sofern für den Angehörigen mindestens ein Vor- und Nachname angegeben wurde.
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wenn die Ressource einen Narrative enthält und in den Metadaten die Canonical-URL des KBV-Profile angegeben wird
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Motivation
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Der Angehörige wird vor allem im Zusammenhang mit Anwendungsszenarien verwendet, in denen das Versicherungsverhältnis eine Rolle spielt. Hier können Angehörige, bspw. der hauptversicherte Elternteil eines minderjährigen Kindes, in der Familienversicherung sein. In Selbstzahler-Szenarien können Angehörige die Zahler für eine im Krankenhaus erbrachte Leistung sein.
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A person that is related to a patient, but who is not a direct target of care
Definition
Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
relatedp-de-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
There are no (further) constraints on this element
Element id
RelatedPerson.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
RelatedPerson.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
RelatedPerson.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
RelatedPerson.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
RelatedPerson.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.identifier
Short description
A human identifier for this person
Definition
Identifier for a person within a particular scope.
+
Requirements
People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
RelatedPerson.patient
Short description
The patient this person is related to
Definition
The patient this person is related to.
+
Requirements
We need to know which patient this RelatedPerson is related to.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: PID-3
rim: scoper[classCode=PSN|ANM and determinerCode='INSTANCE']/playedRole[classCode='PAT']/id
There are no (further) constraints on this element
Element id
RelatedPerson.patient.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
RelatedPerson.patient.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.relationship
Short description
The nature of the relationship
Definition
The nature of the relationship between a patient and the related person.
+
Requirements
We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Related persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
RelatedPerson.telecom
Short description
A contact detail for the person
Definition
A contact detail for the person, e.g. a telephone number or an email address.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
RelatedPerson.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
Address where the related person can be contacted or visited
Definition
Address where the related person can be contacted or visited.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
RelatedPerson.photo
Short description
Image of the person
Definition
Image of the person.
+
Requirements
Many EHR systems have the capability to capture an image of persons. Fits with newer social media usage too.
+
Comments
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
There are no (further) constraints on this element
Element id
RelatedPerson.period
Short description
Period of time that this relationship is considered valid
Definition
The period of time during which this relationship is or was active. If there are no dates defined, then the interval is unknown.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
RelatedPerson.communication
Short description
A language which may be used to communicate with about the patient's health
Definition
A language which may be used to communicate with about the patient's health.
+
Requirements
If a related person does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.
+
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.language
Short description
The language which can be used to communicate with the patient about his or her health
Definition
The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
+
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
+
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
+
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
+
Comments
This language is specifically identified for communicating healthcare information.
Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden
gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
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Anmerkungen zu den Must-Support-Feldern
+
Composition.id
+
Bedeutung: Subsystem-interne Datensatz-ID
+
Composition.profile
+
Bedeutung: Erklärung zur Konformität zum ISiK-Profil
+
Composition.text
+
Bedeutung: menschenlesbare Repräsentation des Dokumentenkopfes (Metadaten)
+
Hinweise: Die Mindestanforderungen an den Inhalt der menschenlesbaren Repräsentation umfasst folgende Informationen:
+
+
Composition.subject:Patient.name.family
+
Composition.subject:Patient.birthDate
+
Composition.subject:Patient.identifier:pid
+
Composition.status
+
Composition.type.text
+
Composition.date
+
Composition.title
+
Composition.author.display
+
+
Composition.identifier
+
Bedeutung: Subsystem-seitig zugewiesener Identifier des Berichtes mit Angabe der URL des vom Subsystem verwendeten Namensraumes
+
Hinweise: Werden eigene Identifier bzw. NamingSystems verwendet, so sei auf den Leitfaden der Basisprofile Deutschland (HL7 Deutschland) zu den Best-Practices bei Namensräumen verwiesen.
+
Dazu ein Beispiel für einen Identifier eines Sub-System-Berichts:
Hinweise: In der aktuellen Ausbaustufe von ISiK ist textuelle Repräsentation des Dokumenttyps (type.text) ausreichend. Die darüber hinausgehende Codierung des Dokumenttyps (z.B. mit LOINC, IHE-Typecodes oder KDL) in type.coding KANN implementiert werden
+
Composition.subject
+
Bedeutung: Patientenbezug des Dokumentes
+
Composition.context
+
Bedeutung: Fallbezug des Dokumentes
+
Composition.date
+
Bedeutung: Datum der letzten Änderung am Dokument
+
Composition.author.display
+
Bedeutung: Autor des Dokumentes (Person, Subsystem)
+
Hinweise: In der aktuellen Ausbaustufe von ISiK ist die Verwendung der textuellen Repräsentation (display) von Autor und Subsystem ausreichend. Die darüber hinaus gehende Verlinkung auf Practitioner bzw. Device-Ressourcen KANN implementiert werden.
+
Composition.title
+
Bedeutung: Dokumentenbezeichnung
+
Hinweise: Die Dokumentenbezeichnung dient der Darstellung des Dokumentes in einer Übersicht, z.B. in einer Patientenakte, und KANN der schnellen Auffindbarkeit eines gesuchten Dokumentes dienen. Geeignete Bezeichnungen sind zum Beispiel
+
+
"Kleines Blutbild vom 13.10.2020"
+
"Pathologiebefund (Abstrich) vom 13.10.2020"
+
"Blutgasmessung vom 13.10.2020 14:14h"
+
+
Composition.section.title
+
Bedeutung: Kapitelüberschrift
+
Composition.section.text
+
Bedeutung: menschenlesbare Repräsentation des Inhalts eines Kapitels
+
Hinweise: Für Aggregation einer vollständigen menschenlesbaren Repräsentation MÜSSEN die Repräsentationen der einzelnen Kapitel an die Repräsentation der Metadaten (Composition.text) angehängt werden. Für die Separierung KÖNNEN einfache <div>-Tags verwendet werden.
+Es ist zu beachten, dass Kapitel auch Unterkapitel enthalten KÖNNEN (Composition.section.section), die bei der Aggregation entsprechend berücksichtigt werden MÜSSEN.
+
Die Mindestanforderungen an den Inhalt der menschenlesbaren Repräsentation umfasst folgende Informationen:
+
+
section.title + Freitext oder
+
section.title + Resource.text der referenzierten Ressource oder
+
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Das Bundle dient der Aggregation aller Ressourcen, die Bestandteil des Dokumentes sind. Dabei ist die erste Ressource im Bundle (Bundle.entry.resource) stets eine Composition, alle weiteren entries enthalten zusätzliche Ressourcen, auf die die Composition verweist.
+
Falls die Referenz auf die in der Composition enthaltenen Patienten und/oder Encounter nicht auflösbar ist, MUSS als Antwort der HTTP Status Code "422 - Unprocessable Entity" zurückgegeben werden. Im Body der Response ist eine OperationOutcome zurückzugeben, welche ein Issue mit dem Verweis auf die nicht auflösbare Referenz enthält. Zur Kodierung von OperationOutcome.issue.code MUSS als Code "processing" verwendet werden.
bdl-7: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) (type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
bdl-9: A document must have an identifier with a system and a value type = 'document' implies (identifier.system.exists() and identifier.value.exists())
bdl-3: entry.request mandatory for batch/transaction/history, otherwise prohibited entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
bdl-4: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
bdl-12: A message must have a MessageHeader as the first resource type = 'message' implies entry.first().resource.is(MessageHeader)
bdl-1: total only when a search or history total.empty() or (type = 'searchset') or (type = 'history')
bdl-2: entry.search only when a search entry.search.empty() or (type = 'searchset')
bdl-11: A document must have a Composition as the first resource type = 'document' implies entry.first().resource.is(Composition)
bdl-10: A document must have a date type = 'document' implies (timestamp.hasValue())
ISiK-docBundle-1: All referenced Resources must be contained in the Bundle Bundle.entry.descendants().reference.distinct().subsetOf(%context.entry.fullUrl)
There are no (further) constraints on this element
Element id
Bundle.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Bundle.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Bundle.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Bundle.identifier
Short description
Persistent identifier for the bundle
Definition
A persistent identifier for the bundle that won't change as a bundle is copied from server to server.
+
Comments
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Indicates the purpose of this bundle - how it is intended to be used.
+
Comments
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
There are no (further) constraints on this element
Element id
Bundle.timestamp
Short description
When the bundle was assembled
Definition
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
+
Comments
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated.
+
Usage:
+
+
document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time
+
message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message
+
history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates
+
searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query
+
transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning
+
+
The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
There are no (further) constraints on this element
Element id
Bundle.total
Short description
If search, the total number of matches
Definition
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
+
Comments
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
There are no (further) constraints on this element
Element id
Bundle.link
Short description
Links related to this Bundle
Definition
A series of links that provide context to this bundle.
+
Comments
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. HATEOAS).
+
Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was read directly.
+
This specification defines some specific uses of Bundle.link for searching and paging, but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
There are no (further) constraints on this element
Element id
Bundle.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.fullUrl
Short description
URI for resource (Absolute URL server address or URI for UUID/OID)
Definition
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that:
+
+
fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle)
+
Results from operations might involve resources that are not identified.
+
+
Comments
fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.
+
Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
There are no (further) constraints on this element
Element id
Bundle.entry.request
Short description
Additional execution information (transaction/batch/history)
Definition
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
There are no (further) constraints on this element
Element id
Bundle.entry.response
Short description
Results of execution (transaction/batch/history)
Definition
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.fullUrl
Short description
URI for resource (Absolute URL server address or URI for UUID/OID)
Definition
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that:
+
+
fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle)
+
Results from operations might involve resources that are not identified.
+
+
Comments
fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.
+
Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
A set of resources composed into a single coherent clinical statement with clinical attestation
Definition
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
+
Comments
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
cda: ClinicalDocument
fhirdocumentreference: when described by DocumentReference
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.mode
Short description
match | include | outcome - why this is in the result set
Definition
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
+
Comments
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.score
Short description
Search ranking (between 0 and 1)
Definition
When searching, the server's search ranking score for the entry.
+
Comments
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order.
+
See Patient Match for the EMPI search which relates to this element.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request
Short description
Additional execution information (transaction/batch/history)
Definition
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.url
Short description
URL for HTTP equivalent of this entry
Definition
The URL for this entry, relative to the root (the address to which the request is posted).
+
Comments
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.ifModifiedSince
Short description
For managing cache currency
Definition
Only perform the operation if the last updated date matches. See the API documentation for "Conditional Read".
+
Comments
Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.ifNoneExist
Short description
For conditional creates
Definition
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for "Conditional Create". This is just the query portion of the URL - what follows the "?" (not including the "?").
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response
Short description
Results of execution (transaction/batch/history)
Definition
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.status
Short description
Status response code (text optional)
Definition
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.outcome
Short description
OperationOutcome with hints and warnings (for batch/transaction)
Definition
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
+
Comments
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned.
+
This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
There are no (further) constraints on this element
Element id
Bundle.signature
Short description
Digital Signature
Definition
Digital Signature - base64 encoded. XML-DSig or a JWT.
+
Requirements
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.
+
Comments
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
rim: N/A
+
Verarbeitung des Dokumentes
+
In der aktuellen Ausbaustufe von ISiK MUSS ein empfangenes Dokument in folgenden Schritten verarbeitet werden:
+
+
Extraktion der Patient-Ressource aus dem Bundle und Herstellung des Patientenbezuges anhand der Aufnahmenummer ('Patient.identifier')
+
Extraktion der Encounter.Ressource aus dem Bundle und Herstellung des Fallbezuges anhand der Aufnahmenummer ('Encounter.identifier')
+
Extraktion der Composition-Ressource aus dem Bundle und Auslesen der mit 'mustSupport' gekennzeichneten Meta-Daten, sowie der menschenlesbaren Repräsentation des Dokumentes ('Composition.text' + 'Composition.section.text')
+
Hinzufügen des Dokumentes und seiner Metadaten zur Fallakte des Patienten
+
Visualisierung des Dokumentes und seiner Metadaten in der Fallakte des Patienten
+
+
+
+
+
+Die Grafik zeigt an einem vereinfachten Beispiel die Zuordnung des HTML-Dokumentes zu Patient und Kontakt in der aktuellen Ausbaustufe von ISiK (schwarze Pfeile). Die grauen Pfeile deuten die Übernahme strukturierter Daten, wie sie in weiteren Ausbaustufen erforderlich wird.
+
Hinweise zum Umgang mit der menschenlesbaren Repräsentation
+
Die menschenlesbare Repräsentation ("Narrative") eines Dokumentes setzt sich zusammen aus dem Inhalt von 'Composition.text', einer Repräsentation der Metadaten (z.B. Dokumenttyp, Patientenname, Patientennummer, Aufnahmenummer, datum) sowie der Aggregation der Inhalte von 'Composition.section', wobei zu beachten ist, dass ein Dokument beliebig viele Sections haben kann.
+Die einzelnen Bestandteile des Narratives KÖNNEN mit <div>-Elementen zusammengefügt werden.
+
Hinweise zum Umgang mit strukturierten Daten
+
Auch wenn in der aktuellen Stufe nur die Übernahme der menschenlesbaren Repräsentation erforderlich ist, empfiehlt es sich dennoch, das vollständige Bundle samt der strukturierten Anteile zu einem Dokument zu persistieren, so dass zu einem späteren Zeitpunkt, wenn eine Übernahme einzelner Daten möglich ist, diese auch rückwirkend erfolgen kann.
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+ Implementierungsleitfaden ISiK-Basismodul
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Motivation
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In der heterogenen Systemlandschaft im Krankenhaus sind eine Vielzahl spezialisierter Subsysteme im Einsatz. Die Ergebnisse aus diesen Subsystemen sind aktuell jedoch häufig nicht in den Primärsystemen des Krankenhauses verfügbar, denn aktuell bestehen noch folgende Herausforderungen:
+
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Die Daten in Subsystemen sind sehr heterogen und können hochspezialisiert sein.
+
Bei der Nutzung dieser Subsysteme besteht häufig ein Interesse, auf die menschenlesbare Repräsentation der strukturierten Daten einwirken zu können.
+
Künftig ist mit Szenarien zu rechnen, bei denen Befunde aus Subsystemen in eine elektronische Patientenakte übertragen werden sollen.
+
Aktuell werden Befunde, obwohl sie in den Subsystemen in hochstrukturierter Form vorliegen, nur als PDF an das Primärsystem zurückübermittelt. Oft weil kein strukturiertes Format spezifiziert ist, das sowohl versendendes Subsystem als auch empfangendes Primärsystem implementiert haben.
+
Der Umfang, in dem eine Datenübernahme in ein Primärsystem möglich ist, variiert stark zwischen den Systemen oder Installationen, z.B. abhängig davon, ob ein Modul für Vitalparameter installiert ist.
+
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Die ISiK-Spezifikation begegnet diesen Herausforderungen, indem sie die Rückübermittlung von Ergebnissen aus Subsystemen an die Primärsysteme in Form von strukturierten Dokumenten erfordert, die über eine menschenlesbare Repräsentation verfügen. Diese strukturierten Dokumente werden im ISiK-Kontext als Berichte bezeichnet. Dabei sind die strukturierten Inhalte der Berichte harmonisiert mit den verbreiteten Formaten für Primärsysteme.
+
In der aktuellen Ausbaustufe von ISiK ist lediglich die Übernahme und Anzeige der Dokument-Metadaten (z.B. Dokumenttyp, Dokumentdatum, Quelle) und der menschenlesbaren HTML-Repräsentation in die Primärsysteme erforderlich.
+
In weiteren Ausbaustufen von ISiK soll darüber hinaus eine Übernahme der strukturierten Anteile der Dokumente möglich sein, die den ISiK-Spezifikationen entsprechen, z.B. Diagnosen und Prozeduren.
+
Es obliegt dabei dem Ermessen des Herstellers, ob die Übernahme strukturierter Daten in das Primärsystem automatisch erfolgt, oder durch den Benutzer initiiert wird.
There are no (further) constraints on this element
Element id
Composition
Short description
A set of resources composed into a single coherent clinical statement with clinical attestation
Definition
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
+
Comments
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
cda: ClinicalDocument
fhirdocumentreference: when described by DocumentReference
There are no (further) constraints on this element
Element id
Composition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Composition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Composition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Composition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
There are no (further) constraints on this element
Element id
Composition.text.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.text.div
Short description
Limited xhtml content
Definition
The actual narrative content, a stripped down version of XHTML.
+
Comments
The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2: The narrative SHALL have some non-whitespace content htmlChecks()
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.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Composition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.identifier.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.identifier.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Composition.identifier.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Composition.identifier.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Composition.identifier.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Composition.identifier.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.
+
Requirements
Need to be able to mark interim, amended, or withdrawn compositions or documents.
+
Comments
If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.
+
Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Fixed value
final
Mappings
rim: n/a
workflow: Event.status
w5: FiveWs.status
rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
There are no (further) constraints on this element
Element id
Composition.type
Short description
Kind of composition (LOINC if possible)
Definition
Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.
+
Requirements
Key metadata element describing the composition, used in searching/filtering.
+
Comments
For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
There are no (further) constraints on this element
Element id
Composition.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Composition.category
Short description
Categorization of Composition
Definition
A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.
+
Requirements
Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.
There are no (further) constraints on this element
Element id
Composition.category.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).
+
Requirements
Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.
+
Comments
For clinical documents, this is usually the patient.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter
Short description
Context of the Composition
Definition
Describes the clinical encounter or type of care this documentation is associated with.
+
Requirements
Provides context for the composition and supports searching.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.context
w5: FiveWs.context
rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
There are no (further) constraints on this element
Element id
Composition.encounter.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.encounter.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.encounter.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.date
Short description
Composition editing time
Definition
The composition editing time, when the composition was last logically changed by the author.
+
Requirements
dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.
+
Comments
The Last Modified Date on the composition may be after the date of the document was attested without being changed.
Identifies who is responsible for the information in the composition, not necessarily who typed it in.
+
Requirements
Identifies who is responsible for the content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.author.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.author.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.author.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.author.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.author.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.title
Short description
Human Readable name/title
Definition
Official human-readable label for the composition.
+
Comments
For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
There are no (further) constraints on this element
Element id
Composition.confidentiality
Short description
As defined by affinity domain
Definition
The code specifying the level of confidentiality of the Composition.
