RIVO-Noord Zorgviewer Implementation Guide
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RIVO-Noord Zorgviewer Implementation Guide - Local Development build (v1.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Procedure - Detailed Descriptions

Draft as of 2024-06-21

Definitions for the Procedure resource profile.

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

0. Procedure
2. Procedure.code
4. Procedure.code.text
Must Supporttrue
6. Procedure.performedPeriod
Must Supporttrue
8. Procedure.performer
10. Procedure.performer.actor
12. Procedure.performer.actor.display
Must Supporttrue
14. Procedure.location
16. Procedure.location.display
Must Supporttrue
18. Procedure.bodySite
20. Procedure.bodySite.extension
Must Supporttrue

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

0. Procedure
Definition

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.

ShortProcedureAn action that is being or was performed on a patient
Control0..*
Alternate NamesVerrichting
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
2. Procedure.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

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

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. Procedure.extension:procedureMethod
Slice NameprocedureMethod
Definition

The method used to perform this procedure.

ShortThe method used to perform the procedure
Comments

Improve definition. Add mappings.

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(method) (Extension Type: CodeableConcept)
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Procedure.extension:procedureMethod.url
Definition

Source of the definition for the extension code - a logical name or a URL.

Shortidentifies the meaning of the extension
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Control1..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://hl7.org/fhir/StructureDefinition/procedure-method
8. Procedure.extension:procedureMethod.valueCodeableConcept:valueCodeableConcept
Slice NamevalueCodeableConcept
Definition

The method or technique that was used to perform the procedure, e.g. approach, lavage, pressuring, ets.


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

ShortProcedureMethodValue of extension
Control0..1
BindingUnless not suitable, these codes SHALL be taken from For codes, see VerrichtingMethodeCodelijst
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.4--20171231000000)

VerrichtingMethodeCodelijst

TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
Alternate NamesVerrichtingMethode
10. Procedure.modifierExtension
Definition

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

ShortExtensions that cannot be ignored
Comments

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

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Alternate Namesextensions, user content
12. Procedure.basedOn
Definition

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

ShortA request for this procedure
Control0..*
TypeReference(CarePlan, ProcedureRequest, ReferralRequest)
Summarytrue
Alternate Namesfulfills
SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • type @ $this.resolve()
  • 14. Procedure.basedOn:request
    Slice Namerequest
    Definition

    The ProcedureRequest that contains the details of the request for this procedure, including the requester information located at ProcedureRequest.requester.


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

    ShortProcedureRequestA request for this procedure
    Comments

    The ProcedureRequest resource is used to capture the healthcare provider who requested the procedure as stated in the HCIM Procedure.

    Control0..*
    TypeReference(HCIM ProcedureRequest, CarePlan, ProcedureRequest, ReferralRequest)
    Summarytrue
    Alternate Namesfulfills
    16. Procedure.status
    Definition

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

    Shortpreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
    Comments

    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.

    Control1..1
    BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status
    (required to http://hl7.org/fhir/ValueSet/event-status)

    A code specifying the state of the procedure.

    Typecode
    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    18. Procedure.notDone
    Definition

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

    ShortTrue if procedure was not performed as scheduled
    Comments

    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.

    Control0..1
    Typeboolean
    Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Default Valuefalse
    20. Procedure.category
    Definition

    A code that classifies the procedure for searching, sorting and display purposes. In the Basisgegevensset Zorg (BgZ) use case, this is used to search and retrieve Surgical Procedures.


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

    ShortClassification of the procedure
    Control10..1
    BindingFor example codes, see Procedure Category Codes (SNOMED CT)http://hl7.org/fhir/ValueSet/procedure-category
    (example to http://hl7.org/fhir/ValueSet/procedure-category)

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

    TypeCodeableConcept
    Summarytrue
    Example<br/><b>Example of category code</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "387713003", "display" : "Surgical procedure" }] }
    22. Procedure.code
    Definition

    The name of the procedure.

    As of 1 January 2013, all procedures in the primary process have to be documented with CBV codes. To meet this requirement, the DHD procedure thesaurus (CBV procedures set) is used to code procedures. It is possible that in addition to the CBV procedures set, the NIC will be used for nurse procedures and that a “coded value set” will be introduced for paramedic procedures.


