de minimum detecteerbare grens (de testprocedure of apparaat is
               de beperkende factor). Synoniemen: Onder analytische grens, off-scale low"/> 
          </extension> 
        </extension> 
      </valueString> 
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    <code value="&lt;"/> 
    <display value="Off scale low"/> 
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        <code value="display"/> 
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    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Onder absolute ondergrens instrumentschaal"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result is above the maximum quantifiable limit (the test procedure or equipment is
         the limiting factor).
Synonyms: Above analytical limit, high off scale">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat is boven de maximum detecteerbare grens (de testprocedure of apparaat is
               de beperkende factor). Synoniemen: Boven analytische grens, off-scale high"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="&gt;"/> 
    <display value="Off scale high"/> 
    <designation> 
      <language value="de"/> 
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        <code value="display"/> 
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    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Boven absolute bovengrens instrumentschaal"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result or observation value is outside the reference range or expected norm (as defined
         for the respective test procedure).
Note: Typically applies to non-numeric results.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat of observatiewaarde is buiten de referentiewaarden of afwijkend van de verwachte
               norm (zoals gedefinieerd voor de betreffende testprocedure. NB: Meest van toepassing op
               niet-numerieke resultaten."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="A"/> 
    <display value="Abnormal"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="anormal"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Abnormaal"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result or observation value is outside a reference range or expected norm at a level
         at which immediate action should be considered for patient safety (as defined for the
         respective test procedure).
[Note: Typically applies to non-numeric results.  Analogous to critical/panic limits for
         numeric results.]">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat of observatiewaarde is buiten de referentiewaarden of afwijkend van de verwachte
               norm waarvoor onmiddellijke actie ondernomen zou moeten worden uit het oogpunt van patiëntveiligheid
               (zoals gedefinieerd voor de betreffende testprocedure. NB: Meest van toepassing op niet-numerieke
               resultaten."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="AA"/> 
    <display value="Critically abnormal"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Pathologisch (nicht numerisch)"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Kritiek abnormaal"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="AC"/> 
    <display value="Anti-complementary substances present"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Anti-complementaire stoffen aanwezig"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The current result or observation value has improved compared to the previous result or
         observation value (the change is significant as defined in the respective test procedure).
Note: This can be applied to quantitative or qualitative observations.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het huidige resultaat of observatiewaarde is verbeterd ten opzichte van vorige resultaat
               of observatiewaarde (de wijziging is significant zoals gedefinieerd in de betreffende
               testprocedure). NB: van toepassing op kwantitatieve of kwalitatieve observaties"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="B"/> 
    <display value="Better"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="besser"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Beter"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The current result has decreased from the previous result for a quantitative observation
         (the change is significant as defined in the respective test procedure).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het huidige resultaat is verlaagd ten opzichte van het vorige resultaat voor een kwantitatieve
               observatie (de wijziging is significant zoals gedefinieerd voor de betreffende testprocedure)."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="D"/> 
    <display value="Significant change down"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Deutlicher Trend nach unten"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Significante wijzging omlaag"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The measurement of the specified component / analyte, organism or clinical sign above
         the limit of detection of the performed test or procedure.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="De meting van het gespecificeerde component / analyte, organisme of klinische teken boven
               de grenswaarde voor detectie van de uitgevoerde test of procedure."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="DET"/> 
    <display value="Detected"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Gedetecteerd"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result for a quantitative observation is above the upper limit of the reference range
         (as defined for the respective test procedure).
Synonym: Above high normal">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat voor een kwalitatieve observatie is boven de bovengrens van de referentiewaarden
               (zoals gedefinieerd voor de betreffende testprocedure). Synoniem: Boven bovenste normaalgrens"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="H"/> 
    <display value="High"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Oberhalb oberer Grenze Referenzbereich"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Hoog"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result for a quantitative observation is above a reference level at which immediate
         action should be considered for patient safety (as defined for the respective test procedure).
Synonym: Above upper panic limits">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="De resultaten voor een kwantitatieve observatie is boven een referentieniveau waarop onmiddellijke
               actie overwogen moet worden uit het oogpunt van patiëntveiligheid (zoals gedefinieerd
               voor betreffende testprocedure. Synoniem: Boven hoogste kritieke grens"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="HH"/> 
    <display value="Critically high"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Oberhalb oberer pathologischer Grenze"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Kritiek hoog"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="HM"/> 
    <display value="Hold for Medical Review"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Vastgehouden voor medische review"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Significantly high: A test result that is significantly higher than the reference (normal)
         or therapeutic interval, but has not reached the critically high value and might need
         special attention, as defined by the laboratory or the clinician.