+
Comments
The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
There are no (further) constraints on this element
Element id
Composition.attester.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.attester.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.attester.party
Short description
Who attested the composition
Definition
Who attested the composition in the specified way.
+
Requirements
Identifies who has taken on the responsibility for accuracy of the composition content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.witness
rim: ./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
There are no (further) constraints on this element
Element id
Composition.custodian
Short description
Organization which maintains the composition
Definition
Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.
+
Requirements
Identifies where to go to find the current version, where to report issues, etc.
+
Comments
This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
There are no (further) constraints on this element
Element id
Composition.relatesTo.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.relatesTo.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.code
Short description
Code(s) that apply to the event being documented
Definition
This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
+
Comments
An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
There are no (further) constraints on this element
Element id
Composition.event.period
Short description
The period covered by the documentation
Definition
The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Composition.event.detail
Short description
The event(s) being documented
Definition
The description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.section.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.section.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.section.title
Short description
Label for section (e.g. for ToC)
Alternate names
header, label, caption
Definition
The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.
+
Requirements
Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.
+
Comments
The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
There are no (further) constraints on this element
Element id
Composition.section.code
Short description
Classification of section (recommended)
Definition
A code identifying the kind of content contained within the section. This must be consistent with the section title.
+
Requirements
Provides computable standardized labels to topics within the document.
+
Comments
The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.
+
If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
There are no (further) constraints on this element
Element id
Composition.section.author
Short description
Who and/or what authored the section
Definition
Identifies who is responsible for the information in this section, not necessarily who typed it in.
+
Requirements
Identifies who is responsible for the content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.section.focus
Short description
Who/what the section is about, when it is not about the subject of composition
Definition
The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).
+
Comments
Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
cda: .subject? (CDA did not differentiate between subject and focus)
There are no (further) constraints on this element
Element id
Composition.section.text
Short description
Text summary of the section, for human interpretation
Definition
A human-readable narrative that contains the attested content of the section, 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.
+
Comments
Document profiles may define what content should be represented in the narrative to ensure clinical safety.
There are no (further) constraints on this element
Element id
Composition.section.mode
Short description
working | snapshot | changes
Definition
How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
+
Requirements
Sections are used in various ways, and it must be known in what way it is safe to use the entries in them.
+
Comments
This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
There are no (further) constraints on this element
Element id
Composition.section.orderedBy
Short description
Order of section entries
Definition
Specifies the order applied to the items in the section entries.
+
Requirements
Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.
+
Comments
Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]
There are no (further) constraints on this element
Element id
Composition.section.emptyReason
Short description
Why the section is empty
Definition
If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.
+
Requirements
Allows capturing things like "none exist" or "not asked" which can be important for most lists.
+
Comments
The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
Das CapabilityStatement in dieser Spezifikation stellt die Anforderungen seitens der gematik dar. (kind = "requirements"). Zur Unterscheidung von Anforderungen, die erfüllt werden MÜSSEN gegenüber jenen, die erfüllt werden KÖNNEN, wird die CapabilityStatement-Expectation-Extension mit den möglichen Werten "SHALL" (=MUSS) und "MAY" (=KANN) verwendet.
+
Eine Server-Instanz MUSS ihrerseits ein CapabilityStatement vom kind= "instance" liefern und im Element software den Namen und die Versionsnummer angeben.
+
Das CapabilityStatement der Instanz MUSS alle Funktionalitäten auflisten, die im folgenden CapabilityStatement mit "SHALL" gekennzeichnet sind. Das CapabilityStatement KANN darüber hinaus die mit "MAY" gekennzeichneten Funktionalitäten, sowie weitere Funktionalitäten auflisten, sofern diese in der Instanz implementiert wurden.
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Die Verwendung der CapabilityStatement-Expectation-Extension ist im CapabilityStatement der Server-Instanz nicht erforderlich.
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Datenobjekte
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In den folgenden Unterkapiteln werden die ISiK-Datenobjekte, die in dem vereinfachten Informationsmodell dargestellt sind, und ihre FHIR-Spezifikation beschrieben.
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Der Angehörige wird vor allem im Zusammenhang mit Anwendungsszenarien verwendet, in denen das Versicherungsverhältnis eine Rolle spielt. Hier können Angehörige, bspw. der hauptversicherte Elternteil eines minderjährigen Kindes, in der Familienversicherung sein. In Selbstzahler-Szenarien können Angehörige die Zahler für eine im Krankenhaus erbrachte Leistung sein.
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Zum Zeitpunkt der Erstellung dieses Leitfadens waren keine geeigneten Basis-Profile zur Darstellung von Angehörigen bekannt.
+
Instanzen, die gegen dieses Profil valide sind, auch valide gegen
A person that is related to a patient, but who is not a direct target of care
Definition
Information about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
relatedp-de-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
There are no (further) constraints on this element
Element id
RelatedPerson.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
RelatedPerson.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
RelatedPerson.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
RelatedPerson.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
RelatedPerson.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.identifier
Short description
A human identifier for this person
Definition
Identifier for a person within a particular scope.
+
Requirements
People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
RelatedPerson.patient
Short description
The patient this person is related to
Definition
The patient this person is related to.
+
Requirements
We need to know which patient this RelatedPerson is related to.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: PID-3
rim: scoper[classCode=PSN|ANM and determinerCode='INSTANCE']/playedRole[classCode='PAT']/id
There are no (further) constraints on this element
Element id
RelatedPerson.patient.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
RelatedPerson.patient.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
RelatedPerson.patient.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.relationship
Short description
The nature of the relationship
Definition
The nature of the relationship between a patient and the related person.
+
Requirements
We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Related persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
RelatedPerson.telecom
Short description
A contact detail for the person
Definition
A contact detail for the person, e.g. a telephone number or an email address.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
RelatedPerson.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
Address where the related person can be contacted or visited
Definition
Address where the related person can be contacted or visited.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
RelatedPerson.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
Need to keep track where the related person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
RelatedPerson.photo
Short description
Image of the person
Definition
Image of the person.
+
Requirements
Many EHR systems have the capability to capture an image of persons. Fits with newer social media usage too.
+
Comments
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
There are no (further) constraints on this element
Element id
RelatedPerson.period
Short description
Period of time that this relationship is considered valid
Definition
The period of time during which this relationship is or was active. If there are no dates defined, then the interval is unknown.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
RelatedPerson.communication
Short description
A language which may be used to communicate with about the patient's health
Definition
A language which may be used to communicate with about the patient's health.
+
Requirements
If a related person does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.
+
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.language
Short description
The language which can be used to communicate with the patient about his or her health
Definition
The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
+
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
+
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
RelatedPerson.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
+
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
+
Comments
This language is specifically identified for communicating healthcare information.
Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden
gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
+
+
+
+
Anmerkungen zu den Must-Support-Feldern
+
Im Profil ISiKAngehoeriger sind keine Must-Support-Felder definiert.
+
+
+
+
Interaktionen
+
Für die Ressource RelatedPerson MUSS die REST-Interaktion "READ" implementiert werden.
+
Folgende Suchparameter sind für das Bestätigungsverfahren relevant, auch in Kombination:
Rückübermittlung Bericht aus Subsystemen (Composition)
+
+
+
+
Motivation
+
In der heterogenen Systemlandschaft im Krankenhaus sind eine Vielzahl spezialisierter Subsysteme im Einsatz. Die Ergebnisse aus diesen Subsystemen sind aktuell jedoch häufig nicht in den Primärsystemen des Krankenhauses verfügbar, denn aktuell bestehen noch folgende Herausforderungen:
+
+
Die Daten in Subsystemen sind sehr heterogen und können hochspezialisiert sein.
+
Bei der Nutzung dieser Subsysteme besteht häufig ein Interesse, auf die menschenlesbare Repräsentation der strukturierten Daten einwirken zu können.
+
Künftig ist mit Szenarien zu rechnen, bei denen Befunde aus Subsystemen in eine elektronische Patientenakte übertragen werden sollen.
+
Aktuell werden Befunde, obwohl sie in den Subsystemen in hochstrukturierter Form vorliegen, nur als PDF an das Primärsystem zurückübermittelt. Oft weil kein strukturiertes Format spezifiziert ist, das sowohl versendendes Subsystem als auch empfangendes Primärsystem implementiert haben.
+
Der Umfang, in dem eine Datenübernahme in ein Primärsystem möglich ist, variiert stark zwischen den Systemen oder Installationen, z.B. abhängig davon, ob ein Modul für Vitalparameter installiert ist.
+
+
Die ISiK-Spezifikation begegnet diesen Herausforderungen, indem sie die Rückübermittlung von Ergebnissen aus Subsystemen an die Primärsysteme in Form von strukturierten Dokumenten erfordert, die über eine menschenlesbare Repräsentation verfügen. Diese strukturierten Dokumente werden im ISiK-Kontext als Berichte bezeichnet. Dabei sind die strukturierten Inhalte der Berichte harmonisiert mit den verbreiteten Formaten für Primärsysteme.
+
In der aktuellen Ausbaustufe von ISiK ist lediglich die Übernahme und Anzeige der Dokument-Metadaten (z.B. Dokumenttyp, Dokumentdatum, Quelle) und der menschenlesbaren HTML-Repräsentation in die Primärsysteme erforderlich.
+
In weiteren Ausbaustufen von ISiK soll darüber hinaus eine Übernahme der strukturierten Anteile der Dokumente möglich sein, die den ISiK-Spezifikationen entsprechen, z.B. Diagnosen und Prozeduren.
+
Es obliegt dabei dem Ermessen des Herstellers, ob die Übernahme strukturierter Daten in das Primärsystem automatisch erfolgt, oder durch den Benutzer initiiert wird.
Das Bundle dient der Aggregation aller Ressourcen, die Bestandteil des Dokumentes sind. Dabei ist die erste Ressource im Bundle (Bundle.entry.resource) stets eine Composition, alle weiteren entries enthalten zusätzliche Ressourcen, auf die die Composition verweist.
+
Falls die Referenz auf die in der Composition enthaltenen Patienten und/oder Encounter nicht auflösbar ist, MUSS als Antwort der HTTP Status Code "422 - Unprocessable Entity" zurückgegeben werden. Im Body der Response ist eine OperationOutcome zurückzugeben, welche ein Issue mit dem Verweis auf die nicht auflösbare Referenz enthält. Zur Kodierung von OperationOutcome.issue.code MUSS als Code "processing" verwendet werden.
bdl-7: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles) (type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
bdl-9: A document must have an identifier with a system and a value type = 'document' implies (identifier.system.exists() and identifier.value.exists())
bdl-3: entry.request mandatory for batch/transaction/history, otherwise prohibited entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
bdl-4: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
bdl-12: A message must have a MessageHeader as the first resource type = 'message' implies entry.first().resource.is(MessageHeader)
bdl-1: total only when a search or history total.empty() or (type = 'searchset') or (type = 'history')
bdl-2: entry.search only when a search entry.search.empty() or (type = 'searchset')
bdl-11: A document must have a Composition as the first resource type = 'document' implies entry.first().resource.is(Composition)
bdl-10: A document must have a date type = 'document' implies (timestamp.hasValue())
ISiK-docBundle-1: All referenced Resources must be contained in the Bundle Bundle.entry.descendants().reference.distinct().subsetOf(%context.entry.fullUrl)
There are no (further) constraints on this element
Element id
Bundle.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Bundle.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Bundle.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Bundle.identifier
Short description
Persistent identifier for the bundle
Definition
A persistent identifier for the bundle that won't change as a bundle is copied from server to server.
+
Comments
Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Indicates the purpose of this bundle - how it is intended to be used.
+
Comments
It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.
There are no (further) constraints on this element
Element id
Bundle.timestamp
Short description
When the bundle was assembled
Definition
The date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
+
Comments
For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated.
+
Usage:
+
+
document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time
+
message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message
+
history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates
+
searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query
+
transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning
+
+
The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.
There are no (further) constraints on this element
Element id
Bundle.total
Short description
If search, the total number of matches
Definition
If a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
+
Comments
Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.
There are no (further) constraints on this element
Element id
Bundle.link
Short description
Links related to this Bundle
Definition
A series of links that provide context to this bundle.
+
Comments
Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. HATEOAS).
+
Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was read directly.
+
This specification defines some specific uses of Bundle.link for searching and paging, but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.
There are no (further) constraints on this element
Element id
Bundle.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry.fullUrl
Short description
URI for resource (Absolute URL server address or URI for UUID/OID)
Definition
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that:
+
+
fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle)
+
Results from operations might involve resources that are not identified.
+
+
Comments
fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.
+
Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
There are no (further) constraints on this element
Element id
Bundle.entry.request
Short description
Additional execution information (transaction/batch/history)
Definition
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
There are no (further) constraints on this element
Element id
Bundle.entry.response
Short description
Results of execution (transaction/batch/history)
Definition
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.fullUrl
Short description
URI for resource (Absolute URL server address or URI for UUID/OID)
Definition
The Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that:
+
+
fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle)
+
Results from operations might involve resources that are not identified.
+
+
Comments
fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.
+
Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).
A set of resources composed into a single coherent clinical statement with clinical attestation
Definition
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
+
Comments
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
cda: ClinicalDocument
fhirdocumentreference: when described by DocumentReference
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.mode
Short description
match | include | outcome - why this is in the result set
Definition
Why this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
+
Comments
There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.
Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.search.score
Short description
Search ranking (between 0 and 1)
Definition
When searching, the server's search ranking score for the entry.
+
Comments
Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order.
+
See Patient Match for the EMPI search which relates to this element.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request
Short description
Additional execution information (transaction/batch/history)
Definition
Additional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.url
Short description
URL for HTTP equivalent of this entry
Definition
The URL for this entry, relative to the root (the address to which the request is posted).
+
Comments
E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.ifModifiedSince
Short description
For managing cache currency
Definition
Only perform the operation if the last updated date matches. See the API documentation for "Conditional Read".
+
Comments
Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.request.ifNoneExist
Short description
For conditional creates
Definition
Instruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for "Conditional Create". This is just the query portion of the URL - what follows the "?" (not including the "?").
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response
Short description
Results of execution (transaction/batch/history)
Definition
Indicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.status
Short description
Status response code (text optional)
Definition
The status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Bundle.entry:Composition.response.outcome
Short description
OperationOutcome with hints and warnings (for batch/transaction)
Definition
An OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
+
Comments
For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned.
+
This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.
There are no (further) constraints on this element
Element id
Bundle.signature
Short description
Digital Signature
Definition
Digital Signature - base64 encoded. XML-DSig or a JWT.
+
Requirements
A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.
+
Comments
The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
rim: N/A
+
Verarbeitung des Dokumentes
+
In der aktuellen Ausbaustufe von ISiK MUSS ein empfangenes Dokument in folgenden Schritten verarbeitet werden:
+
+
Extraktion der Patient-Ressource aus dem Bundle und Herstellung des Patientenbezuges anhand der Aufnahmenummer ('Patient.identifier')
+
Extraktion der Encounter.Ressource aus dem Bundle und Herstellung des Fallbezuges anhand der Aufnahmenummer ('Encounter.identifier')
+
Extraktion der Composition-Ressource aus dem Bundle und Auslesen der mit 'mustSupport' gekennzeichneten Meta-Daten, sowie der menschenlesbaren Repräsentation des Dokumentes ('Composition.text' + 'Composition.section.text')
+
Hinzufügen des Dokumentes und seiner Metadaten zur Fallakte des Patienten
+
Visualisierung des Dokumentes und seiner Metadaten in der Fallakte des Patienten
+
+
+
+
+
+Die Grafik zeigt an einem vereinfachten Beispiel die Zuordnung des HTML-Dokumentes zu Patient und Kontakt in der aktuellen Ausbaustufe von ISiK (schwarze Pfeile). Die grauen Pfeile deuten die Übernahme strukturierter Daten, wie sie in weiteren Ausbaustufen erforderlich wird.
+
Hinweise zum Umgang mit der menschenlesbaren Repräsentation
+
Die menschenlesbare Repräsentation ("Narrative") eines Dokumentes setzt sich zusammen aus dem Inhalt von 'Composition.text', einer Repräsentation der Metadaten (z.B. Dokumenttyp, Patientenname, Patientennummer, Aufnahmenummer, datum) sowie der Aggregation der Inhalte von 'Composition.section', wobei zu beachten ist, dass ein Dokument beliebig viele Sections haben kann.
+Die einzelnen Bestandteile des Narratives KÖNNEN mit <div>-Elementen zusammengefügt werden.
+
Hinweise zum Umgang mit strukturierten Daten
+
Auch wenn in der aktuellen Stufe nur die Übernahme der menschenlesbaren Repräsentation erforderlich ist, empfiehlt es sich dennoch, das vollständige Bundle samt der strukturierten Anteile zu einem Dokument zu persistieren, so dass zu einem späteren Zeitpunkt, wenn eine Übernahme einzelner Daten möglich ist, diese auch rückwirkend erfolgen kann.
There are no (further) constraints on this element
Element id
Composition
Short description
A set of resources composed into a single coherent clinical statement with clinical attestation
Definition
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
+
Comments
While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
Mappings
rim: Entity. Role, or Act
workflow: Event
rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
cda: ClinicalDocument
fhirdocumentreference: when described by DocumentReference
There are no (further) constraints on this element
Element id
Composition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Composition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Composition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Composition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
There are no (further) constraints on this element
Element id
Composition.text.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.text.div
Short description
Limited xhtml content
Definition
The actual narrative content, a stripped down version of XHTML.
+
Comments
The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes htmlChecks()
txt-2: The narrative SHALL have some non-whitespace content htmlChecks()
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.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Composition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.identifier.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.identifier.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Composition.identifier.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Composition.identifier.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Composition.identifier.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Composition.identifier.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.
+
Requirements
Need to be able to mark interim, amended, or withdrawn compositions or documents.
+
Comments
If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.
+
Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Fixed value
final
Mappings
rim: n/a
workflow: Event.status
w5: FiveWs.status
rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
There are no (further) constraints on this element
Element id
Composition.type
Short description
Kind of composition (LOINC if possible)
Definition
Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.
+
Requirements
Key metadata element describing the composition, used in searching/filtering.
+
Comments
For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.