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

    ShortProcedureTypeIdentification of the procedure
    Control0..1
    BindingFor example codes, see Procedure Codes (SNOMED CT)http://hl7.org/fhir/ValueSet/procedure-code
    (example to http://hl7.org/fhir/ValueSet/procedure-code)

    A code to identify a specific procedure .

    TypeCodeableConcept
    Summarytrue
    Requirements

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

    Alternate Namestype, VerrichtingType
    24. Procedure.code.coding
    Definition

    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

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

    Control0..*
    TypeCoding
    Summarytrue
    Requirements

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

    SlicingThis element introduces a set of slices on Procedure.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ system
    • 26. Procedure.code.coding:VerrichtingTypeCodelijst
      Slice NameVerrichtingTypeCodelijst
      Definition

      DHD procedure thesaurus


      A reference to a code defined by a terminology system.

      ShortProcedureTypeCode defined by a terminology system
      Comments

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

      Control0..*
      BindingThe codes SHALL be taken from For codes, see VerrichtingTypeCodelijst
      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.2--20171231000000)

      The name of the procedure using the Verrichtingenthesaurus DHD.

      TypeCoding
      Summarytrue
      Requirements

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

      Alternate NamesVerrichtingType
      28. Procedure.code.coding:VerrichtingTypeCodelijst.system
      Definition

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

      ShortIdentity of the terminology system
      Comments

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

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

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

      Fixed Valuehttp://snomed.info/sct
      30. Procedure.code.text
      Definition

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

      ShortPlain text representation of the concept
      Comments

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

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

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

      32. Procedure.subject
      Definition

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

      ShortWho the procedure was performed on
      Control1..1
      TypeReference(Group, nl-core-patient, Patient)
      Summarytrue
      Alternate Namespatient
      34. Procedure.performed[x]
      Definition

      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.

      ShortDate/Period the procedure was performed
      Control0..1
      TypePeriod, dateTime
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Summarytrue
      SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 36. Procedure.performed[x]:performedPeriod
        Slice NameperformedPeriod
        Definition

        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.

        ShortDate/Period the procedure was performed
        Control0..1
        TypePeriod, dateTime
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Must Supporttrue
        Summarytrue
        38. Procedure.performer
        Definition

        The healthcare professional that carried out the procedure. The healthcare center (location) where the procedure was or is carried out.


        Limited to 'real' people rather than equipment.

        ShortHealthProfessional | Location::HealthcareProviderThe people who performed the procedure
        Comments

        Note: Procedure.location could have been used for mapping the Location::HealthcareProvider. In most anticipated cases this would lead to an empty Location resource except for Location.managingOrganization. For efficiency the mapping has thus been done here. Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

        Control0..*
        TypeBackboneElement
        Summarytrue
        Alternate NamesUitgevoerdDoor, Locatie
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
        40. Procedure.performer.modifierExtension
        Definition

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

        ShortExtensions that cannot be ignored
        Comments

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

        Control0..*
        TypeExtension
        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
        Summarytrue
        Alternate Namesextensions, user content, modifiers
        42. Procedure.performer.actor
        Definition

        The practitioner who was involved in the procedure.

        ShortThe reference to the practitioner
        Control1..1
        TypeReference(nl-core-practitioner, nl-core-organization, Practitioner, Organization, Patient, RelatedPerson, Device)
        Summarytrue
        Requirements

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

        44. Procedure.performer.actor.extension:practitionerRole
        Slice NamepractitionerRole
        Definition

        Optional Extension Element - found in all resources.

        ShortOptional Extensions Element
        Control0..1
        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
        46. Procedure.performer.actor.display
        Definition

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

        ShortText alternative for the resource
        Comments

        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        48. Procedure.location
        Definition

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

        ShortWhere the procedure happened
        Control0..1
        TypeReference(Location)
        Summarytrue
        Requirements

        Ties a procedure to where the records are likely kept.

        50. Procedure.location.display
        Definition

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

        ShortText alternative for the resource
        Comments

        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        52. Procedure.bodySite
        Definition

        Anatomical location which is the focus of the procedure.


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

        ShortProcedureAnatomicalLocationTarget body sites
        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see VerrichtingAnatomischeLocatieCodelijsthttp://hl7.org/fhir/ValueSet/body-site
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.1--20171231000000)

        Anatomical location which is the focus of the procedure.