Note: This level is situated between ‘H’ and ‘HH’.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Significant hoog: Een testresultaat die significant hoger is dan de referentie (normaal)
               of therapeutisch interval, maar nog niet op de kritiek hoger waarde zit en mogelijke speciale
               aandacht nodig heeft, zoals gedefinieerd door het laboratorium of de arts. NB: T"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="HU"/> 
    <display value="Very high"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Zeer hoog"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Bacterial strain inhibited in vitro by a
concentration of an antimicrobial agent that is associated with
uncertain therapeutic effect.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
        Harmonized_Terminolo.htm)
Projects: ISO 20776-1, ISO 20776-2

Note 1: Bacterial strains are categorized as intermediate by applying the appropriate
         breakpoints in a defined phenotypic test system.

Note 2: This class of susceptibility implies that an infection due to the
isolate can be appropriately treated in body sites where the drugs are physiologically
         concentrated or when a high dosage of drug can be used.

Note 3: This class also indicates a “buffer zone,� to prevent small, uncontrolled, technical
         factors from causing major discrepancies in interpretations.

Note 4: These breakpoints can be altered due to changes in circumstances (e.g., changes
         in commonly used drug dosages, emergence of new resistance mechanisms).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Bacteriële stam geblokkeerd door in vitro concentratie van een anti-bacteriële agens die
               is gekoppeld aan een onzekere kans op therapeutisch effect. Referentie: CLSI (http://www.clsi.org/Co
              ntent/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized_Ter"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="I"/> 
    <display value="Intermediate"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Intermediär"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Gemiddeld"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="There is insufficient evidence that the species in question is a good target for therapy
         with the drug.  A categorical interpretation is not possible.
Reference: EUCAST

Note: A MIC with “IE� and/or a comment may be reported (without an accompanying S, I or
         R-categorization).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Er is onvoldoende bewijs dat de betreffende soort een goed doel is voor therapie met de
               medicatie. Een categorische interpretatie is niet mogelijk. Referentie: EUCA. NB: Een
               MIC met &quot;IE&quot; en/of een opmerking wordt mogelijk gerapporteerd (zonder bijbehorende
               S,"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="IE"/> 
    <display value="Insufficient evidence"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Onvoldoende bewijs"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The specified component / analyte, organism or clinical sign could neither be declared
         positive / negative or detected / not detected by the performed test or procedure.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het gespecificeerde component / analyte, organisme of klinische teken kon niet positief
               / negatief of gedetecteerd / niet-gedetecteerd door de uitgevoerde test of procedure"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="IND"/> 
    <display value="Indeterminate"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Onbepaald"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result for a quantitative observation is below the lower limit of the reference range
         (as defined for the respective test procedure).
Synonym: Below low normal">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat voor een kwalitatieve observatie is onder de ondergrens van de referentiewaarden
               (zoals gedefinieerd voor de betreffende testprocedure). Synoniem: Onder onderste normaalgrens"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="L"/> 
    <display value="Low"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Unterhalb unterer Grenze Referenzbereich"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Laag"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result for a quantitative observation is below a reference level at which immediate
         action should be considered for patient safety (as defined for the respective test procedure).
Synonym: Below lower panic limits">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="De resultaten voor een kwantitatieve observatie is onder een referentieniveau waarop onmiddellijke
               actie overwogen moet worden uit het oogpunt van patiëntveiligheid (zoals gedefinieerd
               voor betreffende testprocedure. Synoniem: Onder laagste kritieke grens"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="LL"/> 
    <display value="Critically low"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Unterhalb unterer pathologischer Grenze"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Kritiek laag"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Significantly low: A test result that is significantly lower than the reference (normal)
         or therapeutic interval, but has not reached the critically low value and might need special
         attention, as defined by the laboratory or the clinician.