There are no (further) constraints on this element
Element id
Composition.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:LOINC.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:KDL.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.type.coding:IHE.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Composition.category
Short description
Categorization of Composition
Definition
A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.
+
Requirements
Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.
There are no (further) constraints on this element
Element id
Composition.category.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.category.coding:LOINC.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Composition.category.coding:IHE.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Composition.category.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).
+
Requirements
Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.
+
Comments
For clinical documents, this is usually the patient.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter
Short description
Context of the Composition
Definition
Describes the clinical encounter or type of care this documentation is associated with.
+
Requirements
Provides context for the composition and supports searching.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.context
w5: FiveWs.context
rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
There are no (further) constraints on this element
Element id
Composition.encounter.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.encounter.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.encounter.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.encounter.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.date
Short description
Composition editing time
Definition
The composition editing time, when the composition was last logically changed by the author.
+
Requirements
dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.
+
Comments
The Last Modified Date on the composition may be after the date of the document was attested without being changed.
Identifies who is responsible for the information in the composition, not necessarily who typed it in.
+
Requirements
Identifies who is responsible for the content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.author.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.author.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Composition.author.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Composition.author.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Composition.author.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Composition.title
Short description
Human Readable name/title
Definition
Official human-readable label for the composition.
+
Comments
For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.
There are no (further) constraints on this element
Element id
Composition.confidentiality
Short description
As defined by affinity domain
Definition
The code specifying the level of confidentiality of the Composition.
+
Comments
The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.
There are no (further) constraints on this element
Element id
Composition.attester.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.attester.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.attester.party
Short description
Who attested the composition
Definition
Who attested the composition in the specified way.
+
Requirements
Identifies who has taken on the responsibility for accuracy of the composition content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.witness
rim: ./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
There are no (further) constraints on this element
Element id
Composition.custodian
Short description
Organization which maintains the composition
Definition
Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.
+
Requirements
Identifies where to go to find the current version, where to report issues, etc.
+
Comments
This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
There are no (further) constraints on this element
Element id
Composition.relatesTo.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.relatesTo.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.event.code
Short description
Code(s) that apply to the event being documented
Definition
This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
+
Comments
An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.
There are no (further) constraints on this element
Element id
Composition.event.period
Short description
The period covered by the documentation
Definition
The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Composition.event.detail
Short description
The event(s) being documented
Definition
The description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.section.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Composition.section.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Composition.section.title
Short description
Label for section (e.g. for ToC)
Alternate names
header, label, caption
Definition
The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.
+
Requirements
Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.
+
Comments
The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.
There are no (further) constraints on this element
Element id
Composition.section.code
Short description
Classification of section (recommended)
Definition
A code identifying the kind of content contained within the section. This must be consistent with the section title.
+
Requirements
Provides computable standardized labels to topics within the document.
+
Comments
The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.
+
If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.
There are no (further) constraints on this element
Element id
Composition.section.author
Short description
Who and/or what authored the section
Definition
Identifies who is responsible for the information in this section, not necessarily who typed it in.
+
Requirements
Identifies who is responsible for the content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Composition.section.focus
Short description
Who/what the section is about, when it is not about the subject of composition
Definition
The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).
+
Comments
Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
cda: .subject? (CDA did not differentiate between subject and focus)
There are no (further) constraints on this element
Element id
Composition.section.text
Short description
Text summary of the section, for human interpretation
Definition
A human-readable narrative that contains the attested content of the section, 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.
+
Comments
Document profiles may define what content should be represented in the narrative to ensure clinical safety.
There are no (further) constraints on this element
Element id
Composition.section.mode
Short description
working | snapshot | changes
Definition
How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
+
Requirements
Sections are used in various ways, and it must be known in what way it is safe to use the entries in them.
+
Comments
This element is labeled as a modifier because a change list must not be misunderstood as a complete list.
There are no (further) constraints on this element
Element id
Composition.section.orderedBy
Short description
Order of section entries
Definition
Specifies the order applied to the items in the section entries.
+
Requirements
Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.
+
Comments
Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]
There are no (further) constraints on this element
Element id
Composition.section.emptyReason
Short description
Why the section is empty
Definition
If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.
+
Requirements
Allows capturing things like "none exist" or "not asked" which can be important for most lists.
+
Comments
The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.
Bedeutung: Erklärung zur Konformität zum ISiK-Profil
+
Composition.text
+
Bedeutung: menschenlesbare Repräsentation des Dokumentenkopfes (Metadaten)
+
Hinweise: Die Mindestanforderungen an den Inhalt der menschenlesbaren Repräsentation umfasst folgende Informationen:
+
+
Composition.subject:Patient.name.family
+
Composition.subject:Patient.birthDate
+
Composition.subject:Patient.identifier:pid
+
Composition.status
+
Composition.type.text
+
Composition.date
+
Composition.title
+
Composition.author.display
+
+
Composition.identifier
+
Bedeutung: Subsystem-seitig zugewiesener Identifier des Berichtes mit Angabe der URL des vom Subsystem verwendeten Namensraumes
+
Hinweise: Werden eigene Identifier bzw. NamingSystems verwendet, so sei auf den Leitfaden der Basisprofile Deutschland (HL7 Deutschland) zu den Best-Practices bei Namensräumen verwiesen.
+
Dazu ein Beispiel für einen Identifier eines Sub-System-Berichts:
Hinweise: In der aktuellen Ausbaustufe von ISiK ist textuelle Repräsentation des Dokumenttyps (type.text) ausreichend. Die darüber hinausgehende Codierung des Dokumenttyps (z.B. mit LOINC, IHE-Typecodes oder KDL) in type.coding KANN implementiert werden
+
Composition.subject
+
Bedeutung: Patientenbezug des Dokumentes
+
Composition.context
+
Bedeutung: Fallbezug des Dokumentes
+
Composition.date
+
Bedeutung: Datum der letzten Änderung am Dokument
+
Composition.author.display
+
Bedeutung: Autor des Dokumentes (Person, Subsystem)
+
Hinweise: In der aktuellen Ausbaustufe von ISiK ist die Verwendung der textuellen Repräsentation (display) von Autor und Subsystem ausreichend. Die darüber hinaus gehende Verlinkung auf Practitioner bzw. Device-Ressourcen KANN implementiert werden.
+
Composition.title
+
Bedeutung: Dokumentenbezeichnung
+
Hinweise: Die Dokumentenbezeichnung dient der Darstellung des Dokumentes in einer Übersicht, z.B. in einer Patientenakte, und KANN der schnellen Auffindbarkeit eines gesuchten Dokumentes dienen. Geeignete Bezeichnungen sind zum Beispiel
+
+
"Kleines Blutbild vom 13.10.2020"
+
"Pathologiebefund (Abstrich) vom 13.10.2020"
+
"Blutgasmessung vom 13.10.2020 14:14h"
+
+
Composition.section.title
+
Bedeutung: Kapitelüberschrift
+
Composition.section.text
+
Bedeutung: menschenlesbare Repräsentation des Inhalts eines Kapitels
+
Hinweise: Für Aggregation einer vollständigen menschenlesbaren Repräsentation MÜSSEN die Repräsentationen der einzelnen Kapitel an die Repräsentation der Metadaten (Composition.text) angehängt werden. Für die Separierung KÖNNEN einfache <div>-Tags verwendet werden.
+Es ist zu beachten, dass Kapitel auch Unterkapitel enthalten KÖNNEN (Composition.section.section), die bei der Aggregation entsprechend berücksichtigt werden MÜSSEN.
+
Die Mindestanforderungen an den Inhalt der menschenlesbaren Repräsentation umfasst folgende Informationen:
+
+
section.title + Freitext oder
+
section.title + Resource.text der referenzierten Ressource oder
+
section.title + eine aggregierte Repräsentation von Resource.text wenn in einer Section mehrere Ressourcen referenziert werden.
Die Möglichkeit, auf eine Übersicht der Diagnosen eines Patienten zuzugreifen, Patienten anhand ihrer Diagnose zu suchen oder zu prüfen, ob eine konkrete Diagnose bei einem Patienten vorliegt, sind wichtige Funktionen im klinischen Behandlungsablauf.
+
In FHIR werden Diagnosen mit der Condition-Ressource repräsentiert.
+
Da die Diagnosen in klinischen Primärsystemen in der Regel in ICD-10-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches.
+Falls eine Diagnose zwar dokumentiert, aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), ist alternativ eine Repräsentation als Freitext-Diagnose möglich.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
isik-con1: Falls eine kodierte Diagnose vorliegt muss der dazugehörige Einrichtungskontakt angegeben werden code.coding.exists() implies encounter.exists()
Mappings
rim: Entity. Role, or Act
workflow: Event
sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
There are no (further) constraints on this element
Element id
Condition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Condition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Condition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Condition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Condition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.identifier
Short description
External Ids for this condition
Definition
Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
+
Requirements
Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.
+
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
The verification status to support the clinical status of the condition.
+
Comments
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status.
+The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Identification of the condition, problem or diagnosis
Alternate names
type
Definition
Identification of the condition, problem or diagnosis.
+
Requirements
0..1 to account for primarily narrative only resources.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
icd-text-1: Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt. coding.exists().not() implies text.exists()
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.code
w5: FiveWs.what[x]
sct-concept: code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS
+<< 420134006 |Propensity to adverse reactions| MINUS
+<< 473010000 |Hypersensitivity condition| MINUS
+<< 79899007 |Drug interaction| MINUS
+<< 69449002 |Drug action| MINUS
+<< 441742003 |Evaluation finding| MINUS
+<< 307824009 |Administrative status| MINUS
+<< 385356007 |Tumor stage finding|)
+OR < 413350009 |Finding with explicit context|
+OR < 272379006 |Event|
There are no (further) constraints on this element
Element id
Condition.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
Optional Extension Element - found in all resources.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.system
Short description
Canonische CodeSystem URL für ICD-10-GM
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.version
Short description
Die Jahresversion von ICD-10-GM. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von ICD-10-GM ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von ICD-10-GM ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.code
Short description
Der ICD-10-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).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.system
Short description
Canonische CodeSystem URL für Alpha-ID
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.version
Short description
Die Jahresversion von Alpha-ID. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von Alpha-ID ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von Alpha-ID ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.code
Short description
Der Alpha-ID-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).
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Requirements
Need to refer to a particular code in the system.
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Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
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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.
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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.
A reference to a code defined by a terminology system.
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Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.system
Short description
Identity of the terminology system
Definition
The identification of the code system that defines the meaning of the symbol in the code.
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Requirements
Need to be unambiguous about the source of the definition of the symbol.
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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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
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Requirements
Need to refer to a particular code in the system.
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Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
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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.
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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.
A reference to a code defined by a terminology system.
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Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.system
Short description
Identity of the terminology system
Definition
The identification of the code system that defines the meaning of the symbol in the code.
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Requirements
Need to be unambiguous about the source of the definition of the symbol.
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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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
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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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
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Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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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.
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Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Condition.bodySite
Short description
Anatomical location, if relevant
Definition
The anatomical location where this condition manifests itself.
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Comments
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
There are no (further) constraints on this element
Element id
Condition.subject
Short description
Who has the condition?
Alternate names
patient
Definition
Indicates the patient or group who the condition record is associated with.
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Requirements
Group is typically used for veterinary or public health use cases.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Condition.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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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.
There are no (further) constraints on this element
Element id
Condition.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
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The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
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Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Condition.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
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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.
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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
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Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
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Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Condition.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
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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.
There are no (further) constraints on this element
Element id
Condition.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Condition was created or to which the creation of this record is tightly associated.
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Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.start.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
Optional Extension Element - found in all resources.
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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.
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
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Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
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Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.end.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
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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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
workflow: Event.occurrence[x]
w5: FiveWs.init
v2: PRB-16
rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
abatement[x]
I
0..1
There are no (further) constraints on this element
Element id
Condition.abatement[x]
Short description
When in resolution/remission
Definition
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
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Comments
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
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Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
w5: FiveWs.done[x]
rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
There are no (further) constraints on this element
Element id
Condition.recorder
Short description
Who recorded the condition
Definition
Individual who recorded the record and takes responsibility for its content.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.asserter
Short description
Person who asserts this condition
Definition
Individual who is making the condition statement.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.stage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.stage.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
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Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.stage.summary
Short description
Simple summary (disease specific)
Definition
A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
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Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.stage.assessment
Short description
Formal record of assessment
Definition
Reference to a formal record of the evidence on which the staging assessment is based.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.stage.type
Short description
Kind of staging
Definition
The kind of staging, such as pathological or clinical staging.
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Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.evidence
Short description
Supporting evidence
Definition
Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.
+
Comments
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
There are no (further) constraints on this element
Element id
Condition.evidence.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.evidence.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.evidence.code
Short description
Manifestation/symptom
Definition
A manifestation or symptom that led to the recording of this condition.
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Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.evidence.detail
Short description
Supporting information found elsewhere
Definition
Links to other relevant information, including pathology reports.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.note
Short description
Additional information about the Condition
Definition
Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
+
Comments
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
isik-con1
error
Falls eine kodierte Diagnose vorliegt muss der dazugehörige Einrichtungskontakt angegeben werden
code.coding.exists() implies encounter.exists()
+
icd-text-1
error
Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.
coding.exists().not() implies text.exists()
+
+
+
+
+
Anmerkungen zu den Must-Support-Feldern
+
Condition.clinicalStatus
+
Bedeutung:
+Kodierter klinischer Status der Diagnose. MUSS angegeben werden, da die Interpretation der Diagnose davon abhängt ob diese 'aktiv' ist oder einen anderen Status aufweist.
Bedeutung: Codierte Diagnose. Die Kodierung KANN nach den Vorgaben des BfArM per ICD-10GM kodiert werden. Weiterhin sind folgende Kodiersysteme u.a. auf Basis von Empfehlungen des BfArM zulässig:
Hinweise: Angaben zur ICD-Diagnosesicherheit ("A", "G", "V", "Z") müssen vom Code abgetrennt und in der Extension angegeben werden.
+
Condition.subject
+
Bedeutung: Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Condition.encounter
+
Bedeutung: Fallbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Hinweise:
+
Eine Verlinkung der Referenz auf den dazugehörigen Kontakt SOLLTE auf die Ebene des Einrichtungskontaktes erfolgen, falls die Kontaktebene (Encounter.type) kodiert wird.
+Bei der Auswahl des Kontaktes ist zu beachten, dass mehrere Encounter-Ressourcen mit identischen Aufnahmenummer-Identifiern existieren können (Abbildung Vor- und nachstationäre Kontakte).
+
Condition.recordedDate
+
Bedeutung: Das Dokumentationsdatum der Diagnose MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein.
+
Hinweise:
+
Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden (vgl. FHIRPath Constraint rec-1)
+
Condition.note
+
Bedeutung: Weitere optionale Freitext-Notizen bezogen auf die Diagnose.
+
Condition.extension:ReferenzPrimaerdiagnose
+
Bedeutung: Bei Mehrfachkodierten ICD-Diagnosen (z.B. Kreuz-Stern-Notation) muss die Sekundär- auf die Primärdiagnose verlinkt werden
+
+
+
+
Interaktionen
+
Für die Ressource Condition MUSS die REST-Interaktion "READ" implementiert werden.
+
Folgende Suchparameter sind für das Bestätigungsverfahren relevant, auch in Kombination:
Informationen über die Kontakte des Patienten entlang seines Behandlungspfades im Krankenhaus sind ein wichtiger Bestandteil des einrichtungsinternen Datenaustausches.
+Sie ermöglichen die Unterscheidung von stationären und ambulanten sowie aufgenommenen und entlassenen Patienten.
+Weiterhin ist aus den Kontaktinformationen der aktuelle Aufenthaltsort des Patienten (Fachabteilung, Station, Bettplatz) ermittelbar.
+Klinische Ressourcen werden in FHIR durch Verlinkung auf die Encounter-Ressource in einen Kontext zum Einrichtungskontakt gestellt. Dieser Kontext ist wichtig für die Steuerung von Zugriffsberechtigungen und Abrechnungsprozessen.
+
Am Beginn der meisten klinischen Workflows steht die Auswahl des Fallkontextes. Dies geschieht bspw. durch Suchen der Encounter-Ressource anhand von Eigenschaften wie Aufnahmenummer, Fallart oder Aufnahmedatum. Daraufhin werden die zutreffenden Suchergebnisse angezeigt und der gewünschte Einrichtungskontakt ausgewählt.
An interaction during which services are provided to the patient
Alternate names
Visit
Definition
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
ISiK-enc-1: Abgeschlossene Kontakte sollten einen End-Zeitpunkt angeben status = 'finished' implies period.end.exists()
There are no (further) constraints on this element
Element id
Encounter.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Encounter.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Encounter.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Encounter.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Encounter.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.extension:Aufnahmegrund.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Encounter.extension:Aufnahmegrund.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Encounter.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
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.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Encounter.statusHistory
Short description
List of past encounter statuses
Definition
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
+
Comments
The current status is always found in the current version of the resource, not the status history.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.period
Short description
The time that the episode was in the specified status
Definition
The time that the episode was in the specified status.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
+
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory
Short description
List of past encounter classes
Definition
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
There are no (further) constraints on this element
Element id
Encounter.classHistory.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
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Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory.period
Short description
The time that the episode was in the specified class
Definition
The time that the episode was in the specified class.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.serviceType
Short description
Specific type of service
Definition
Broad categorization of the service that is to be provided (e.g. cardiology).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.serviceType.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
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Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceType.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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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.
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Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.priority
Short description
Indicates the urgency of the encounter
Definition
Indicates the urgency of the encounter.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.subject
Short description
The patient or group present at the encounter
Alternate names
patient
Definition
The patient or group present at the encounter.
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Comments
While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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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.
There are no (further) constraints on this element
Element id
Encounter.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
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The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
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Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
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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.
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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
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Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
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Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
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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.
There are no (further) constraints on this element
Element id
Encounter.episodeOfCare
Short description
Episode(s) of care that this encounter should be recorded against
Definition
Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.basedOn
Short description
The ServiceRequest that initiated this encounter
Alternate names
incomingReferral
Definition
The request this encounter satisfies (e.g. incoming referral or procedure request).
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.participant.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.participant.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.participant.type
Short description
Role of participant in encounter
Definition
Role of participant in encounter.