        Codes describing anatomical locations. May include laterality.

        TypeCodeableConcept
        Summarytrue
        Alternate NamesVerrichtingAnatomischeLocatie
        54. Procedure.bodySite.extension
        Definition

        An Extension


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

        ShortExtensionAdditional Content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Must Supporttrue
        Alternate Namesextensions, user content
        SlicingThis element introduces a set of slices on Procedure.bodySite.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 56. Procedure.bodySite.extension:ProcedureLaterality
          Slice NameProcedureLaterality
          Definition

          Laterality adds information about body side to the anatomic location, e.g. left

          ShortProcedureLaterality
          Control0..1
          TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
          58. Procedure.bodySite.extension:ProcedureLaterality.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          XML FormatIn the XML format, this property is represented as an attribute.
          Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier
          60. Procedure.bodySite.extension:ProcedureLaterality.value[x]
          Definition

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

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

            Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.


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

            ShortBodySite qualifierValue of extension
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see VerrichtingLateraliteitCodelijst
            (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.3--20171231000000)

            ProcedureLateralityCodelist

            TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]

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

            0. Procedure
            Definition

            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.

            ShortProcedure
            Control0..*
            Alternate NamesVerrichting
            Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
            dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.empty())
            dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
            dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
            pro-1: Reason not done is only permitted if notDone indicator is true (notDoneReason.empty() or notDone = true)
            2. Procedure.id
            Definition

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

            ShortLogical id of this artifact
            Comments

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

            Control0..1
            Typeid
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            4. Procedure.meta
            Definition

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

            ShortMetadata about the resource
            Control0..1
            TypeMeta
            Summarytrue
            6. Procedure.implicitRules
            Definition

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

            ShortA set of rules under which this content was created
            Comments

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

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

            Control0..1
            Typeuri
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            8. Procedure.language
            Definition

            The base language in which the resource is written.

            ShortLanguage of the resource content
            Comments

            Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from Common Languages
            (extensible to http://hl7.org/fhir/ValueSet/languages)

            A human language.

            Additional BindingsPurpose
            AllLanguagesMax Binding
            Typecode
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            10. Procedure.text
            Definition

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

            ShortText summary of the resource, for human interpretation
            Comments

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

            Control0..1
            This element is affected by the following invariants: dom-1
            TypeNarrative
            Alternate Namesnarrative, html, xhtml, display
            12. Procedure.contained
            Definition

            These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

            ShortContained, inline Resources
            Comments

            This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

            Control0..*
            TypeResource
            Alternate Namesinline resources, anonymous resources, contained resources
            14. Procedure.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            SlicingThis element introduces a set of slices on Procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 16. Procedure.extension:procedureMethod
              Slice NameprocedureMethod
              Definition

              The method used to perform this procedure.

              ShortThe method used to perform the procedure
              Comments

              Improve definition. Add mappings.

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(method) (Extension Type: CodeableConcept)
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              18. Procedure.extension:procedureMethod.id
              Definition

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

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

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

              ShortAdditional Content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Alternate Namesextensions, user content
              SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 22. Procedure.extension:procedureMethod.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/procedure-method
                24. Procedure.extension:procedureMethod.valueCodeableConcept:valueCodeableConcept
                Slice NamevalueCodeableConcept
                Definition

                The method or technique that was used to perform the procedure, e.g. approach, lavage, pressuring, ets.

                ShortProcedureMethod
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from VerrichtingMethodeCodelijst
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.4--20171231000000)

                VerrichtingMethodeCodelijst

                TypeCodeableConcept
                Alternate NamesVerrichtingMethode
                26. Procedure.modifierExtension
                Definition

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

                ShortExtensions that cannot be ignored
                Comments

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

                Control0..*
                TypeExtension
                Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                Alternate Namesextensions, user content
                28. Procedure.identifier
                Definition

                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).

                ShortExternal Identifiers for this procedure
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..*
                TypeIdentifier
                Summarytrue
                Requirements

                Need to allow connection to a wider workflow.