Note: This level is situated between ‘L’ and ‘LL’.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Significant laag: Een testresultaat die significant lager is dan de referentie (normaal)
               of therapeutisch interval, maar nog niet op de kritiek lage waarde zit en mogelijke speciale
               aandacht nodig heeft, zoals gedefinieerd door het laboratorium of de arts. NB: T"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="LU"/> 
    <display value="Very low"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Zeer laag"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated - CLSI now only supports S, I &amp; R. This information can be found in CLSI
         document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
          Jan 2012.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen - CLSI ondersteunt nu alleen nog S, I &amp; R. Deze informatie vindt u in CLSI
               document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
                Jan 2012."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="MS"/> 
    <display value="Moderately susceptible. Indicates for microbiology susceptibilities only."/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="mäßig empfindlich"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Gemiddeld gevoelig. Alleen voor microbiologische gevoeligheid."/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The result or observation value is within the reference range or expected norm (as defined
         for the respective test procedure).
Note: Applies to numeric or non-numeric results.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het resultaat of observatiewaarde is binnen de referentiewaarden of verwachte norm (zoals
               gedefinieerd voor de betreffende testprocedure. NB: Van toepassing op numerieke of niet-numerieke
               resultaten."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="N"/> 
    <display value="Normal"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Normal (nicht numerisch)"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Normaal"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The presence of the specified component / analyte, organism or clinical sign could not
         be determined  within the limit of detection of the performed test or procedure.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="De meting van het gespecificeerde component / analyte, organisme of klinische teken kon
               niet worden gedetecteerd binnen de grenswaarde voor detectie van de uitgevoerde test of
               procedure."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="ND"/> 
    <display value="Not Detected"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Niet-gedetecteerd"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="An absence finding of the specified component / analyte, organism or clinical sign based
         on the established threshold of the performed test or procedure.
Note: Negative does not necessarily imply the complete absence of the specified item.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een afwezigheidsbevinding voor het gespecificeerde component / analyte, organisme of klinische
               teken gebaseerd op de geldende grenswaarde van de uitgevoerde test of procedure.
NB: Negatief betekent niet noodzakelijk de volledige afwezigheid van het het gespecificeerde
               item."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="NEG"/> 
    <display value="Negative"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Negatief"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="An absence finding used to indicate that the specified component / analyte did not react
         measurably with the reagent.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een afwezigheidsbevinding om aan te geven dat het gespecificeerde component / analyte
               niet meetbaar reageerde met het reagens."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="NR"/> 
    <display value="Non-reactive"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Niet-reactief"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A category used for isolates for which only a susceptible interpretive criterion has been
         designated because of the absence or rare occurrence of resistant strains. Isolates that
         have MICs above or zone diameters below the value indicated for the susceptible breakpoint
         should be reported as non-susceptible.

Synonym: decreased susceptibility

Note 1: An isolate that is interpreted as non-susceptible does not necessarily mean that
         the isolate has a resistance mechanism. It is possible that isolates with MICs above the
         susceptible breakpoint that lack resistance mechanisms may be encountered within the wild-type
         distribution subsequent to the time the susceptible-only breakpoint is set.