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Comments
The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
There are no (further) constraints on this element
Element id
Encounter.participant.period
Short description
Period of time during the encounter that the participant participated
Definition
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
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Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.participant.individual
Short description
Persons involved in the encounter other than the patient
Definition
Persons involved in the encounter other than the patient.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.appointment
Short description
The appointment that scheduled this encounter
Definition
The appointment that scheduled this encounter.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
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Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
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Meaning when missing
If the end of the period is missing, it means that the period is ongoing
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present code.empty() or system.exists()
drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. code.exists() implies ((system = %ucum) and value.exists())
Mappings
rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: PQ, IVL<PQ> depending on the values
workflow: Event.occurrence[x]
v2: (PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
There are no (further) constraints on this element
Element id
Encounter.reasonCode
Short description
Coded reason the encounter takes place
Alternate names
Indication, Admission diagnosis
Definition
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
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Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.reasonCode
w5: FiveWs.why[x]
v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
There are no (further) constraints on this element
Element id
Encounter.reasonReference
Short description
Reason the encounter takes place (reference)
Alternate names
Indication, Admission diagnosis
Definition
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
+
Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.reasonCode
w5: FiveWs.why[x]
v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
There are no (further) constraints on this element
Element id
Encounter.diagnosis.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
+
Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.reasonReference
w5: FiveWs.why[x]
v2: Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Definition
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.account
Short description
The set of accounts that may be used for billing for this Encounter
Definition
The set of accounts that may be used for billing for this Encounter.
+
Comments
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.hospitalization.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.hospitalization.origin
Short description
The location/organization from which the patient came before admission
Definition
The location/organization from which the patient came before admission.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
From where patient was admitted (physician referral, transfer)
Definition
From where patient was admitted (physician referral, transfer).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.reAdmission
Short description
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Definition
Whether this hospitalization is a readmission and why if known.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.dietPreference
Short description
Diet preferences reported by the patient
Definition
Diet preferences reported by the patient.
+
Requirements
Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
+
Comments
For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
There are no (further) constraints on this element
Element id
Encounter.hospitalization.specialCourtesy
Short description
Special courtesies (VIP, board member)
Definition
Special courtesies (VIP, board member).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.specialArrangement
Short description
Wheelchair, translator, stretcher, etc.
Definition
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.destination
Short description
Location/organization to which the patient is discharged
Definition
Location/organization to which the patient is discharged.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.hospitalization.dischargeDisposition
Short description
Category or kind of location after discharge
Definition
Category or kind of location after discharge.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
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.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.location
Short description
List of locations where the patient has been
Definition
List of locations where the patient has been during this encounter.
+
Comments
Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
There are no (further) constraints on this element
Element id
Encounter.location.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location
Short description
Location the encounter takes place
Definition
The location where the encounter takes place.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.location.location.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.location.location.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.location.location.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.status
Short description
planned | active | reserved | completed
Definition
The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
+
Comments
When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
There are no (further) constraints on this element
Element id
Encounter.location.physicalType
Short description
The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
Definition
This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
+
Comments
This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query.
+
There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
There are no (further) constraints on this element
Element id
Encounter.location.period
Short description
Time period during which the patient was present at the location
Definition
Time period during which the patient was present at the location.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider
Short description
The organization (facility) responsible for this encounter
Definition
The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Bedeutung: Der Status MUSS insbesondere zur Differenzierung von abgeschlossenen und derzeitig noch aktiven Kontakten angegeben werden. Alle in einem System möglichen Status-Werte müssen über FHIR korrekt repräsentiert werden können, mindestens jedoch die Status-Werte, "in-progress", "finished" und "cancelled". Deren korrekte Abbildung wird im Rahmen des Bestätigungsverfahrens überprüft.
Die nachfolgenden Festlegungen spezifizieren die Abbildung von Minimalanforderungen für die Bereitstellung von administrativen Patientendaten im Rahmen des Bestätigungsverfahrens der gematik.
+
+
+
+
Motivation
+
Der Austausch administrativer Patientendaten ist eine der grundlegenden Funktionalitäten beim Datenaustausch in der klinischen Versorgung.
+
In FHIR werden sämtliche klinischen Ressourcen durch Verlinkung auf die Ressource 'Patient' in einen Patientenkontext gestellt.
+
Die Herstellung des korrekten Patientenkontextes durch Suchen der Patientenressource anhand von Eigenschaften wie Aufnahmenummer, Name oder Geburtsdatum, die Anzeige der zutreffenden Suchergebnisse und der Auswahl bzw. Bestätigung des richtigen Datensatzes durch den Anwender steht am Beginn der meisten klinischen Workflows.
hier ist zu beachten, dass die KBV im Patienten-Profil für Address.country ein "extensible"-Binding auf die DEÜV-Codes festlegt; dies weicht von der ISiK Verwendung von ISO-Codes ab
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
isik-pat-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
There are no (further) constraints on this element
Element id
Patient.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Patient.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Patient.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Patient.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Patient.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Patient.active
Short description
Whether this patient's record is in active use
Definition
Whether this patient record is in active use.
+Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.
+
It is often used to filter patient lists to exclude inactive patients
+
Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
+
Requirements
Need to be able to mark a patient record as not to be used because it was created in error.
+
Comments
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
+
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
In order to maintain the differntiations of name parts as given in the VSDM dataset or qualify prefixes as academic titles, vendors can opt to support the extensions specified in the German HumanName Base Profile https://simplifier.net/basisprofil-de-r4/humannamedebasis
+This is however not required within the scope of this specification.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Patient.name:Name.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Name.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.name:Name.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Patient.name:Name.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Patient.name:Name.prefix.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Name.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.telecom
Short description
A contact detail for the individual
Definition
A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
There are no (further) constraints on this element
Element id
Patient.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
+
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
Patient.telecom.period
Short description
Time period when the contact point was/is in use
Definition
Time period when the contact point was/is in use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.gender
Short description
male | female | other | unknown
Definition
Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
+
Requirements
Needed for identification of the individual, in combination with (at least) name and birth date.
+
Comments
The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
There are no (further) constraints on this element
Element id
Patient.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Patient.birthDate
Short description
The date of birth for the individual
Definition
The date of birth for the individual.
+
Requirements
Age of the individual drives many clinical processes.
+
Comments
At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
There are no (further) constraints on this element
Element id
Patient.birthDate.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Provides a reason why the expected value or elements in the element that is extended are missing.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Patient.birthDate.value
Short description
Primitive value for date
Definition
Primitive value for date
+
Data type
System.Date
deceased[x]
Σ?!
0..1
There are no (further) constraints on this element
Element id
Patient.deceased[x]
Short description
Indicates if the individual is deceased or not
Definition
Indicates if the individual is deceased or not.
+
Requirements
The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
+
Comments
If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: PID-30 (bool) and PID-29 (datetime)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Patient.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.extension:Stadtteil
Short description
Stadt- oder Ortsteil
Alternate names
extensions, user content
Definition
A subsection of a municipality.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Patient.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Patient.maritalStatus
Short description
Marital (civil) status of a patient
Definition
This field contains a patient's most recent marital (civil) status.
+
Requirements
Most, if not all systems capture it.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: PID-16
rim: player[classCode=PSN]/maritalStatusCode
cda: .patient.maritalStatusCode
multipleBirth[x]
0..1
There are no (further) constraints on this element
Element id
Patient.multipleBirth[x]
Short description
Whether patient is part of a multiple birth
Definition
Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
+
Requirements
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
+
Comments
Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: PID-24 (bool), PID-25 (integer)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
There are no (further) constraints on this element
Element id
Patient.contact
Short description
A contact party (e.g. guardian, partner, friend) for the patient
Definition
A contact party (e.g. guardian, partner, friend) for the patient.
+
Requirements
Need to track people you can contact about the patient.
+
Comments
Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
pat-1: SHALL at least contain a contact's details or a reference to an organization name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings
rim: n/a
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
There are no (further) constraints on this element
Element id
Patient.contact.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.contact.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Patient.contact.relationship
Short description
The kind of relationship
Definition
The nature of the relationship between the patient and the contact person.
+
Requirements
Used to determine which contact person is the most relevant to approach, depending on circumstances.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Patient.contact.name
Short description
A name associated with the contact person
Definition
A name associated with the contact person.
+
Requirements
Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
There are no (further) constraints on this element
Element id
Patient.contact.telecom
Short description
A contact detail for the person
Definition
A contact detail for the person, e.g. a telephone number or an email address.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
Patient.contact.address
Short description
Address for the contact person
Definition
Address for the contact person.
+
Requirements
Need to keep track where the contact person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.contact.organization
Short description
Organization that is associated with the contact
Definition
Organization on behalf of which the contact is acting or for which the contact is working.
+
Requirements
For guardians or business related contacts, the organization is relevant.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.contact.period
Short description
The period during which this contact person or organization is valid to be contacted relating to this patient
Definition
The period during which this contact person or organization is valid to be contacted relating to this patient.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.communication
Short description
A language which may be used to communicate with the patient about his or her health
Definition
A language which may be used to communicate with the patient about his or her health.
+
Requirements
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
+
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
There are no (further) constraints on this element
Element id
Patient.communication.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Patient.communication.language
Short description
The language which can be used to communicate with the patient about his or her health
Definition
The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
+
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
+
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
Patient.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
+
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
+
Comments
This language is specifically identified for communicating healthcare information.
There are no (further) constraints on this element
Element id
Patient.generalPractitioner
Short description
Patient's nominated primary care provider
Alternate names
careProvider
Definition
Patient's nominated care provider.
+
Comments
This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
+Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.
+
Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.managingOrganization
Short description
Organization that is the custodian of the patient record
Definition
Organization that is the custodian of the patient record.
+
Requirements
Need to know who recognizes this patient record, manages and updates it.
+
Comments
There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
isik-pat-1
error
Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden
gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
+
+
+
+
Anmerkungen zu Must-Support-Feldern
+
Patient.active
+
Bedeutung: Indikator "Patientdatensatz ist in aktiver Benutzung"
PersonImGesundheitsberuf können alle denkbaren medizinischen Fachexperten sein, die in ISiK-Interaktionen eine Rolle spielen. In den ISiK-FHIR-Profilen können PersonImGesundheitsberuf bspw. als Ausführende einer Prozedur auftreten, im Element performer der Procedure Ressource, oder als die Person, die eine Diagnose stellt, im Element asserter der Condition Ressource.
+
In FHIR werden PersonImGesundheitsberuf mit der Practitioner-Ressource repräsentiert.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
prac-de-1: Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist gender='other' or gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').empty()
There are no (further) constraints on this element
Element id
Practitioner.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Practitioner.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Practitioner.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Practitioner.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Practitioner.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.assigner.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
Requirements
Often, specific identities are assigned for the agent.
+
Comments
In bestimmten KIS wird keine EFN geführt, da diese aus Compliance-Gründen getrennt in HR-Systemen vorgehalten wird (Hinweis kam von Stakeholder), daher soll der entsprechende Test im Test-System mit "warningOnly" ausgegeben werden.
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.active
Short description
Whether this practitioner's record is in active use
Definition
Whether this practitioner's record is in active use.
+
Requirements
Need to be able to mark a practitioner record as not to be used because it was created in error.
+
Comments
If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.
+
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.
+
In general, select the value to be used in the ResourceReference.display based on this:
+
+
There is more than 1 name
+
Use = usual
+
Period is current to the date of the usage
+
Use = official
+
Other order as decided by internal business rules.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Practitioner.name:Name.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.family.extension:nachname
Short description
Nachname ohne Vor- und Zusätze
Alternate names
extensions, user content
Definition
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.prefix.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.telecom
Short description
A contact detail for the practitioner (that apply to all roles)
Definition
A contact detail for the practitioner, e.g. a telephone number or an email address.
+
Requirements
Need to know how to reach a practitioner independent to any roles the practitioner may have.
+
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.
There are no (further) constraints on this element
Element id
Practitioner.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
+
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
Practitioner.telecom.period
Short description
Time period when the contact point was/is in use
Definition
Time period when the contact point was/is in use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Address(es) of the practitioner that are not role specific (typically home address)
Definition
Address(es) of the practitioner that are not role specific (typically home address).
+Work addresses are not typically entered in this property as they are usually role dependent.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Practitioner.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
gender-amtlich-1: Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist %resource.where(gender='other').exists()
There are no (further) constraints on this element
Element id
Practitioner.birthDate.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Provides a reason why the expected value or elements in the element that is extended are missing.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.photo
Short description
Image of the person
Definition
Image of the person.
+
Requirements
Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.
+
Comments
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
There are no (further) constraints on this element
Element id
Practitioner.qualification
Short description
Certification, licenses, or training pertaining to the provision of care
Definition
The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.
There are no (further) constraints on this element
Element id
Practitioner.qualification.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.qualification.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.qualification.code
Short description
Coded representation of the qualification
Definition
Coded representation of the qualification.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Practitioner.qualification.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.qualification.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Practitioner.qualification.period
Short description
Period during which the qualification is valid
Definition
Period during which the qualification is valid.
+
Requirements
Qualifications are often for a limited period of time, and can be revoked.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.qualification.issuer
Short description
Organization that regulates and issues the qualification
Definition
Organization that regulates and issues the qualification.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Practitioner.communication
Short description
A language the practitioner can use in patient communication
Definition
A language the practitioner can use in patient communication.
+
Requirements
Knowing which language a practitioner speaks can help in facilitating communication with patients.
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Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
prac-de-1
error
Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist
gender='other' or gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').empty()
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+
+
+
+
Anmerkungen zu den Must-Support-Feldern
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Practitioner.identifier:ANR
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Bedeutung: Lebenslange Arztnummer. Im Krankenhaus ist die Lebenslange Arztnummer der Ärzte bekannt und MUSS zur eindeutigen Identifikation eines Arztes bereitgestellt werden.
Während die Deutschen Basisprofile hier die Abkürzung LANR verwenden, ist im KBV-Kontext das Akronym ANR gebräuchlich. Die Bezeichnung des Slices hat jedoch keinerlei Auswirkungen auf die Kompatibilität.
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Practitioner.name:name
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Bedeutung: Vollständiger Name. Der Name des Arztes MUSS in konkreten Anwendungen angezeigt werden können. Es MUSS nach dem Namen des Arztes gesucht werden können.
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Practitioner.gender
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Bedeutung: Administratives Geschlecht. Ist das Geschlecht des Arztes bekannt, MUSS es bereitgestellt werden.
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Practitioner.birthDate
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Bedeutung: Geburtsdatum. Ist das Geburtsdatum des Arztes bekannt, MUSS es bereitgestellt werden.
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Practitioner.qualification
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Bedeutung: Ärztliche Qualifikation(en). Es MÜSSEN die Qualifikationen des Arztes bereitgestellt werden, um nach Ärzten einer Qualifikation zu suchen oder sie bspw. in Dokumenten anzuzeigen.
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+
+
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Interaktionen
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Für die Ressource Practitioner MUSS die REST-Interaktion "READ" implementiert werden.
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Folgende Suchparameter sind für das Bestätigungsverfahren relevant, auch in Kombination:
Die Möglichkeit, auf eine Übersicht der Prozeduren eines Patienten zuzugreifen, Patienten anhand durchgeführter oder geplanter Prozeduren zu suchen, oder zu prüfen, ob eine konkrete Prozedur bei einem Patienten durchgeführt wurde, sind wichtige Funktionen im klinischen Behandlungsablauf.
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In FHIR werden Prozeduren mit der Procedure-Ressource repräsentiert.
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Da die Prozeduren in klinischen Primärsystemen in der Regel in OPS-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches.
+Falls eine Prozedur zwar dokumentiert aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), ist alternativ eine Repräsentation als Freitext-Prozedur möglich.
An action that is being or was performed on a patient
Definition
An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
proc-ISiK-1: Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
proc-ISiK-2: Falls eine codierte Prozedur vorliegt MUSS eine kodierte Category abgebildet werden code.coding.exists() implies category.coding.exists()
There are no (further) constraints on this element
Element id
Procedure.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Procedure.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Procedure.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Procedure.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Procedure.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
Dokumentationsdatum der Prozedur, falls abweichend vom Durchführungsdatum
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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.
There are no (further) constraints on this element
Element id
Procedure.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
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Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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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.
There are no (further) constraints on this element
Element id
Procedure.identifier
Short description
External Identifiers for this procedure
Definition
Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.
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Requirements
Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
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Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
w5: FiveWs.identifier
v2: Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4
There are no (further) constraints on this element
Element id
Procedure.instantiatesUri
Short description
Instantiates external protocol or definition
Definition
The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
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Comments
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
There are no (further) constraints on this element
Element id
Procedure.basedOn
Short description
A request for this procedure
Alternate names
fulfills
Definition
A reference to a resource that contains details of the request for this procedure.
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Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
rim: .outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code
There are no (further) constraints on this element
Element id
Procedure.partOf
Short description
Part of referenced event
Alternate names
container
Definition
A larger event of which this particular procedure is a component or step.
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Comments
The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.partOf
rim: .inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
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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.
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This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
There are no (further) constraints on this element
Element id
Procedure.statusReason
Short description
Reason for current status
Alternate names
Suspended Reason, Cancelled Reason
Definition
Captures the reason for the current state of the procedure.
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Comments
This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
There are no (further) constraints on this element
Element id
Procedure.category
Short description
Classification of the procedure
Definition
A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
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Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.category.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
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Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
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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.
A reference to a code defined by a terminology system.
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Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
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Requirements
Need to be unambiguous about the source of the definition of the symbol.
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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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
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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.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Procedure.category.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
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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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
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Requirements
0..1 to account for primarily narrative only resources.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
sct-ops-1: Falls die Prozedur kodiert vorliegt, SOLL mindestens ein OPS oder SNOMED-CT Code angegeben werden. Liegt die Prozedur nicht kodiert vor SOLL Freitext angegeben werden. coding.exists() implies coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()
proc-ISiK-3: Entweder MUSS eine kodierte Prozedur vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt. coding.exists().not() implies text.exists()
There are no (further) constraints on this element
Element id
Procedure.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
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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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.system
Short description
Canonische CodeSystem URL für OPS
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.version
Short description
Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von OPS ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von OPS ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.code
Short description
Der OPS-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).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Procedure.subject
Short description
Who the procedure was performed on
Alternate names
patient
Definition
The person, animal or group on which the procedure was performed.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Procedure.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Procedure.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Procedure.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Procedure.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
+
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performed[x]
Short description
When the procedure was performed
Definition
Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.