                30. Procedure.definition
                Definition

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

                ShortInstantiates protocol or definition
                Control0..*
                TypeReference(PlanDefinition, ActivityDefinition, HealthcareService)
                Summarytrue
                32. Procedure.basedOn
                Definition

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

                ShortA request for this procedure
                Control0..*
                TypeReference(CarePlan, ProcedureRequest, ReferralRequest)
                Summarytrue
                Alternate Namesfulfills
                SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • type @ $this.resolve()
                • 34. Procedure.basedOn:request
                  Slice Namerequest
                  Definition

                  The ProcedureRequest that contains the details of the request for this procedure, including the requester information located at ProcedureRequest.requester.

                  ShortProcedureRequest
                  Comments

                  The ProcedureRequest resource is used to capture the healthcare provider who requested the procedure as stated in the HCIM Procedure.

                  Control0..*
                  TypeReference(HCIM ProcedureRequest)
                  Summarytrue
                  Alternate Namesfulfills
                  36. Procedure.partOf
                  Definition

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

                  ShortPart of referenced event
                  Comments

                  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.

                  Control0..*
                  TypeReference(Procedure, Observation, MedicationAdministration)
                  Summarytrue
                  Alternate Namescontainer
                  38. Procedure.status
                  Definition

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

                  Shortpreparation | in-progress | suspended | aborted | completed | entered-in-error | unknown
                  Comments

                  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.

                  Control1..1
                  BindingThe codes SHALL be taken from EventStatus
                  (required to http://hl7.org/fhir/ValueSet/event-status)

                  A code specifying the state of the procedure.

                  Typecode
                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  40. Procedure.notDone
                  Definition

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

                  ShortTrue if procedure was not performed as scheduled
                  Comments

                  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.

                  Control0..1
                  Typeboolean
                  Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Default Valuefalse
                  42. Procedure.notDoneReason
                  Definition

                  A code indicating why the procedure was not performed.

                  ShortReason procedure was not performed
                  Control0..1
                  This element is affected by the following invariants: pro-1
                  BindingFor example codes, see Procedure Not Performed Reason (SNOMED-CT)
                  (example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

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

                  TypeCodeableConcept
                  Summarytrue
                  44. Procedure.category
                  Definition

                  A code that classifies the procedure for searching, sorting and display purposes. In the Basisgegevensset Zorg (BgZ) use case, this is used to search and retrieve Surgical Procedures.

                  ShortClassification of the procedure
                  Control1..1
                  BindingFor example codes, see Procedure Category Codes (SNOMED CT)
                  (example to http://hl7.org/fhir/ValueSet/procedure-category)

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

                  TypeCodeableConcept
                  Summarytrue
                  Example<br/><b>Example of category code</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "387713003", "display" : "Surgical procedure" }] }
                  46. Procedure.code
                  Definition

                  The name of the procedure.

                  As of 1 January 2013, all procedures in the primary process have to be documented with CBV codes. To meet this requirement, the DHD procedure thesaurus (CBV procedures set) is used to code procedures. It is possible that in addition to the CBV procedures set, the NIC will be used for nurse procedures and that a “coded value set” will be introduced for paramedic procedures.

                  ShortProcedureType
                  Control0..1
                  BindingFor example codes, see Procedure Codes (SNOMED CT)
                  (example to http://hl7.org/fhir/ValueSet/procedure-code)

                  A code to identify a specific procedure .

                  TypeCodeableConcept
                  Summarytrue
                  Requirements

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

                  Alternate Namestype, VerrichtingType
                  48. Procedure.code.id
                  Definition

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

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

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

                  ShortAdditional Content defined by implementations
                  Comments

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

                  Control0..*
                  TypeExtension
                  Alternate Namesextensions, user content
                  SlicingThis element introduces a set of slices on Procedure.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 52. Procedure.code.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

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

                    Control0..*
                    TypeCoding
                    Summarytrue
                    Requirements

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

                    SlicingThis element introduces a set of slices on Procedure.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ system
                    • 54. Procedure.code.coding:VerrichtingTypeCodelijst
                      Slice NameVerrichtingTypeCodelijst
                      Definition

                      DHD procedure thesaurus

                      ShortProcedureType
                      Comments

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

                      Control0..*
                      BindingThe codes SHALL be taken from VerrichtingTypeCodelijst
                      (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.2--20171231000000)

                      The name of the procedure using the Verrichtingenthesaurus DHD.