Note 2: For strains yielding results in the “nonsusceptible� category, organism identification
         and antimicrobial susceptibility test results should be confirmed.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een categorie voor isolaten waarvoor alleen een gevoelig interpretabel criterium is ontworpen
               vanwege de afwezigheid of zeldzaam voorkomen van resistente stammen. Isolaten met MIC's
               boven of zonediameters onder de waarde aangewezen voor de gevoeli"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="NS"/> 
    <display value="Non-susceptible"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Niet-gevoelig"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="null"/> 
    <display value="No range defined, or normal ranges don't apply"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Kein Referenzbereich / Referenzbereich nicht anwendbar"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Geen referentiewaarden gedefinieerd of normale waarden niet van toepassing"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="OBX"/> 
    <display value="Interpretation qualifiers in separate OBX segments"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Interpretatie qualifiers in afzonderlijke OBX-segmenten"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A presence finding of the specified component / analyte, organism or clinical sign based
         on the established threshold of the performed test or procedure.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een aanwezigheidsbevinding voor het gespecificeerde component / analyte, organisme of
               klinische teken gebaseerd op de geldende grenswaarde van de uitgevoerde test of procedure."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="POS"/> 
    <display value="Positive"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Positief"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="QCF"/> 
    <display value="Quality Control Failure"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Kwaliteitscontrole fout"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that
         is associated with a high likelihood of therapeutic failure.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
        Harmonized_Terminolo.htm)
Projects: ISO 20776-1, ISO 20776-2

Note 1: Bacterial strains are categorized as resistant by applying the appropriate breakpoints
         in a defined phenotypic test system.

Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes
         in commonly used drug dosages, emergence of new resistance mechanisms).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Bacteriële stam geblokkeerd door in vitro concentratie van een anti-bacteriële agens die
               is gekoppeld aan een hoge kans op therapeutisch falen. Referentie: CLSI (http://www.clsi.org/Content
              /NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmoniz"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="R"/> 
    <display value="Resistant"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Resistent"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Resistent"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A presence finding used to indicate that the specified component / analyte reacted with
         the reagent above the reliably measurable limit of the performed test.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een aanwezigheidsbevinding om aan te geven dat het gespecificeerde component / analyte
               reageerde met het reagens, boven de betrouwbaar meetbare grens van de uitgevoerde test."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="RR"/> 
    <display value="Reactive"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Reactief"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Bacterial strain inhibited by in vitro concentration of an antimicrobial agent that is
         associated with a high likelihood of therapeutic success.
Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/
        Harmonized_Terminolo.htm) 
Projects: ISO 20776-1, ISO 20776-2

Synonym (earlier term): Sensitive

Note 1: Bacterial strains are categorized as susceptible by applying the appropriate breakpoints
         in a defined phenotypic system.

Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes
         in commonly used drug dosages, emergence of new resistance mechanisms).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Bacteriële stam geblokkeerd door in vitro concentratie van een anti-bacteriële agens die
               is gekoppeld aan een hoge kans op therapeutisch succes. Referentie: CLSI (http://www.clsi.org/Conten
              t/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmoniz"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="S"/> 
    <display value="Susceptible"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Empfindlich"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Gevoelig"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A category that includes isolates with antimicrobial agent minimum inhibitory concentrations
         (MICs) that approach usually attainable blood and tissue levels and for which response
         rates may be lower than for susceptible isolates.
Reference: CLSI document M44-A2 2009 “Method for antifungal disk diffusion susceptibility
         testing of yeasts; approved guideline – second edition� – page 2.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een categorie inclusief isolaten met anti-microben agens minimum blokkerende concentraties
               (MIC's) die in de buurt van normaal bereikbare bloed en weefsel-niveau's komen en waarvoor
               antwoordratio's mogelijk lager zijn dan voor gevoelige isolaten. Referentie: CLSI document"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="SDD"/> 
    <display value="Susceptible-dose dependent"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Gevoelig dosis-afhankelijk"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A category for isolates where the bacteria (e.g. enterococci) are not susceptible in vitro
         to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent).
         This is predictive that this combination therapy will not be effective. 

Usage Note: Since the use of penicillin or ampicillin alone often results in treatment
         failure of serious enterococcal or other bacterial infections, combination therapy is
         usually indicated to enhance bactericidal activity. The synergy between a cell wall active
         agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin,
         kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance
         to the aminoglycoside.

Open Issue: The print name of the code is very general and the description is very specific
         to a pair of classes of agents, which may lead to confusion of these concepts in the future
         should other synergies be found.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een categorie voor isolaten waarbij de bacteriën (bijv. enterococcen) in vitro niet gevoelig
               zijn voor een combinatietherapie (bijv. een hoog-niveau aminoglycoside en celwand actieve
               agens). Dit is een goede indicatie dat combinatietherapie niet effectief zal zijn. Gebr"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="SYN-R"/> 
    <display value="Synergy - resistant"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Synergie - resistent"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A category for isolates where the bacteria (e.g. enterococci) are susceptible in vitro
         to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent).
         This is predictive that this combination therapy will be effective. 