+
Comments
Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
There are no (further) constraints on this element
Element id
Procedure.recorder
Short description
Who recorded the procedure
Definition
Individual who recorded the record and takes responsibility for its content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.asserter
Short description
Person who asserts this procedure
Definition
Individual who is making the procedure statement.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.performer.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Procedure.performer.function
Short description
Type of performance
Definition
Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.
+
Requirements
Allows disambiguation of the types of involvement of different performers.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.performer.actor
Short description
The reference to the practitioner
Definition
The practitioner who was involved in the procedure.
+
Requirements
A reference to Device supports use cases, such as pacemakers.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performer.onBehalfOf
Short description
Organization the device or practitioner was acting for
Definition
The organization the device or practitioner was acting on behalf of.
+
Requirements
Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.location
Short description
Where the procedure happened
Definition
The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.
+
Requirements
Ties a procedure to where the records are likely kept.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.reasonCode
Short description
Coded reason procedure performed
Definition
The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.
+
Comments
Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
There are no (further) constraints on this element
Element id
Procedure.reasonReference
Short description
The justification that the procedure was performed
Definition
The justification of why the procedure was performed.
+
Comments
It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use).
+Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.bodySite
Short description
Target body sites
Definition
Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
+
Comments
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.
There are no (further) constraints on this element
Element id
Procedure.report
Short description
Any report resulting from the procedure
Definition
This could be a histology result, pathology report, surgical report, etc.
+
Comments
There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.complication
Short description
Complication following the procedure
Definition
Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
+
Comments
If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.
There are no (further) constraints on this element
Element id
Procedure.complicationDetail
Short description
A condition that is a result of the procedure
Definition
Any complications that occurred during the procedure, or in the immediate post-performance period.
+
Requirements
This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.followUp
Short description
Instructions for follow up
Definition
If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.note
Short description
Additional information about the procedure
Definition
Any other notes and comments about the procedure.
+
Comments
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
There are no (further) constraints on this element
Element id
Procedure.focalDevice
Short description
Manipulated, implanted, or removed device
Definition
A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.action
Short description
Kind of change to device
Definition
The kind of change that happened to the device during the procedure.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.manipulated
Short description
Device that was changed
Definition
The device that was manipulated (changed) during the procedure.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .participation[typeCode=DEV].role[classCode=MANU] or
+.participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
Falls die Prozedur kodiert vorliegt, SOLL mindestens ein OPS oder SNOMED-CT Code angegeben werden. Liegt die Prozedur nicht kodiert vor SOLL Freitext angegeben werden.
coding.exists() implies coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()
+
proc-ISiK-3
error
Entweder MUSS eine kodierte Prozedur vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.
coding.exists().not() implies text.exists()
+
+
+
+
+
Anmerkungen zu den Must-Support Feldern
+
Procedure.extension:recordedDate
+
Bedeutung:
+Das Dokumentationsdatum der Prozedur MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein.
+
Procedure.status
+
Bedeutung:
+Kodierter klinischer Status der Prozedur. MUSS angegeben werden, da die Interpretation der Prozedur davon abhängt ob diese 'completed' ist oder einen anderen Status aufweist.
+
Procedure.category
+
Bedeutung:
+Zur groben Kategorisierung MUSS eine Kodierung auf Basis der OPS-Klassencodes erfolgen. Eine ConceptMap für das Mapping von OPS-Kodes -> Kategorie findet sich in den Deutschen Basisprofilen - Implementierungsleitfaden Abschnitt Terminologien. Die Angabe der Kategeorie MUSS nur für OPS-kodierte Prozeduren erfolgen.
+
Procedure.code.coding
+
Bedeutung: Codierte Prozedur. Entweder kodiert per OPS oder SNOMED CT. Bei der Kodierung per SNOMED CT ist das ValueSet ProzedurenCodes-SCT zu beachten.
+
Procedure.code.text
+
Bedeutung: Freitext-Beschreibung der Prozedur
+
Procedure.performed
+
Bedeutung: Zur zeitlichen Einordnung der Prozedur KANN das Durchführungsdatum der Prozedur dokumentiert werden. Mindestens MUSS der Beginn der Prozedur dokumentiert werden, das Ende KANN implementiert werden.
+
Procedure.subject
+
Bedeutung: Ein Patientenbezug der Prozedur MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Procedure.note
+
Bedeutung: Weitere optionale Freitext-Notizen bezogen auf die durchgeführte Prozedur.
+
+
+
+
Interaktionen
+
Für die Ressource Procedure MUSS die REST-Interaktion "READ" implementiert werden.
+
Folgende Suchparameter sind für das Bestätigungsverfahren relevant, auch in Kombination:
ISiK unterstützt Anwendungsszenarien, in denen durch das Krankenhaus erbrachte Leistungen erfasst oder gegenüber Kostenträgern abgerechnet werden. In diesen Anwendungsszenarien wird das Versicherungsverhältnis verwendet, um bspw. den Versicherungsstatus oder die Rechnungsanschrift der Versicherung zu ermitteln.
+
In FHIR werden Versicherungsverhältnisse mit der Coverage-Ressource repräsentiert.
Kostenübernahme im Rahmen eines gesetzlichen Versicherungsverhältnisses in Deutschland.
+
Comments
The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
There are no (further) constraints on this element
Element id
Coverage.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Coverage.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Coverage.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Coverage.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Coverage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Coverage.status
Short description
active | cancelled | draft | entered-in-error
Definition
The status of the resource instance.
+
Requirements
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
+
Comments
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
+
Requirements
The order of application of coverages is dependent on the types of coverage.
+
Comments
28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dortigen Codes nicht passen.
There are no (further) constraints on this element
Element id
Coverage.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Coverage.type.coding.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.type.coding.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Coverage.policyHolder
Short description
Owner of the policy
Definition
The party who 'owns' the insurance policy.
+
Requirements
This provides employer information in the case of Worker's Compensation and other policies.
+
Comments
Es gibt derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Pattern
{
+ "system": "http://fhir.de/sid/gkv/kvid-10"
+}
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
This is the party who receives treatment for which the costs are reimbursed under the coverage.
+
Comments
Die Angabe der 10-stelligen Krankenversichertennummer ist verpflichtend. Durch die Referenz auf eine Patient-Resource können weitere Informationen zum Patienten hinterlegt werden.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.beneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Pattern
{
+ "system": "http://fhir.de/sid/gkv/kvid-10"
+}
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Die Angabe des Namens des Versicherten dient der geeigenten Darstellung für den Benutzer und hat keine technische Bedeutung.
+
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.
There are no (further) constraints on this element
Element id
Coverage.period
Short description
Coverage start and end dates
Definition
Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
+
Requirements
Some insurers require the submission of the coverage term.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Gibt den Kostenträger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namens als Display ist zwingend erforderlich.
+Die Referenz auf eine Resource vom Typ Organization, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional.
+Sofern eine zweite Referenz auf einen Kostenträger existiert, so handelt es sich hierbei um den abrechnenden Kostenträger
+
Requirements
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
+
Comments
Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage.payor.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Coverage.payor.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.type
Short description
Type of class such as 'group' or 'plan'
Definition
The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
+
Requirements
The insurer issued label for a specific health card value.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.order
Short description
Relative order of the coverage
Definition
The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
+
Requirements
Used in managing the coordination of benefits.
+
Comments
Es git derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann.
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
There are no (further) constraints on this element
Element id
Coverage.network
Short description
Insurer network
Definition
Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden
+
Requirements
Used in referral for treatment and in claims processing.
+
Comments
Es gibt derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary
Short description
Patient payments for services/products
Alternate names
CoPay, Deductible, Exceptions
Definition
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
+
Requirements
Required by providers to manage financial transaction with the patient.
+
Comments
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.type
Short description
Exception category
Definition
The code for the specific exception.
+
Requirements
Needed to identify the exception associated with the amount for the patient.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.period
Short description
The effective period of the exception
Definition
The timeframe during when the exception is in force.
+
Requirements
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.subrogation
Short description
Reimbursement to insurer
Definition
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
+
Requirements
See definition for when to be used.
+
Comments
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
There are no (further) constraints on this element
Element id
Coverage.contract
Short description
Contract details
Definition
The policy(s) which constitute this insurance coverage.
+
Requirements
To reference the legally binding contract between the policy holder and the insurer.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage
Short description
Insurance or medical plan or a payment agreement
Definition
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
+
Comments
The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
There are no (further) constraints on this element
Element id
Coverage.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Coverage.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Coverage.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Coverage.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Coverage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.identifier
Short description
Business Identifier for the coverage
Definition
A unique identifier assigned to this coverage.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.status
Short description
active | cancelled | draft | entered-in-error
Definition
The status of the resource instance.
+
Requirements
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
+
Comments
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
There are no (further) constraints on this element
Element id
Coverage.type
Short description
Coverage category such as medical or accident
Definition
The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
+
Requirements
The order of application of coverages is dependent on the types of coverage.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
There are no (further) constraints on this element
Element id
Coverage.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Coverage.type.coding.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.type.coding.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber
Short description
Subscriber to the policy
Definition
The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
+
Requirements
This is the party who is entitled to the benfits under the policy.
+
Comments
May be self or a parent in the case of dependants.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Coverage.subscriber.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.subscriber.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary
Short description
Plan beneficiary
Definition
The party who benefits from the insurance coverage; the patient when products and/or services are provided.
+
Requirements
This is the party who receives treatment for which the costs are reimbursed under the coverage.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.beneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.beneficiary.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.period
Short description
Coverage start and end dates
Definition
Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
+
Requirements
Some insurers require the submission of the coverage term.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
+
Requirements
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
+
Comments
May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
+For selfpay it may provide multiple paying persons and/or organizations.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage.class.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.type
Short description
Type of class such as 'group' or 'plan'
Definition
The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
+
Requirements
The insurer issued label for a specific health card value.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.order
Short description
Relative order of the coverage
Definition
The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
+
Requirements
Used in managing the coordination of benefits.
+
Comments
32 bit number; for values larger than this, use decimal
There are no (further) constraints on this element
Element id
Coverage.network
Short description
Insurer network
Definition
The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
+
Requirements
Used in referral for treatment and in claims processing.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary
Short description
Patient payments for services/products
Alternate names
CoPay, Deductible, Exceptions
Definition
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
+
Requirements
Required by providers to manage financial transaction with the patient.
+
Comments
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.type
Short description
Exception category
Definition
The code for the specific exception.
+
Requirements
Needed to identify the exception associated with the amount for the patient.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.period
Short description
The effective period of the exception
Definition
The timeframe during when the exception is in force.
+
Requirements
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.subrogation
Short description
Reimbursement to insurer
Definition
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
+
Requirements
See definition for when to be used.
+
Comments
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
There are no (further) constraints on this element
Element id
Coverage.contract
Short description
Contract details
Definition
The policy(s) which constitute this insurance coverage.
+
Requirements
To reference the legally binding contract between the policy holder and the insurer.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Bedeutung: Der unveränderliche, 10-stellige Teil der Krankenversichertennummer zur Identifikation des Versicherten, die Krankenversicherten-ID.
+Hinweise: Dieser identifier ist zur eindeutigen Identifikation des gesetzlich Versicherten nötig, in den von diesem Profil unterstützten Anwendungsszenarien, siehe Beschreibung der Deutschen Basisprofile.
+
Coverage.status
+
Bedeutung: Der Status einer Instanz des Profils ISiKVersicherungsverhaeltnisGesetzlich.
+
Hinweise: Das Element status macht deutlich, ob diese Instanz genutzt werden kann oder ob sie bspw. als ungültig oder falsch gekennzeichnet ist, siehe FHIR Kernspezifikaton.
+
Coverage.type
+
Bedeutung: Das Element type kennzeichnet die Art der Versicherung.
+
+
+
+
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+ Implementierungsleitfaden ISiK-Basismodul
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Anmerkungen zu den Must-Support-Feldern
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Condition.clinicalStatus
+
Bedeutung:
+Kodierter klinischer Status der Diagnose. MUSS angegeben werden, da die Interpretation der Diagnose davon abhängt ob diese 'aktiv' ist oder einen anderen Status aufweist.
Bedeutung: Codierte Diagnose. Die Kodierung KANN nach den Vorgaben des BfArM per ICD-10GM kodiert werden. Weiterhin sind folgende Kodiersysteme u.a. auf Basis von Empfehlungen des BfArM zulässig:
Hinweise: Angaben zur ICD-Diagnosesicherheit ("A", "G", "V", "Z") müssen vom Code abgetrennt und in der Extension angegeben werden.
+
Condition.subject
+
Bedeutung: Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Condition.encounter
+
Bedeutung: Fallbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Hinweise:
+
Eine Verlinkung der Referenz auf den dazugehörigen Kontakt SOLLTE auf die Ebene des Einrichtungskontaktes erfolgen, falls die Kontaktebene (Encounter.type) kodiert wird.
+Bei der Auswahl des Kontaktes ist zu beachten, dass mehrere Encounter-Ressourcen mit identischen Aufnahmenummer-Identifiern existieren können (Abbildung Vor- und nachstationäre Kontakte).
+
Condition.recordedDate
+
Bedeutung: Das Dokumentationsdatum der Diagnose MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein.
+
Hinweise:
+
Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden (vgl. FHIRPath Constraint rec-1)
+
Condition.note
+
Bedeutung: Weitere optionale Freitext-Notizen bezogen auf die Diagnose.
+
Condition.extension:ReferenzPrimaerdiagnose
+
Bedeutung: Bei Mehrfachkodierten ICD-Diagnosen (z.B. Kreuz-Stern-Notation) muss die Sekundär- auf die Primärdiagnose verlinkt werden
+
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+ Implementierungsleitfaden ISiK-Basismodul
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wenn unter Condition.code.coding mindestens eine ICD-10-codierte Darstellung der Diagnose angegeben wurde
+
wenn unter Condition.verificationStatus ein Wert angegeben wurde
+
wenn unter Condition.asserter eine Referenz auf einen Practitioner angegeben werden.
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Motivation
+
Die Möglichkeit, auf eine Übersicht der Diagnosen eines Patienten zuzugreifen, Patienten anhand ihrer Diagnose zu suchen oder zu prüfen, ob eine konkrete Diagnose bei einem Patienten vorliegt, sind wichtige Funktionen im klinischen Behandlungsablauf.
+
In FHIR werden Diagnosen mit der Condition-Ressource repräsentiert.
+
Da die Diagnosen in klinischen Primärsystemen in der Regel in ICD-10-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches.
+Falls eine Diagnose zwar dokumentiert, aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), ist alternativ eine Repräsentation als Freitext-Diagnose möglich.
+
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dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
isik-con1: Falls eine kodierte Diagnose vorliegt muss der dazugehörige Einrichtungskontakt angegeben werden code.coding.exists() implies encounter.exists()
Mappings
rim: Entity. Role, or Act
workflow: Event
sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
There are no (further) constraints on this element
Element id
Condition.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Condition.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Condition.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Condition.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Condition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.identifier
Short description
External Ids for this condition
Definition
Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
+
Requirements
Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.
+
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
The verification status to support the clinical status of the condition.
+
Comments
verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status.
+The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.
Identification of the condition, problem or diagnosis
Alternate names
type
Definition
Identification of the condition, problem or diagnosis.
+
Requirements
0..1 to account for primarily narrative only resources.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
icd-text-1: Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt. coding.exists().not() implies text.exists()
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.code
w5: FiveWs.what[x]
sct-concept: code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS
+<< 420134006 |Propensity to adverse reactions| MINUS
+<< 473010000 |Hypersensitivity condition| MINUS
+<< 79899007 |Drug interaction| MINUS
+<< 69449002 |Drug action| MINUS
+<< 441742003 |Evaluation finding| MINUS
+<< 307824009 |Administrative status| MINUS
+<< 385356007 |Tumor stage finding|)
+OR < 413350009 |Finding with explicit context|
+OR < 272379006 |Event|
There are no (further) constraints on this element
Element id
Condition.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
Optional Extension Element - found in all resources.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.system
Short description
Canonische CodeSystem URL für ICD-10-GM
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.version
Short description
Die Jahresversion von ICD-10-GM. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von ICD-10-GM ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von ICD-10-GM ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.code
Short description
Der ICD-10-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).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:ICD-10-GM.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.system
Short description
Canonische CodeSystem URL für Alpha-ID
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.version
Short description
Die Jahresversion von Alpha-ID. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von Alpha-ID ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von Alpha-ID ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.code
Short description
Der Alpha-ID-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).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:Alpha-ID.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.system
Short description
Identity of the terminology system
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.system
Short description
Identity of the terminology system
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Condition.code.coding:Orphanet.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Condition.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Condition.bodySite
Short description
Anatomical location, if relevant
Definition
The anatomical location where this condition manifests itself.
+
Comments
Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.
There are no (further) constraints on this element
Element id
Condition.subject
Short description
Who has the condition?
Alternate names
patient
Definition
Indicates the patient or group who the condition record is associated with.
+
Requirements
Group is typically used for veterinary or public health use cases.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Condition.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Condition.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Condition.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Condition.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Condition was created or to which the creation of this record is tightly associated.
+
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.start.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetPeriod.end.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
workflow: Event.occurrence[x]
w5: FiveWs.init
v2: PRB-16
rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
abatement[x]
I
0..1
There are no (further) constraints on this element
Element id
Condition.abatement[x]
Short description
When in resolution/remission
Definition
The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
+
Comments
There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
w5: FiveWs.done[x]
rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
There are no (further) constraints on this element
Element id
Condition.recorder
Short description
Who recorded the condition
Definition
Individual who recorded the record and takes responsibility for its content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.asserter
Short description
Person who asserts this condition
Definition
Individual who is making the condition statement.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.stage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.stage.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.stage.summary
Short description
Simple summary (disease specific)
Definition
A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.stage.assessment
Short description
Formal record of assessment
Definition
Reference to a formal record of the evidence on which the staging assessment is based.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.stage.type
Short description
Kind of staging
Definition
The kind of staging, such as pathological or clinical staging.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.evidence
Short description
Supporting evidence
Definition
Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.
+
Comments
The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.