                      TypeCoding
                      Summarytrue
                      Requirements

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

                      Alternate NamesVerrichtingType
                      56. Procedure.code.coding:VerrichtingTypeCodelijst.id
                      Definition

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

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

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

                      ShortAdditional Content defined by implementations
                      Comments

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

                      Control0..*
                      TypeExtension
                      Alternate Namesextensions, user content
                      SlicingThis element introduces a set of slices on Procedure.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 60. Procedure.code.coding:VerrichtingTypeCodelijst.system
                        Definition

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

                        ShortIdentity of the terminology system
                        Comments

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

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

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

                        Fixed Valuehttp://snomed.info/sct
                        62. Procedure.code.coding:VerrichtingTypeCodelijst.version
                        Definition

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

                        ShortVersion of the system - if relevant
                        Comments

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

                        NoteThis is a business version Id, not a resource version Id (see discussion)
                        Control0..1
                        Typestring
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        64. Procedure.code.coding:VerrichtingTypeCodelijst.code
                        Definition

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

                        ShortSymbol in syntax defined by the system
                        Control0..1
                        Typecode
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summarytrue
                        Requirements

                        Need to refer to a particular code in the system.

                        66. Procedure.code.coding:VerrichtingTypeCodelijst.display
                        Definition

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

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

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

                        68. Procedure.code.coding:VerrichtingTypeCodelijst.userSelected
                        Definition

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

                        ShortIf this coding was chosen directly by the user
                        Comments

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

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

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

                        70. Procedure.code.text
                        Definition

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

                        ShortPlain text representation of the concept
                        Comments

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

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

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

                        72. Procedure.subject
                        Definition

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

                        ShortWho the procedure was performed on
                        Control1..1
                        TypeReference(Group, nl-core-patient)
                        Summarytrue
                        Alternate Namespatient
                        74. Procedure.context
                        Definition

                        The encounter during which the procedure was performed.

                        ShortEncounter or episode associated with the procedure
                        Control0..1
                        TypeReference(Encounter, EpisodeOfCare)
                        Summarytrue
                        Alternate Namesencounter
                        76. Procedure.performed[x]
                        Definition

                        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.

                        ShortDate/Period the procedure was performed
                        Control0..1
                        TypePeriod
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Summarytrue
                        SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 78. Procedure.performed[x]:performedPeriod
                          Slice NameperformedPeriod
                          Definition

                          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.

                          ShortDate/Period the procedure was performed
                          Control0..1
                          TypePeriod
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Must Supporttrue
                          Summarytrue
                          80. Procedure.performed[x]:performedPeriod.id
                          Definition

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

                          Shortxml:id (or equivalent in JSON)
                          Control0..1
                          Typestring
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          82. Procedure.performed[x]:performedPeriod.extension
                          Definition

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

                          ShortAdditional Content defined by implementations
                          Comments

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

                          Control0..*
                          TypeExtension
                          Alternate Namesextensions, user content
                          SlicingThis element introduces a set of slices on Procedure.performed[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 84. Procedure.performed[x]:performedPeriod.start
                            Definition

                            The start date (and if possible start time) of the procedure. A ‘vague’ date, such as only the year, is permitted. The element offers the option to indicate the start of the period of a series of related procedures.

                            ShortProcedureStartDate
                            Comments

                            If the low element is missing, the meaning is that the low boundary is not known.

                            Control0..1
                            This element is affected by the following invariants: per-1
                            TypedateTime
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Alternate NamesVerrichtingStartDatum
                            86. Procedure.performed[x]:performedPeriod.end
                            Definition

                            The end date (and if possible end time) of the procedure. A ‘vague’ date, such as only the year, is permitted. The element offers the option to indicate the end of the period of a series of related procedures.

                            ShortProcedureEndDate
                            Comments

                            The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

                            Control0..1
                            This element is affected by the following invariants: per-1
                            TypedateTime
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Alternate NamesVerrichtingEindDatum
                            Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                            88. Procedure.performer
                            Definition

                            The healthcare professional that carried out the procedure. The healthcare center (location) where the procedure was or is carried out.