Usage Note: Since the use of penicillin or ampicillin alone often results in treatment
         failure of serious enterococcal or other bacterial infections, combination therapy is
         usually indicated to enhance bactericidal activity. The synergy between a cell wall active
         agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin,
         kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance
         to the aminoglycoside.

Open Issue: The print name of the code is very general and the description is very specific
         to a pair of classes of agents, which may lead to confusion of these concepts in the future
         should other synergies be found.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een categorie voor isolaten waarbij de bacteriën (bijv. enterococcen) in vitro gevoelig
               zijn voor een combinatietherapie (bijv. een hoog-niveau aminoglycoside en celwand actieve
               agens). Dit is een goede indicatie dat combinatietherapie effectief zal zijn. Gebr"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="SYN-S"/> 
    <display value="Synergy - susceptible"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Synergie - gevoelig"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="TOX"/> 
    <display value="Cytotoxic substance present"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Cytotoxische stoffen aanwezig"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The current result has increased from the previous result for a quantitative observation
         (the change is significant as defined in the respective test procedure).">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het huidige resultaat is verhoogd ten opzichte van het vorige resultaat voor een kwantitatieve
               observatie (de wijziging is significant zoals gedefinieerd voor de betreffende testprocedure)."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="U"/> 
    <display value="Significant change up"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Deutlicher Trend nach oben"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Significante wijzging omhoog"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="Deprecated - CLSI now only supports S, I &amp; R. This information can be found in CLSI
         document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
          Jan 2012.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Vervallen - CLSI ondersteunt nu alleen nog S, I &amp; R. Deze informatie vindt u in CLSI
               document M100-S22;  Vol. 32 No.3;  CLSI Performance
Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement.
                Jan 2012."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="VS"/> 
    <display value="Very susceptible. Indicates for microbiology susceptibilities only."/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Sehr empfindlich"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Zeer gevoelig. Alleen voor microbiologische gevoeligheid."/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="The current result or observation value has degraded compared to the previous result or
         observation value (the change is significant as defined in the respective test procedure).
Note: This can be applied to quantitative or qualitative observations.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Het huidige resultaat of observatiewaarde is verslechterd ten opzichte van vorige resultaat
               of observatiewaarde (de wijziging is significant zoals gedefinieerd in de betreffende
               testprocedure). NB: van toepassing op kwantitatieve of kwalitatieve observaties"/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="W"/> 
    <display value="Worse"/> 
    <designation> 
      <language value="de"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Verschlechterung"/> 
    </designation> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Slechter"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
  <concept> 
    <extension url="http://hl7.org/fhir/StructureDefinition/codesystem-concept-comments">
      <valueString value="A weighted presence finding used to indicate that the specified component / analyte reacted
         with the reagent, but below the reliably measurable limit of the performed test.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl"/> 
          </extension> 
          <extension url="content">
            <valueString value="Een gewogen aanwezigheidsbevinding om aan te geven dat het gespecificeerde component /
               analyte reageerde met het reagens, maar onder de betrouwbaar meetbare grens van de uitgevoerde
               test."/> 
          </extension> 
        </extension> 
      </valueString> 
    </extension> 
    <code value="WR"/> 
    <display value="Weakly reactive"/> 
    <designation> 
      <language value="nl"/> 
      <use> 
        <system value="http://terminology.hl7.org/CodeSystem/designation-usage"/> 
        <code value="display"/> 
      </use> 
      <value value="Zwak reactief"/> 
    </designation> 
    <property> 
      <code value="status"/> 
      <valueCode value="deprecated"/> 
    </property> 
    <property> 
      <code value="deprecationDate"/> 
      <valueDateTime value="2015-09"/> 
    </property> 
  </concept> 
</CodeSystem>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.