There are no (further) constraints on this element
Element id
Condition.evidence.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Condition.evidence.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Condition.evidence.code
Short description
Manifestation/symptom
Definition
A manifestation or symptom that led to the recording of this condition.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Condition.evidence.detail
Short description
Supporting information found elsewhere
Definition
Links to other relevant information, including pathology reports.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Condition.note
Short description
Additional information about the Condition
Definition
Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
+
Comments
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
isik-con1
error
Falls eine kodierte Diagnose vorliegt muss der dazugehörige Einrichtungskontakt angegeben werden
code.coding.exists() implies encounter.exists()
+
icd-text-1
error
Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.
coding.exists().not() implies text.exists()
+
+
+
+
+
+
+
+
+
+
+
+
+
+
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+ Implementierungsleitfaden ISiK-Basismodul
+
+
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Interoperabler Datenaustausch durch Informationssysteme im Krankenhaus (ISiK)
+
Die gematik wurde vom Gesetzgeber beauftragt, im Benehmen mit der Deutschen Krankenhausgesellschaft (DKG) und den maßgeblichen Bundesverbänden der Industrie im Gesundheitswesen, verbindliche Standards für den Austausch von Gesundheitsdaten mit Informationssystemen im Krankenhaus zu erarbeiten. Dieser FHIR ImplementationGuide (IG) beschreibt die für diesen Zweck entwickelten FHIR Profile und das REST-basierte Application Programming Interface (API). Die REST-API wird im Wesentlichen vom FHIR Standard vorgegeben. Dieser Leitfaden konkretisiert die ISiK-relevanten Funktionen der Standard-REST-API und trifft inhaltliche Festlegungen zu den ISiK-relevanten Ressourcen in Form von Ressourcen-Profilen.
+
Hersteller bestätigungsrelevanter Systeme sollen durch diesen IG in die Lage versetzt werden, eine konforme Implementierung zu erstellen und das Bestätigungsverfahren der gematik erfolgreich zu absolvieren.
Hinweis: Sowohl für die Implementierung der ISiK-Spezifikation als auch für den Betrieb eines Produktes, das die ISiK-Spezifikation implementiert, ist eine SNOMED-CT-Lizenz notwendig. Diese kann beim National Release Center für SNOMED CT in Deutschland beantragt werden.
+
Kontakt
+
Bringen Sie allgemeine Fragen und Anmerkungen gerne über unser Anfrageportal ein: Anfragen ISiK + ISiP
+
Falls Sie keinen Zugang zum Anfrageportal haben und dieses nutzen wollen, senden Sie uns bitte eine Nachricht an die Adresse isik [ at ] gematik.de mit dem Betreff "Portalzugang".
Hierbei ist anzumerken, dass der Zusatz "for mobile" seitens IHE irreführend sein kann.
+Konkret fasst IHE unter diesem Begriff nicht nur Systeme zusammen, die "Plattform- und Ressourcenbeschränkt sind, wie z.B. Tablets, Smatphones und Embedded Devices, sondern auch größere Systeme in Umgebungen, in denen die Interoperabilitätsanforderungen einfach sind (z.B. Anzeige der aktuellen Übersicht eines Patienten)" (Quelle: IHE QEDm - Introduction)
+
Die im folgenden genannten IHE-Spezifikationen beschreiben lediglich Interaktionen zwischen den Systemen und machen verbindliche Vorgaben zum Ablauf, Format und zu den unterstützten Such-Parametern, jedoch keine inhaltlichen Vorgaben. So beschreibt PDQm beispielweise den Ablauf einer Suche nach Patientendaten, enthält aber keine Vereinbarungen, wie die zurückgelieferte Patientenressource konkret auszusehen hat (Pflichtfelder, Terminologien, Contraints).
+
Der Mehrwert der ISiK-Spezifikation besteht darin, dass die genannten IHE-Interaktionen um Festlegungen zu den auszutauschenden Inhalten ergänzt werden, die zugeschnitten sind auf die Anforderungen des Datenaustausches zwischen Systemen innerhalb einer Einrichtung, basierend auf den Deutschen Basisprofilen von HL7 Deutschland e.V. und abgeglichen mit den Festlegungen der KBV zu den Inhalten der elektronischen Patientenakte (MIOs) sowie den Spezifikationen der Medizininformatik-Initiative.
+
Die Darstellungen der in diesen IHE-Profilen festgelegten Interaktionen und UseCases sind den oben verlinkten Dokumenten zu entnehmen.
+
IHE PDQm
+
Umfang
+
PDQm unterstützt das Abfragen von demografischen Patientendaten.
+Damit fällt dieser Anwendungfall vollständig in den Umfang der Festlegungen von ISiK.
+
Akteure
+
PDQm definiert die Kommunikation zwischen zwei Akteuren:
+
+
dem Patient Demographics Consumer und
+
dem Patient Demographics Supplier
+
+
Im ISiK Kontext nehmen die bestätigungsrelevanten Systeme die Rolle des Patient Demographics Supplier ein.
+Die Pediatric Demographics Option liegt außerhalb des Abdeckungsbereiches von ISiK
+
Transaktionen
+
PDQm definiert die Transaktion ITI-78 (Mobile Patient Demographics Query), deren Grundlagen identisch sind mit den in ISiK definierten Interaktionen auf dem Datenobjekt "Patient".
+Der Unterschied zwischen PDQm und ISiK besteht lediglich darin, dass ISiK nicht alle in PDQm spezifizierten Suchparameter zwingend erfordert.
+Suchparameter, die in PDQm obligatorisch sind, in ISiK jedoch optional sind in diesem Leitfaden mit einem entsprechenden Hinweis versehen.
+
IHE QEDm
+
Umfang
+
QEDm unterstützt das Abfragen klinischer Informationen wie zum Beispiel Diagnosen, Beobachtungen (u.a. Vitalparamter), Messdaten und Allergien unter Verwendung des FHIR-Standards.
+Damit überlappt der Anwendunsfall von QEDm in großen Teilen mit den Festlegungen von ISiK
+
Akteuere
+
QEDm definiert die Kommunikation zwischen zwei Akteueren:
+
+
dem Clinical Data Consumer und
+
der Clinical Data Source
+
+
Im ISiK Kontext nehmen die bestätigungsrelevanten Systeme die Rolle der Clinical Data Source mit folgenden Optionen ein:
+
+
Conditions Option
+
Procedures Option
+
Encounters Option
+
+
alle weiteren Optionen liegen außerhalb des Abdeckungsbereiches von ISiK (in Stufe 1).
+
Die Aufgabe der Clinical Data Source liegt in der Beantwortung der Anfragen nach Informationen durch die Rückgabe von FHIR-Ressourcen, die den gegebenen Suchparametern entsprechen.
+
Transaktionen
+
QEDm definiert die Transaktion PCC-44 (Mobile Query for Existing Data), deren Grundlagen identisch sind mit den in ISiK definierten Interaktionen auf den Datenobjekten "Diagnose" "Prozedur" und "Kontakt/Fall".
+Der Unterschied zwischen QEDm und ISiK besteht lediglich darin, dass ISiK über die Vorgaben von PDQm hinaus die Implementierung weiterer Suchparameter fordert.
+
So beschränkt sich QEDm zum Beispiel auf die Encounter-Suchparameter patient und date, während ISiK auch die Suche nach der Fallnummer (identifier) und weiteren, für die einrichtungsinterne Kommunikation relevanten Kriterien unterstützt.
+
Abweichungen
+
Hersteller, die die ISiK-Vorgaben implementiert haben, können erwarten, dass ihre Systeme damit die Anforderungen von QEDm im Rahmen der oben genannten Optionen sowie PDQm vollständig erfüllen.
+
Sollten sich Abweichungen ergeben in dem Sinne, dass Hersteller, die ISiK implementiert und erfogreich bestätigt haben zusätzliche Funktionen implementieren müssen, um QEDm- bzw. PDQm-konform zu sein, so werden diese hier aufgelistet:
+
+
PDQm fordert die Implementierung des Suchparameters address-state. Dieser ist nicht Bestandteil der ISiK-Spezifikation
+
IHE fordert von Clinical Data Source- sowie Patient Demographic Supplier-Akteuren die Implementierung der Spezifikationen ATNA Secure Node oder ATNA Secure Application. Diese sind nicht Bestandteil des ISiK-Bestätigungsverfahrens.
+
+
+
+
+
Kompatibilität zu anderen nationalen FHIR-basierten Spezifikationen
+
Grundlage des ISiK-Leitfadens sind in Deutschland bereits abgestimmte und erprobte Profile, unter anderem:
Dennoch erstellt die gematik für die Durchführung des Verfahrens eigene, technisch unabhängige Profile. Dabei wird jedoch stets sichergestellt, dass Instanzen, die gegen gematik-Profile valide sind, ebenfalls gegen die zugrunde gelegten Profile valide sind. Ist dies ausnahmsweise nicht der Fall, dann enthalten die Profile der gematik einen entsprechenden Hinweis mit einer Begründung, warum von dem Profil abgewichen wurde bzw. eine Information darüber, welche Schritte notwendig sind, um die Kompatibilität herzustellen. Dies kann beispielsweise die zusätzliche Implementierung weiterer Elemente sein, die nicht Bestandteil des ISiK-Bestätigungsverfahrens sind, für die Erfüllung des zugrundeliegenden Profils jedoch notwendig sind. Bei der Betrachtung der Kompatibilität wird stets von Implementierungen ausgegangen, die exakt die Minimalanforderungen (Pflichtfelder, Must-Support-Felder) der gematik-Spezifikation umsetzen. Weiterhin ist die Betrachtung auf harte Inkompatibilitäten begrenzt, d.h. widersprüchliche Kardinalitäten oder abweichende Kodierungen. Auf ggf. abweichende Must-Support-Felder mit optionaler Kardinalität, die zu keiner technischen Inkompatibilität führen, wird nicht explizit hingewiesen.
+
Die Hinweise zur Kompatibilität sind jeweils im Unterkapitel "Kompatibilität" der einzelnen Datenobjekte zu finden.
+
Wichtig: Inkompatibilitäten, die sich dadurch ergeben, dass die KBV-Basisprofile und die Formularübergreifenden Vorgaben für Digitale Muster noch eine ältere Fassung der Deutschen Basisprofile (<1.0) verwenden, werden bei der Betrachtung der Kompatibilitäten nicht gesondert aufgeführt. Hierzu verweisen wir auf die Releasenotes der Deutschen Basisprofile. Ein Update dieser Profile auf die Version 1.0 ist seitens der KBV avisiert, zum Zeitpunkt der Veröffentlichung konnte jedoch noch kein konkreter Termin genannt werden.
+
Das Erfordernis der Erstellung eigener, unabhängiger Profile für ISiK ergibt sich aus folgenden Gründen:
+
+
Technische Gründe: Im Rahmen von Connectathons können kurzfristige Bugfixes erforderlich werden, die von der gematik umsetzbar sein müssen, ohne auf einen Beschluss/ein Update seitens der MI-Initiative oder der KBV warten zu müssen.
+
Tooling: Das von der gematik verwendete Tooling für die Bestätigung kann es erforderlich machen, dass Profile mit zusätzlichen Attributen/Extensions versehen werden müssen, die seitens anderer Organisationen nicht benötigt werden.
+
Darstellung: Für die Teilnehmer am Bestätigungsverfahren soll auf einen Blick erkennbar sein, welche Elemente der Profile für die Bestätigung relevant sind. Um dies zu vereinfachen, setzt die gematik sog. "Must-Support"-Flags ein, um die relevanten Merkmale hervorzuheben. Die Bedeutung des Must-Support-Flags und der Umfang der entsprechend markierten Elemente kann in anderen Szenarien abweichen. Da es sich beim Must-Support-Flags jedoch um rein informative Attribute handelt, deren Einhaltung im Rahmen der Validierung nicht maschinell überprüft werden kann, hat dies keinen Einfluss auf die Kompatibilität. Slices und Extensions, die in den zugrundeliegenden Profilen optional und nicht Bestandteil des Bestätigungsverfahrens sind, können in den gematik-Profilen weggelassen werden, um die Lesbarkeit zu verbessern. Auch diese haben keine Auswirkungen auf die Kompatibilität.
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new file mode 100644
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+
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+ Implementierungsleitfaden ISiK-Basismodul
+
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Kompatibilität zu anderen nationalen FHIR-basierten Spezifikationen
+
Grundlage des ISiK-Leitfadens sind in Deutschland bereits abgestimmte und erprobte Profile, unter anderem:
Dennoch erstellt die gematik für die Durchführung des Verfahrens eigene, technisch unabhängige Profile. Dabei wird jedoch stets sichergestellt, dass Instanzen, die gegen gematik-Profile valide sind, ebenfalls gegen die zugrunde gelegten Profile valide sind. Ist dies ausnahmsweise nicht der Fall, dann enthalten die Profile der gematik einen entsprechenden Hinweis mit einer Begründung, warum von dem Profil abgewichen wurde bzw. eine Information darüber, welche Schritte notwendig sind, um die Kompatibilität herzustellen. Dies kann beispielsweise die zusätzliche Implementierung weiterer Elemente sein, die nicht Bestandteil des ISiK-Bestätigungsverfahrens sind, für die Erfüllung des zugrundeliegenden Profils jedoch notwendig sind. Bei der Betrachtung der Kompatibilität wird stets von Implementierungen ausgegangen, die exakt die Minimalanforderungen (Pflichtfelder, Must-Support-Felder) der gematik-Spezifikation umsetzen. Weiterhin ist die Betrachtung auf harte Inkompatibilitäten begrenzt, d.h. widersprüchliche Kardinalitäten oder abweichende Kodierungen. Auf ggf. abweichende Must-Support-Felder mit optionaler Kardinalität, die zu keiner technischen Inkompatibilität führen, wird nicht explizit hingewiesen.
+
Die Hinweise zur Kompatibilität sind jeweils im Unterkapitel "Kompatibilität" der einzelnen Datenobjekte zu finden.
+
Wichtig: Inkompatibilitäten, die sich dadurch ergeben, dass die KBV-Basisprofile und die Formularübergreifenden Vorgaben für Digitale Muster noch eine ältere Fassung der Deutschen Basisprofile (<1.0) verwenden, werden bei der Betrachtung der Kompatibilitäten nicht gesondert aufgeführt. Hierzu verweisen wir auf die Releasenotes der Deutschen Basisprofile. Ein Update dieser Profile auf die Version 1.0 ist seitens der KBV avisiert, zum Zeitpunkt der Veröffentlichung konnte jedoch noch kein konkreter Termin genannt werden.
+
Das Erfordernis der Erstellung eigener, unabhängiger Profile für ISiK ergibt sich aus folgenden Gründen:
+
+
Technische Gründe: Im Rahmen von Connectathons können kurzfristige Bugfixes erforderlich werden, die von der gematik umsetzbar sein müssen, ohne auf einen Beschluss/ein Update seitens der MI-Initiative oder der KBV warten zu müssen.
+
Tooling: Das von der gematik verwendete Tooling für die Bestätigung kann es erforderlich machen, dass Profile mit zusätzlichen Attributen/Extensions versehen werden müssen, die seitens anderer Organisationen nicht benötigt werden.
+
Darstellung: Für die Teilnehmer am Bestätigungsverfahren soll auf einen Blick erkennbar sein, welche Elemente der Profile für die Bestätigung relevant sind. Um dies zu vereinfachen, setzt die gematik sog. "Must-Support"-Flags ein, um die relevanten Merkmale hervorzuheben. Die Bedeutung des Must-Support-Flags und der Umfang der entsprechend markierten Elemente kann in anderen Szenarien abweichen. Da es sich beim Must-Support-Flags jedoch um rein informative Attribute handelt, deren Einhaltung im Rahmen der Validierung nicht maschinell überprüft werden kann, hat dies keinen Einfluss auf die Kompatibilität. Slices und Extensions, die in den zugrundeliegenden Profilen optional und nicht Bestandteil des Bestätigungsverfahrens sind, können in den gematik-Profilen weggelassen werden, um die Lesbarkeit zu verbessern. Auch diese haben keine Auswirkungen auf die Kompatibilität.
+
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+ Implementierungsleitfaden ISiK-Basismodul
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Kompatibilität zu IHE-Profilen
+
Die ISiK-Spezifikationen werden basierend auf folgenden IHE-Profilen entwickelt:
Hierbei ist anzumerken, dass der Zusatz "for mobile" seitens IHE irreführend sein kann.
+Konkret fasst IHE unter diesem Begriff nicht nur Systeme zusammen, die "Plattform- und Ressourcenbeschränkt sind, wie z.B. Tablets, Smatphones und Embedded Devices, sondern auch größere Systeme in Umgebungen, in denen die Interoperabilitätsanforderungen einfach sind (z.B. Anzeige der aktuellen Übersicht eines Patienten)" (Quelle: IHE QEDm - Introduction)
+
Die im folgenden genannten IHE-Spezifikationen beschreiben lediglich Interaktionen zwischen den Systemen und machen verbindliche Vorgaben zum Ablauf, Format und zu den unterstützten Such-Parametern, jedoch keine inhaltlichen Vorgaben. So beschreibt PDQm beispielweise den Ablauf einer Suche nach Patientendaten, enthält aber keine Vereinbarungen, wie die zurückgelieferte Patientenressource konkret auszusehen hat (Pflichtfelder, Terminologien, Contraints).
+
Der Mehrwert der ISiK-Spezifikation besteht darin, dass die genannten IHE-Interaktionen um Festlegungen zu den auszutauschenden Inhalten ergänzt werden, die zugeschnitten sind auf die Anforderungen des Datenaustausches zwischen Systemen innerhalb einer Einrichtung, basierend auf den Deutschen Basisprofilen von HL7 Deutschland e.V. und abgeglichen mit den Festlegungen der KBV zu den Inhalten der elektronischen Patientenakte (MIOs) sowie den Spezifikationen der Medizininformatik-Initiative.
+
Die Darstellungen der in diesen IHE-Profilen festgelegten Interaktionen und UseCases sind den oben verlinkten Dokumenten zu entnehmen.
+
IHE PDQm
+
Umfang
+
PDQm unterstützt das Abfragen von demografischen Patientendaten.
+Damit fällt dieser Anwendungfall vollständig in den Umfang der Festlegungen von ISiK.