                            ShortHealthProfessional | Location::HealthcareProvider
                            Comments

                            Note: Procedure.location could have been used for mapping the Location::HealthcareProvider. In most anticipated cases this would lead to an empty Location resource except for Location.managingOrganization. For efficiency the mapping has thus been done here. Should a Location::HealthcareProvider with an OrganizationLocation be targeted, then this may be solved using Organization.name 'OrganizationLocation' + Organization.partOf 'HealthcareProvider'

                            Control0..*
                            TypeBackboneElement
                            Summarytrue
                            Alternate NamesUitgevoerdDoor, Locatie
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                            90. Procedure.performer.id
                            Definition

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

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

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

                            ShortAdditional Content defined by implementations
                            Comments

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

                            Control0..*
                            TypeExtension
                            Alternate Namesextensions, user content
                            94. Procedure.performer.modifierExtension
                            Definition

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

                            ShortExtensions that cannot be ignored
                            Comments

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

                            Control0..*
                            TypeExtension
                            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                            Summarytrue
                            Alternate Namesextensions, user content, modifiers
                            96. Procedure.performer.role
                            Definition

                            For example: surgeon, anaethetist, endoscopist.

                            ShortThe role the actor was in
                            Control0..1
                            BindingFor example codes, see Procedure Performer Role Codes
                            (example to http://hl7.org/fhir/ValueSet/performer-role)

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

                            TypeCodeableConcept
                            Summarytrue
                            98. Procedure.performer.role.id
                            Definition

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

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

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

                            ShortAdditional Content defined by implementations
                            Comments

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

                            Control0..*
                            TypeExtension
                            Alternate Namesextensions, user content
                            SlicingThis element introduces a set of slices on Procedure.performer.role.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 102. Procedure.performer.role.coding
                              Definition

                              A reference to a code defined by a terminology system.

                              ShortCode defined by a terminology system
                              Comments

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

                              Control0..*
                              TypeCoding
                              Summarytrue
                              Requirements

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

                              SlicingThis element introduces a set of slices on Procedure.performer.role.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ $this
                              • 104. Procedure.performer.role.coding:healthProfessionalRole
                                Slice NamehealthProfessionalRole
                                Definition

                                The role the healthcare provider fulfils in the healthcare process. For healthcare providers, this could be for example main practitioner, referrer or general practitioner.

                                ShortHealthProfessionalRole
                                Comments

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

                                Control0..*
                                BindingThe codes SHALL be taken from ZorgverlenerRolCodelijst
                                (required to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.17.1.5--20171231000000)
                                TypeCoding
                                Summarytrue
                                Requirements

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

                                Alternate NamesZorgverlenerRol
                                106. Procedure.performer.role.text
                                Definition

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

                                ShortPlain text representation of the concept
                                Comments

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

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

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

                                108. Procedure.performer.actor
                                Definition

                                The practitioner who was involved in the procedure.

                                ShortThe reference to the practitioner
                                Control1..1
                                TypeReference(nl-core-practitioner, nl-core-organization)
                                Summarytrue
                                Requirements

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

                                110. Procedure.performer.actor.id
                                Definition

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

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

                                An Extension

                                ShortExtension
                                Control0..*
                                TypeExtension
                                SlicingThis element introduces a set of slices on Procedure.performer.actor.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 114. Procedure.performer.actor.extension:practitionerRole
                                  Slice NamepractitionerRole
                                  Definition

                                  Optional Extension Element - found in all resources.

                                  ShortOptional Extensions Element
                                  Control0..1
                                  TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                  116. Procedure.performer.actor.reference
                                  Definition

                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                  ShortLiteral reference, Relative, internal or absolute URL
                                  Comments

                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                  Control0..1
                                  This element is affected by the following invariants: ref-1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summarytrue
                                  118. Procedure.performer.actor.identifier
                                  Definition

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

                                  ShortLogical reference, when literal reference is not known
                                  Comments

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

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

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

                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control0..1
                                  TypeIdentifier
                                  Summarytrue
                                  120. Procedure.performer.actor.display
                                  Definition

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

                                  ShortText alternative for the resource
                                  Comments

                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                  Control0..1
                                  Typestring
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Summarytrue
                                  122. Procedure.performer.onBehalfOf
                                  Definition

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

                                  ShortOrganization the device or practitioner was acting for
                                  Control0..1
                                  TypeReference(Organization)
                                  Requirements

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

                                  124. Procedure.location
                                  Definition

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

                                  ShortWhere the procedure happened
                                  Control0..1
                                  TypeReference(Location)
                                  Summarytrue
                                  Requirements

                                  Ties a procedure to where the records are likely kept.