+
Akteure
+
PDQm definiert die Kommunikation zwischen zwei Akteuren:
+
+
dem Patient Demographics Consumer und
+
dem Patient Demographics Supplier
+
+
Im ISiK Kontext nehmen die bestätigungsrelevanten Systeme die Rolle des Patient Demographics Supplier ein.
+Die Pediatric Demographics Option liegt außerhalb des Abdeckungsbereiches von ISiK
+
Transaktionen
+
PDQm definiert die Transaktion ITI-78 (Mobile Patient Demographics Query), deren Grundlagen identisch sind mit den in ISiK definierten Interaktionen auf dem Datenobjekt "Patient".
+Der Unterschied zwischen PDQm und ISiK besteht lediglich darin, dass ISiK nicht alle in PDQm spezifizierten Suchparameter zwingend erfordert.
+Suchparameter, die in PDQm obligatorisch sind, in ISiK jedoch optional sind in diesem Leitfaden mit einem entsprechenden Hinweis versehen.
+
IHE QEDm
+
Umfang
+
QEDm unterstützt das Abfragen klinischer Informationen wie zum Beispiel Diagnosen, Beobachtungen (u.a. Vitalparamter), Messdaten und Allergien unter Verwendung des FHIR-Standards.
+Damit überlappt der Anwendunsfall von QEDm in großen Teilen mit den Festlegungen von ISiK
+
Akteuere
+
QEDm definiert die Kommunikation zwischen zwei Akteueren:
+
+
dem Clinical Data Consumer und
+
der Clinical Data Source
+
+
Im ISiK Kontext nehmen die bestätigungsrelevanten Systeme die Rolle der Clinical Data Source mit folgenden Optionen ein:
+
+
Conditions Option
+
Procedures Option
+
Encounters Option
+
+
alle weiteren Optionen liegen außerhalb des Abdeckungsbereiches von ISiK (in Stufe 1).
+
Die Aufgabe der Clinical Data Source liegt in der Beantwortung der Anfragen nach Informationen durch die Rückgabe von FHIR-Ressourcen, die den gegebenen Suchparametern entsprechen.
+
Transaktionen
+
QEDm definiert die Transaktion PCC-44 (Mobile Query for Existing Data), deren Grundlagen identisch sind mit den in ISiK definierten Interaktionen auf den Datenobjekten "Diagnose" "Prozedur" und "Kontakt/Fall".
+Der Unterschied zwischen QEDm und ISiK besteht lediglich darin, dass ISiK über die Vorgaben von PDQm hinaus die Implementierung weiterer Suchparameter fordert.
+
So beschränkt sich QEDm zum Beispiel auf die Encounter-Suchparameter patient und date, während ISiK auch die Suche nach der Fallnummer (identifier) und weiteren, für die einrichtungsinterne Kommunikation relevanten Kriterien unterstützt.
+
Abweichungen
+
Hersteller, die die ISiK-Vorgaben implementiert haben, können erwarten, dass ihre Systeme damit die Anforderungen von QEDm im Rahmen der oben genannten Optionen sowie PDQm vollständig erfüllen.
+
Sollten sich Abweichungen ergeben in dem Sinne, dass Hersteller, die ISiK implementiert und erfogreich bestätigt haben zusätzliche Funktionen implementieren müssen, um QEDm- bzw. PDQm-konform zu sein, so werden diese hier aufgelistet:
+
+
PDQm fordert die Implementierung des Suchparameters address-state. Dieser ist nicht Bestandteil der ISiK-Spezifikation
+
IHE fordert von Clinical Data Source- sowie Patient Demographic Supplier-Akteuren die Implementierung der Spezifikationen ATNA Secure Node oder ATNA Secure Application. Diese sind nicht Bestandteil des ISiK-Bestätigungsverfahrens.
+
+
+
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Anmerkungen zu den Must-Support Feldern
+
Encounter.status
+
Bedeutung: Der Status MUSS insbesondere zur Differenzierung von abgeschlossenen und derzeitig noch aktiven Kontakten angegeben werden. Alle in einem System möglichen Status-Werte müssen über FHIR korrekt repräsentiert werden können, mindestens jedoch die Status-Werte, "in-progress", "finished" und "cancelled". Deren korrekte Abbildung wird im Rahmen des Bestätigungsverfahrens überprüft.
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+ Implementierungsleitfaden ISiK-Basismodul
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Motivation
+
Informationen über die Kontakte des Patienten entlang seines Behandlungspfades im Krankenhaus sind ein wichtiger Bestandteil des einrichtungsinternen Datenaustausches.
+Sie ermöglichen die Unterscheidung von stationären und ambulanten sowie aufgenommenen und entlassenen Patienten.
+Weiterhin ist aus den Kontaktinformationen der aktuelle Aufenthaltsort des Patienten (Fachabteilung, Station, Bettplatz) ermittelbar.
+Klinische Ressourcen werden in FHIR durch Verlinkung auf die Encounter-Ressource in einen Kontext zum Einrichtungskontakt gestellt. Dieser Kontext ist wichtig für die Steuerung von Zugriffsberechtigungen und Abrechnungsprozessen.
+
Am Beginn der meisten klinischen Workflows steht die Auswahl des Fallkontextes. Dies geschieht bspw. durch Suchen der Encounter-Ressource anhand von Eigenschaften wie Aufnahmenummer, Fallart oder Aufnahmedatum. Daraufhin werden die zutreffenden Suchergebnisse angezeigt und der gewünschte Einrichtungskontakt ausgewählt.
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+ Implementierungsleitfaden ISiK-Basismodul
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An interaction during which services are provided to the patient
Alternate names
Visit
Definition
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
ISiK-enc-1: Abgeschlossene Kontakte sollten einen End-Zeitpunkt angeben status = 'finished' implies period.end.exists()
There are no (further) constraints on this element
Element id
Encounter.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Encounter.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Encounter.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Encounter.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Encounter.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.extension:Aufnahmegrund.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Encounter.extension:Aufnahmegrund.url
Short description
identifies the meaning of the extension
Definition
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Encounter.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
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.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.identifier:Aufnahmenummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Encounter.statusHistory
Short description
List of past encounter statuses
Definition
The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
+
Comments
The current status is always found in the current version of the resource, not the status history.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.statusHistory.period
Short description
The time that the episode was in the specified status
Definition
The time that the episode was in the specified status.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
+
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory
Short description
List of past encounter classes
Definition
The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
There are no (further) constraints on this element
Element id
Encounter.classHistory.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
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.
There are no (further) constraints on this element
Element id
Encounter.classHistory.period
Short description
The time that the episode was in the specified class
Definition
The time that the episode was in the specified class.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.serviceType
Short description
Specific type of service
Definition
Broad categorization of the service that is to be provided (e.g. cardiology).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.serviceType.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceType.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.priority
Short description
Indicates the urgency of the encounter
Definition
Indicates the urgency of the encounter.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.subject
Short description
The patient or group present at the encounter
Alternate names
patient
Definition
The patient or group present at the encounter.
+
Comments
While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Encounter.episodeOfCare
Short description
Episode(s) of care that this encounter should be recorded against
Definition
Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.basedOn
Short description
The ServiceRequest that initiated this encounter
Alternate names
incomingReferral
Definition
The request this encounter satisfies (e.g. incoming referral or procedure request).
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.participant.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.participant.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.participant.type
Short description
Role of participant in encounter
Definition
Role of participant in encounter.
+
Comments
The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
There are no (further) constraints on this element
Element id
Encounter.participant.period
Short description
Period of time during the encounter that the participant participated
Definition
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.participant.individual
Short description
Persons involved in the encounter other than the patient
Definition
Persons involved in the encounter other than the patient.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.appointment
Short description
The appointment that scheduled this encounter
Definition
The appointment that scheduled this encounter.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
qty-3: If a code for the unit is present, the system SHALL also be present code.empty() or system.exists()
drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM. code.exists() implies ((system = %ucum) and value.exists())
Mappings
rim: n/a
v2: SN (see also Range) or CQ
rim: PQ, IVL<PQ>, MO, CO, depending on the values
rim: PQ, IVL<PQ> depending on the values
workflow: Event.occurrence[x]
v2: (PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes
There are no (further) constraints on this element
Element id
Encounter.reasonCode
Short description
Coded reason the encounter takes place
Alternate names
Indication, Admission diagnosis
Definition
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
+
Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
workflow: Event.reasonCode
w5: FiveWs.why[x]
v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
There are no (further) constraints on this element
Element id
Encounter.reasonReference
Short description
Reason the encounter takes place (reference)
Alternate names
Indication, Admission diagnosis
Definition
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
+
Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.reasonCode
w5: FiveWs.why[x]
v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations )
There are no (further) constraints on this element
Element id
Encounter.diagnosis.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
+
Comments
For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.reasonReference
w5: FiveWs.why[x]
v2: Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.diagnosis.condition.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Definition
Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.account
Short description
The set of accounts that may be used for billing for this Encounter
Definition
The set of accounts that may be used for billing for this Encounter.
+
Comments
The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.hospitalization.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.hospitalization.origin
Short description
The location/organization from which the patient came before admission
Definition
The location/organization from which the patient came before admission.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
From where patient was admitted (physician referral, transfer)
Definition
From where patient was admitted (physician referral, transfer).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.reAdmission
Short description
The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission
Definition
Whether this hospitalization is a readmission and why if known.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.dietPreference
Short description
Diet preferences reported by the patient
Definition
Diet preferences reported by the patient.
+
Requirements
Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
+
Comments
For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
There are no (further) constraints on this element
Element id
Encounter.hospitalization.specialCourtesy
Short description
Special courtesies (VIP, board member)
Definition
Special courtesies (VIP, board member).
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.specialArrangement
Short description
Wheelchair, translator, stretcher, etc.
Definition
Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Encounter.hospitalization.destination
Short description
Location/organization to which the patient is discharged
Definition
Location/organization to which the patient is discharged.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.hospitalization.dischargeDisposition
Short description
Category or kind of location after discharge
Definition
Category or kind of location after discharge.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
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.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Encounter.location
Short description
List of locations where the patient has been
Definition
List of locations where the patient has been during this encounter.
+
Comments
Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
There are no (further) constraints on this element
Element id
Encounter.location.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location
Short description
Location the encounter takes place
Definition
The location where the encounter takes place.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.location.location.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.location.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.location.location.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.location.location.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Encounter.location.status
Short description
planned | active | reserved | completed
Definition
The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
+
Comments
When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
There are no (further) constraints on this element
Element id
Encounter.location.physicalType
Short description
The physical type of the location (usually the level in the location hierachy - bed room ward etc.)
Definition
This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
+
Comments
This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query.
+
There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
There are no (further) constraints on this element
Element id
Encounter.location.period
Short description
Time period during which the patient was present at the location
Definition
Time period during which the patient was present at the location.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider
Short description
The organization (facility) responsible for this encounter
Definition
The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Encounter.serviceProvider.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
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Motivation
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Die Landschaft informationstechnischer Systeme in Krankenhäusern ist enorm heterogen. Für die Patientenverwaltung und -abrechnung, die medizinische Dokumentation, die Laborverwaltung, die Blutbank bis hin zum Dokumentenarchiv werden verschiedene, auf das jeweilige Fachgebiet spezialisierte Systeme verwendet. Es besteht daher der Bedarf, diese Systeme über ihren Primärzweck hinaus sinnvoll zu integrieren. Ein Szenario ist beispielsweise die Abrechnung der im Krankenhaus erbrachten Leistungen. Aus den ursprünglich in verschiedenen Spezialsystemen erfassten Informationen werden die für die Abrechnung relevanten Informationen an ein Abrechnungssystem gesendet und dort zur Rechnungslegung weiterverarbeitet.
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Herausforderungen stellen dabei die Vielzahl der Schnittstellen von informationstechnischen Systemen im Krankenhaus sowie zusätzliche Anforderungen für die Nutzung in mobilen Anwendungen dar. Durch die Festlegung und Verwendung von offenen und standardisierten Schnittstellen können diese Herausforderungen effizienter angenommen werden.
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Im Folgenden leiten wir - die gematik GmbH - her, warum die bestehenden Integrationsansätze im Krankenhaus noch unzureichend sind und durch die im Bestätigungsverfahren „Interoperabler Datenaustausch durch Informationssysteme im Krankenhaus“ (ISiK) spezifizierten Ansätze ergänzt werden, um die Vielzahl sinnvoller Integrationsszenarien effizient abzudecken.
+
Reaktiver Datenaustausch im Krankenhaus
+
Der aktuell in Krankenhäusern vorherrschende Integrationsansatz nach dem Standard HL7 Version 2 (HL7v2) sieht vor, dass fachdomänenspezifische Systeme Nachrichten versenden, sobald für andere Systeme interessante Ereignisse eintreten. Bei Anlegen einer Diagnose in einem System für medizinische Dokumentation wird beispielsweise eine entsprechende Nachricht versendet, die vom Abrechnungssystem konsumiert und in der Rechnungslegung berücksichtigt wird. Für diesen Ansatz ist es nötig, dass die konsumierenden Systeme direkt auf die für sie passenden Nachrichten reagieren können. Leider werden dieselben Inhalte in verschiedenen Krankenhäusern oft unterschiedlich in HL7v2-Nachrichten kodiert. Darum wird häufig ein Kommunikationsserver verwendet, der die krankenhausspezifischen Nachrichten in ein Format übersetzt, dass die konsumierenden Systeme verarbeiten können. Erst wenn diese Übersetzung der HL7v2 Nachrichten eingerichtet ist, können Daten zwischen den Systemen ausgetauscht werden.
+
Daraus ergeben sich einige relevante Nachteile.
+
+
Es ist nur eine im Voraus definierte Datenverarbeitung möglich. Es müssen Verarbeitungsregeln im Kommunikationsserver festgelegt werden, die empfangene HL7v2-Nachrichten zur Weiterverarbeitung in ein geeignetes Format überführen.
+
Es können keine HL7v2-Nachrichten genutzt werden, die vor Aktivierung der Verarbeitungsregeln im Krankenhaus versandt wurden. Damit bleibt ein großer Teil der verfügbaren Daten des Krankenhauses ungenutzt.
+
Gerade große Krankenhäuser müssen tausende dieser Verarbeitungsregeln verwalten. So wird der Überblick erschwert und nicht mehr benötigte Regeln belasten den Kommunikationsserver.
+
+
Daher hat der Gesetzgeber im Patientendaten-Schutzgesetz (PDSG) der gematik den Auftrag erteilt, offene und standardisierte Schnittstellen zu spezifizieren, die über den reaktiven Datenaustausch hinaus einen bedarfsgerechten Datenaustausch ermöglichen. Die Einhaltung dieser Spezifikation wird in dem ISiK Bestätigungsverfahren geprüft. Die Beschreibung des Bestätigungsverfahrens ist nicht Inhalt dieses Implementierungsleitfadens und wird im Fachportal der gematik erfolgen (https://fachportal.gematik.de/).
+
Bedarfsgerechter Datenaustausch im Krankenhaus
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Um die oben skizzierten Nachteile zu vermeiden, wird in diesem Leitfaden ein bedarfsgerechter Datenaustausch im Krankenhaus spezifiziert. Benötigte Daten werden zum gewünschten Zeitpunkt im nötigen Umfang angefragt und zur Verfügung gestellt. So sind prinzipiell alle Daten eines Krankenhauses nutzbar, auch wenn sie lange vor dem Bedarf zur Nachnutzung erhoben wurden. Es müssen keine statischen Verarbeitungsregeln in einer Drittsoftware - dem Kommunikationsserver - verwaltet werden. Diese Art des bedarfsgerechten Datenaustausches wird in ISiK durch den internationalen HL7-Standard FHIR in seiner aktuellen Version R4 realisiert. Dabei folgt die Kommunikation dem Architekturstil Representational State Transfer - REST - auf dem auch wesentliche Teile der Kommunikation im Internet und mit mobilen Geräten im Besonderen basieren.
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Anwendungsfälle und Interaktionen
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Mit ISiK sollen eine Vielzahl digital unterstützter Anwendungsfälle im Krankenhaus realisiert werden. Dabei soll nicht die Vielfalt an möglichen Anwendungsfällen im Voraus komplett spezifiziert werden. Damit würde die Implementierung von ISiK durch zu enge und komplexe Vorgaben eher verhindert werden, gerade mit Blick auf zu erwartende zukünftige Anwendungsfälle.
+Das Ziel von ISiK ist es, digitale Interaktionen in den Anwendungsfällen zu identifizieren, für die eine Standardisierung besonders wertstiftend ist. Wertstiftend sind Interaktionen, die bspw. viele Anwendungsfälle unterstützen oder in einem Anwendungsfall einen besonders aufwändigen manuellen Schritt automatisieren.
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+ Implementierungsleitfaden ISiK-Basismodul
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Anmerkungen zu Must-Support-Feldern
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Patient.active
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Bedeutung: Indikator "Patientdatensatz ist in aktiver Benutzung"
hier ist zu beachten, dass die KBV im Patienten-Profil für Address.country ein "extensible"-Binding auf die DEÜV-Codes festlegt; dies weicht von der ISiK Verwendung von ISO-Codes ab
es MUSS der offizielle Name der Person angegeben werden (Angabe des Geburtsnamen nicht erlaubt)
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es MUSS die Straßenanschrift der Person angegeben werden (Angabe einer Postfach-Adresse nicht erlaubt)
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innerhalb der Straßenanschrift der Person MÜSSEN alle Zustell- oder Abholangabe in eine Adresszeile abgebildet werden
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+ Implementierungsleitfaden ISiK-Basismodul
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Motivation
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Der Austausch administrativer Patientendaten ist eine der grundlegenden Funktionalitäten beim Datenaustausch in der klinischen Versorgung.
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In FHIR werden sämtliche klinischen Ressourcen durch Verlinkung auf die Ressource 'Patient' in einen Patientenkontext gestellt.
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Die Herstellung des korrekten Patientenkontextes durch Suchen der Patientenressource anhand von Eigenschaften wie Aufnahmenummer, Name oder Geburtsdatum, die Anzeige der zutreffenden Suchergebnisse und der Auswahl bzw. Bestätigung des richtigen Datensatzes durch den Anwender steht am Beginn der meisten klinischen Workflows.