                                  126. Procedure.location.id
                                  Definition

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

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

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

                                  ShortAdditional Content defined by implementations
                                  Comments

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

                                  Control0..*
                                  TypeExtension
                                  Alternate Namesextensions, user content
                                  SlicingThis element introduces a set of slices on Procedure.location.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 130. Procedure.location.reference
                                    Definition

                                    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                    ShortLiteral reference, Relative, internal or absolute URL
                                    Comments

                                    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                    Control0..1
                                    This element is affected by the following invariants: ref-1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    132. Procedure.location.identifier
                                    Definition

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

                                    ShortLogical reference, when literal reference is not known
                                    Comments

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

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

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

                                    NoteThis is a business identifier, not a resource identifier (see discussion)
                                    Control0..1
                                    TypeIdentifier
                                    Summarytrue
                                    134. Procedure.location.display
                                    Definition

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

                                    ShortText alternative for the resource
                                    Comments

                                    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                    Control0..1
                                    Typestring
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    136. Procedure.reasonCode
                                    Definition

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

                                    ShortCoded reason procedure performed
                                    Control0..*
                                    BindingFor example codes, see Procedure Reason Codes
                                    (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                                    A code that identifies the reason a procedure is required.

                                    TypeCodeableConcept
                                    Summarytrue
                                    138. Procedure.reasonReference
                                    Definition

                                    The indication is the reason for the procedure.

                                    ShortIndication
                                    Comments

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

                                    Control0..*
                                    TypeReference(HCIM Problem)
                                    Summarytrue
                                    Alternate NamesIndicatie
                                    140. Procedure.bodySite
                                    Definition

                                    Anatomical location which is the focus of the procedure.

                                    ShortProcedureAnatomicalLocation
                                    Control0..*
                                    BindingUnless not suitable, these codes SHALL be taken from VerrichtingAnatomischeLocatieCodelijst
                                    (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.1--20171231000000)

                                    Anatomical location which is the focus of the procedure.

                                    TypeCodeableConcept
                                    Summarytrue
                                    Alternate NamesVerrichtingAnatomischeLocatie
                                    142. Procedure.bodySite.id
                                    Definition

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

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

                                    An Extension

                                    ShortExtension
                                    Control0..*
                                    TypeExtension
                                    Must Supporttrue
                                    SlicingThis element introduces a set of slices on Procedure.bodySite.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 146. Procedure.bodySite.extension:ProcedureLaterality
                                      Slice NameProcedureLaterality
                                      Definition

                                      Laterality adds information about body side to the anatomic location, e.g. left

                                      ShortProcedureLaterality
                                      Control0..1
                                      TypeExtension(BodySite Qualifier) (Extension Type: CodeableConcept)
                                      148. Procedure.bodySite.extension:ProcedureLaterality.id
                                      Definition

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

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

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

                                      ShortAdditional Content defined by implementations
                                      Comments

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

                                      Control0..*
                                      TypeExtension
                                      Alternate Namesextensions, user content
                                      SlicingThis element introduces a set of slices on Procedure.bodySite.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 152. Procedure.bodySite.extension:ProcedureLaterality.url
                                        Definition

                                        Source of the definition for the extension code - a logical name or a URL.

                                        Shortidentifies the meaning of the extension
                                        Comments

                                        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                        Control1..1
                                        Typeuri
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Fixed Valuehttp://nictiz.nl/fhir/StructureDefinition/BodySite-Qualifier
                                        154. Procedure.bodySite.extension:ProcedureLaterality.value[x]
                                        Definition

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

                                        ShortValue of extension
                                        Control0..1
                                        TypeCodeableConcept
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        SlicingThis element introduces a set of slices on Procedure.bodySite.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                        • type @ $this
                                        • 156. Procedure.bodySite.extension:ProcedureLaterality.value[x]:valueCodeableConcept
                                          Slice NamevalueCodeableConcept
                                          Definition

                                          Qualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.

                                          ShortBodySite qualifier
                                          Control0..1
                                          BindingUnless not suitable, these codes SHALL be taken from VerrichtingLateraliteitCodelijst
                                          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.14.1.3--20171231000000)

                                          ProcedureLateralityCodelist

                                          TypeCodeableConcept
                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                          158. Procedure.bodySite.coding
                                          Definition

                                          A reference to a code defined by a terminology system.

                                          ShortCode defined by a terminology system
                                          Comments

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

                                          Control0..*
                                          TypeCoding
                                          Summarytrue
                                          Requirements

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

                                          160. Procedure.bodySite.text
                                          Definition

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

                                          ShortPlain text representation of the concept
                                          Comments

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

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

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

                                          162. Procedure.outcome
                                          Definition

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

                                          ShortThe result of procedure
                                          Comments

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

                                          Control0..1
                                          BindingFor example codes, see Procedure Outcome Codes (SNOMED CT)
                                          (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

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

                                          TypeCodeableConcept
                                          Summarytrue
                                          164. Procedure.report
                                          Definition

                                          Any report resulting from the procedure.

                                          ShortAny report resulting from the procedure
                                          Comments

                                          Note that the HCIM TextResultForTransfer-v1.2 has this relationship reversed, so the relationship goes from report to procedure.

                                          Control0..*
                                          TypeReference(HCIM TextResult)
                                          166. Procedure.complication
                                          Definition

                                          Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.

                                          ShortComplication following the procedure
                                          Comments

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

                                          Control0..*
                                          BindingFor example codes, see Condition/Problem/Diagnosis Codes
                                          (example to http://hl7.org/fhir/ValueSet/condition-code)

                                          Codes describing complications that resulted from a procedure.

                                          TypeCodeableConcept
                                          168. Procedure.complicationDetail
                                          Definition

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

                                          ShortA condition that is a result of the procedure
                                          Control0..*
                                          TypeReference(Condition)
                                          Requirements

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

                                          170. Procedure.followUp
                                          Definition

                                          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.

                                          ShortInstructions for follow up
                                          Control0..*
                                          BindingFor example codes, see Procedure Follow up Codes (SNOMED CT)
                                          (example to http://hl7.org/fhir/ValueSet/procedure-followup)

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

                                          TypeCodeableConcept
                                          172. Procedure.note
                                          Definition

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

                                          ShortAdditional information about the procedure
                                          Control0..*
                                          TypeAnnotation
                                          174. Procedure.focalDevice
                                          Definition

                                          A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

                                          ShortDevice changed in procedure
                                          Control0..*
                                          TypeBackboneElement
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                          176. Procedure.focalDevice.id
                                          Definition

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

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

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

                                          ShortAdditional Content defined by implementations
                                          Comments

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

                                          Control0..*
                                          TypeExtension
                                          Alternate Namesextensions, user content
                                          180. Procedure.focalDevice.modifierExtension
                                          Definition

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

                                          ShortExtensions that cannot be ignored
                                          Comments

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

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                          Summarytrue
                                          Alternate Namesextensions, user content, modifiers
                                          182. Procedure.focalDevice.action
                                          Definition

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

                                          ShortKind of change to device
                                          Control0..1
                                          BindingThe codes SHOULD be taken from Procedure Device Action Codes
                                          (preferred to http://hl7.org/fhir/ValueSet/device-action)

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

                                          TypeCodeableConcept
                                          184. Procedure.focalDevice.manipulated
                                          Definition

                                          The product, the placing of which in or on the body is the purpose of the procedure, for example placing an implant.

                                          ShortMedicalDevice
                                          Control1..1
                                          TypeReference(HCIM MedicalDevice Product)
                                          Alternate NamesMedischHulpmiddel
                                          186. Procedure.usedReference
                                          Definition

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

                                          ShortItems used during procedure
                                          Comments

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

                                          Control0..*
                                          TypeReference(Device, Medication, Substance)
                                          Requirements

                                          Used for tracking contamination, etc.

                                          188. Procedure.usedCode
                                          Definition

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

                                          ShortCoded items used during the procedure
                                          Comments

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

                                          Control0..*
                                          BindingFor example codes, see FHIR Device Types
                                          (example to http://hl7.org/fhir/ValueSet/device-kind)

                                          Codes describing items used during a procedure

                                          TypeCodeableConcept