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+ Implementierungsleitfaden ISiK-Basismodul
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dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
isik-pat-1: Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
There are no (further) constraints on this element
Element id
Patient.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Patient.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Patient.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Patient.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
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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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Patient.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Patient.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
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Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
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Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
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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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
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Requirements
Allows users to make use of identifiers when the identifier system is not known.
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Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
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Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
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Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
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Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.identifier:VersichertenId-GKV.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
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Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
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Requirements
Allows users to make use of identifiers when the identifier system is not known.
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Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
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Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
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Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
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Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.identifier:Patientennummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
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Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
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Requirements
Allows users to make use of identifiers when the identifier system is not known.
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Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
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Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Patient.identifier:Versichertennummer_PKV.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
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Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
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Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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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.
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
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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.
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
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The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
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Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
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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.
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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
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Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.
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Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Patient.active
Short description
Whether this patient's record is in active use
Definition
Whether this patient record is in active use.
+Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules.
+
It is often used to filter patient lists to exclude inactive patients
+
Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
+
Requirements
Need to be able to mark a patient record as not to be used because it was created in error.
+
Comments
If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
+
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
In order to maintain the differntiations of name parts as given in the VSDM dataset or qualify prefixes as academic titles, vendors can opt to support the extensions specified in the German HumanName Base Profile https://simplifier.net/basisprofil-de-r4/humannamedebasis
+This is however not required within the scope of this specification.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Patient.name:Name.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Name.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.name:Name.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Patient.name:Name.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Patient.name:Name.prefix.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Name.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Patient.name:Geburtsname.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.telecom
Short description
A contact detail for the individual
Definition
A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
There are no (further) constraints on this element
Element id
Patient.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
+
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
Patient.telecom.period
Short description
Time period when the contact point was/is in use
Definition
Time period when the contact point was/is in use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.gender
Short description
male | female | other | unknown
Definition
Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
+
Requirements
Needed for identification of the individual, in combination with (at least) name and birth date.
+
Comments
The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
There are no (further) constraints on this element
Element id
Patient.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Patient.birthDate
Short description
The date of birth for the individual
Definition
The date of birth for the individual.
+
Requirements
Age of the individual drives many clinical processes.
+
Comments
At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
There are no (further) constraints on this element
Element id
Patient.birthDate.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Provides a reason why the expected value or elements in the element that is extended are missing.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
There are no (further) constraints on this element
Element id
Patient.birthDate.value
Short description
Primitive value for date
Definition
Primitive value for date
+
Data type
System.Date
deceased[x]
Σ?!
0..1
There are no (further) constraints on this element
Element id
Patient.deceased[x]
Short description
Indicates if the individual is deceased or not
Definition
Indicates if the individual is deceased or not.
+
Requirements
The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
+
Comments
If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: PID-30 (bool) and PID-29 (datetime)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Strassenanschrift.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Patient.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.extension:Stadtteil
Short description
Stadt- oder Ortsteil
Alternate names
extensions, user content
Definition
A subsection of a municipality.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Patient.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
address-cnt-2or3-char: The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2. country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
Mappings
rim: n/a
v2: XAD.6
rim: AD.part[parttype = CNT]
vcard: country
servd: ./Country
BDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
KVDT: 3114 oder 3124 (Postfach), abweichendes CodeSystem
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Patient.maritalStatus
Short description
Marital (civil) status of a patient
Definition
This field contains a patient's most recent marital (civil) status.
+
Requirements
Most, if not all systems capture it.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CE/CNE/CWE
rim: CD
orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
v2: PID-16
rim: player[classCode=PSN]/maritalStatusCode
cda: .patient.maritalStatusCode
multipleBirth[x]
0..1
There are no (further) constraints on this element
Element id
Patient.multipleBirth[x]
Short description
Whether patient is part of a multiple birth
Definition
Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
+
Requirements
For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
+
Comments
Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: PID-24 (bool), PID-25 (integer)
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
There are no (further) constraints on this element
Element id
Patient.contact
Short description
A contact party (e.g. guardian, partner, friend) for the patient
Definition
A contact party (e.g. guardian, partner, friend) for the patient.
+
Requirements
Need to track people you can contact about the patient.
+
Comments
Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
pat-1: SHALL at least contain a contact's details or a reference to an organization name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings
rim: n/a
rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
There are no (further) constraints on this element
Element id
Patient.contact.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.contact.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Patient.contact.relationship
Short description
The kind of relationship
Definition
The nature of the relationship between the patient and the contact person.
+
Requirements
Used to determine which contact person is the most relevant to approach, depending on circumstances.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Patient.contact.name
Short description
A name associated with the contact person
Definition
A name associated with the contact person.
+
Requirements
Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
There are no (further) constraints on this element
Element id
Patient.contact.telecom
Short description
A contact detail for the person
Definition
A contact detail for the person, e.g. a telephone number or an email address.
+
Requirements
People have (primary) ways to contact them in some way such as phone, email.
+
Comments
Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
There are no (further) constraints on this element
Element id
Patient.contact.address
Short description
Address for the contact person
Definition
Address for the contact person.
+
Requirements
Need to keep track where the contact person can be contacted per postal mail or visited.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Patient.contact.organization
Short description
Organization that is associated with the contact
Definition
Organization on behalf of which the contact is acting or for which the contact is working.
+
Requirements
For guardians or business related contacts, the organization is relevant.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.contact.period
Short description
The period during which this contact person or organization is valid to be contacted relating to this patient
Definition
The period during which this contact person or organization is valid to be contacted relating to this patient.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Patient.communication
Short description
A language which may be used to communicate with the patient about his or her health
Definition
A language which may be used to communicate with the patient about his or her health.
+
Requirements
If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
+
Comments
If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
There are no (further) constraints on this element
Element id
Patient.communication.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.communication.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Patient.communication.language
Short description
The language which can be used to communicate with the patient about his or her health
Definition
The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
+
Requirements
Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
+
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
There are no (further) constraints on this element
Element id
Patient.communication.preferred
Short description
Language preference indicator
Definition
Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
+
Requirements
People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
+
Comments
This language is specifically identified for communicating healthcare information.
There are no (further) constraints on this element
Element id
Patient.generalPractitioner
Short description
Patient's nominated primary care provider
Alternate names
careProvider
Definition
Patient's nominated care provider.
+
Comments
This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources.
+Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.
+
Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.managingOrganization
Short description
Organization that is the custodian of the patient record
Definition
Organization that is the custodian of the patient record.
+
Requirements
Need to know who recognizes this patient record, manages and updates it.
+
Comments
There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Patient.link.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Patient.link.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
isik-pat-1
error
Falls die Geschlechtsangabe 'other' gewählt wird, muss die amtliche Differenzierung per Extension angegeben werden
gender.exists() and gender='other' implies gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').exists()
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
+
address-cnt-2or3-char
warning
The content of the country element (if present) SHALL be selected EITHER from ValueSet ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2 OR MAY be selected from ISO Country Alpha-3 Value Set http://hl7.org/fhir/ValueSet/iso3166-1-3, IF the country is not specified in value Set ISO Country Alpha-2 http://hl7.org/fhir/ValueSet/iso3166-1-2.
country.empty() or (country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-2') or country.memberOf('http://hl7.org/fhir/ValueSet/iso3166-1-3'))
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_AnmerkungenZuDenMustSupportFeldern.html b/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_AnmerkungenZuDenMustSupportFeldern.html
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+ Implementierungsleitfaden ISiK-Basismodul
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Anmerkungen zu den Must-Support-Feldern
+
Practitioner.identifier:ANR
+
Bedeutung: Lebenslange Arztnummer. Im Krankenhaus ist die Lebenslange Arztnummer der Ärzte bekannt und MUSS zur eindeutigen Identifikation eines Arztes bereitgestellt werden.
Während die Deutschen Basisprofile hier die Abkürzung LANR verwenden, ist im KBV-Kontext das Akronym ANR gebräuchlich. Die Bezeichnung des Slices hat jedoch keinerlei Auswirkungen auf die Kompatibilität.
+
Practitioner.name:name
+
Bedeutung: Vollständiger Name. Der Name des Arztes MUSS in konkreten Anwendungen angezeigt werden können. Es MUSS nach dem Namen des Arztes gesucht werden können.
+
Practitioner.gender
+
Bedeutung: Administratives Geschlecht. Ist das Geschlecht des Arztes bekannt, MUSS es bereitgestellt werden.
+
Practitioner.birthDate
+
Bedeutung: Geburtsdatum. Ist das Geburtsdatum des Arztes bekannt, MUSS es bereitgestellt werden.
+
Practitioner.qualification
+
Bedeutung: Ärztliche Qualifikation(en). Es MÜSSEN die Qualifikationen des Arztes bereitgestellt werden, um nach Ärzten einer Qualifikation zu suchen oder sie bspw. in Dokumenten anzuzeigen.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_Beispiele.html b/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_Beispiele.html
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+ Implementierungsleitfaden ISiK-Basismodul
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das Element address mindestens einmal vorhanden ist
+
das Element birthDate vorhanden ist und
+
das Element qualification vorhanden ist
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_Motivation.html b/IG/1.0.10/ImplementationGuide-markdown-PersonImGesundheitsberuf_Motivation.html
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Motivation
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PersonImGesundheitsberuf können alle denkbaren medizinischen Fachexperten sein, die in ISiK-Interaktionen eine Rolle spielen. In den ISiK-FHIR-Profilen können PersonImGesundheitsberuf bspw. als Ausführende einer Prozedur auftreten, im Element performer der Procedure Ressource, oder als die Person, die eine Diagnose stellt, im Element asserter der Condition Ressource.
+
In FHIR werden PersonImGesundheitsberuf mit der Practitioner-Ressource repräsentiert.
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dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
prac-de-1: Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist gender='other' or gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').empty()
There are no (further) constraints on this element
Element id
Practitioner.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Practitioner.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Practitioner.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Practitioner.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Practitioner.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:Arztnummer.assigner.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
Requirements
Often, specific identities are assigned for the agent.
+
Comments
In bestimmten KIS wird keine EFN geführt, da diese aus Compliance-Gründen getrennt in HR-Systemen vorgehalten wird (Hinweis kam von Stakeholder), daher soll der entsprechende Test im Test-System mit "warningOnly" ausgegeben werden.
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Practitioner.identifier:EFN.assigner.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.active
Short description
Whether this practitioner's record is in active use
Definition
Whether this practitioner's record is in active use.
+
Requirements
Need to be able to mark a practitioner record as not to be used because it was created in error.
+
Comments
If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.
+
Meaning when missing
This resource is generally assumed to be active if no value is provided for the active element
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.
+
In general, select the value to be used in the ResourceReference.display based on this:
+
+
There is more than 1 name
+
Use = usual
+
Period is current to the date of the usage
+
Use = official
+
Other order as decided by internal business rules.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Practitioner.name:Name.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.family.extension:nachname
Short description
Nachname ohne Vor- und Zusätze
Alternate names
extensions, user content
Definition
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.prefix.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Name.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Personenname mit in Deutschland üblichen Erweiterungen
+
Requirements
The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.
+
Comments
Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts may or may not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
hum-1: Wenn die Extension 'namenszusatz' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://fhir.de/StructureDefinition/humanname-namenszusatz').empty() or family.hasValue()
hum-2: Wenn die Extension 'nachname' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-name').empty() or family.hasValue()
hum-3: Wenn die Extension 'vorsatzwort' verwendet wird, dann muss der vollständige Name im Attribut 'family' angegeben werden family.extension('http://hl7.org/fhir/StructureDefinition/humanname-own-prefix').empty() or family.hasValue()
hum-4: Wenn die Extension 'prefix-qualifier' verwendet wird, dann muss ein Namenspräfix im Attribut 'prefix' angegeben werden prefix.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier').empty() or $this.hasValue())
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.text
Short description
Text representation of the full name
Definition
Specifies the entire name as it should be displayed e.g. on an application UI. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating a name SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.family.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Namenszusatz als Bestandteil das Nachnamens, wie in VSDM (Versichertenstammdatenmanagement, "eGK") definiert.
+Beispiele: Gräfin, Prinz oder Fürst
+
Comments
Die Extension wurde erstellt aufgrund der Anforderung, die auf der eGK vorhandenen Patientenstammdaten in FHIR abbilden zu können. Auf der eGK werden die Namensbestandteile "Namenszusatz" und "Vorsatzwort" getrennt vom Nachnamen gespeichert. Anhand der Liste der zulässigen Namenszusätze ist deutlich erkennbar, dass es sich hierbei sinngemäß um Adelstitel handelt.
+Das Vorsatzwort kann durch die Core-Extension own-prefix (Canonical: http://hl7.org/fhir/StructureDefinition/humanname-own-prefix) abgebildet werden, für den Namenszusatz ergibt sich jedoch die Notwendikeit einer nationalen Extension, da in andern Ländern Adelstitel entweder gar nicht oder als reguläres Namenspräfix erfasst werden.
Nachname ohne Vor- und Zusätze.
+Dient z.B. der alphabetischen Einordnung des Namens.
+
Comments
If the person's surname has legally changed to become (or incorporate) the surname of the person's partner or spouse, this is the person's surname immediately prior to such change. Often this is the person's "maiden name".
Vorsatzwort wie z.B.: von, van, zu
+Vgl. auch VSDM-Spezifikation der Gematik (Versichertenstammdatenmanagement, "eGK")
+
Comments
An example of a voorvoegsel is the "van" in "Ludwig van Beethoven". Since the voorvoegsel doesn't sort completely alphabetically, it is reasonable to specify it as a separate sub-component.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.given
Short description
Vorname
Alternate names
first name, middle name
Definition
Vorname der Person
+
Comments
If only initials are recorded, they may be used in place of the full name parts. Initials may be separated into multiple given names but often aren't due to paractical limitations. This element is not called "first name" since given names do not always come first.
There are no (further) constraints on this element
Element id
Practitioner.name:Geburtsname.period
Short description
Time period when name was/is in use
Definition
Indicates the period of time when this name was valid for the named person.
+
Requirements
Allows names to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.telecom
Short description
A contact detail for the practitioner (that apply to all roles)
Definition
A contact detail for the practitioner, e.g. a telephone number or an email address.
+
Requirements
Need to know how to reach a practitioner independent to any roles the practitioner may have.
+
Comments
Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.
There are no (further) constraints on this element
Element id
Practitioner.telecom.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.telecom.rank
Short description
Specify preferred order of use (1 = highest)
Definition
Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
+
Comments
Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
There are no (further) constraints on this element
Element id
Practitioner.telecom.period
Short description
Time period when the contact point was/is in use
Definition
Time period when the contact point was/is in use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
Address(es) of the practitioner that are not role specific (typically home address)
Definition
Address(es) of the practitioner that are not role specific (typically home address).
+Work addresses are not typically entered in this property as they are usually role dependent.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
In order to differentiate between post box addresses and physical addresses, street names and house numbers, and to add city district names, vendors can opt to support the extensions as suggested in the German Address Base Profile http://fhir.de/StructureDefinition/address-de-basis.
+Such differentiations are however not required within the scope of this specification.
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Strassenanschrift.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Eine Adresse gemäß postalischer Konventionen (im Gegensatz zu bspw. GPS-Koordinaten). Die Adresse kann sowohl zur Zustellung von Postsendungen oder zum Aufsuchen von Orten, die keine gültige Postadresse haben, verwendet werden.
+
Die verwendeten Extensions in diesem Profil bilden die Struktur der Adresse ab, wie sie im VSDM-Format der elektronischen Versichertenkarte verwendet wird.
+
Insbesondere bei ausländischen Adresse oder Adressen, die nicht durch Einlesen einer elektronischen Versichertenkarte erfasst wurden, sind abweichende Strukturen möglich. Die Verwendung der Extensions ist nicht verpflichtend.
+
Requirements
The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.
+
Comments
Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
add-1: Wenn die Extension 'Hausnummer' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty() or $this.hasValue())
add-2: Wenn die Extension 'Strasse' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() or $this.hasValue())
add-3: Wenn die Extension 'Postfach' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue())
add-4: Eine Postfach-Adresse darf nicht vom Type "physical" oder "both" sein. line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or $this.hasValue()) or type='postal' or type.empty()
add-5: Wenn die Extension 'Adresszusatz' verwendet wird, muss auch Address.line gefüllt werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-additionalLocator').empty() or $this.hasValue())
add-6: Wenn die Extension 'Postfach' verwendet wird, dürfen die Extensions 'Strasse' und 'Hausnummer' nicht verwendet werden line.all($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-postBox').empty() or ($this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-streetName').empty() and $this.extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-houseNumber').empty()))
add-7: Wenn die Extension 'Precinct' (Stadtteil) verwendet wird, dann muss diese Information auch als separates line-item abgebildet sein. extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').empty() or all(line contains extension('http://hl7.org/fhir/StructureDefinition/iso21090-ADXP-precinct').value.ofType(string))
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.type
Short description
postal | physical | both
Definition
Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
+
Comments
The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.text
Short description
Text representation of the address
Definition
Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
+
Requirements
A renderable, unencoded form.
+
Comments
Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.line
Short description
Straßenname mit Hausnummer oder Postfach sowie weitere Angaben zur Zustellung
Definition
Diese Komponente kann Straßennamen, Hausnummer, Appartmentnummer, Postfach, c/o sowie weitere Zustellungshinweise enthalten. Die Informationen können in mehrere line-Komponenten aufgeteilt werden.
+Bei Verwendung der Extensions, um Straße, Hausnnummer und Postleitzahl strukturiert zu übermitteln, müssen diese Informationen stets vollständig auch in der line-Komponente, die sie erweitern, enthalten sein, um es Systemen, die diese Extensions nicht verwenden zu ermöglichen, auf diese Informationen zugreifen zu können.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.line.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Strassenname (ohne Hausnummer)
+Bei Angabe einer Strasse in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Hausnummer, sowie Zusätze (Appartmentnummer, Etage...)
+Bei Angabe einer Hausnummer in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Zusätzliche Informationen, wie z.B. "3. Etage", "Appartment C"
+Bei Angabe einer Zusatzinformation in dieser Extension muss diese auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+
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.
Postfach-Adresse.
+Bei Angabe eines Postfaches in dieser Extension muss das Postfach auch in Address.line angegeben werden um die Interoperabilität mit Systemen zu gewährleisten, die diese Extension nicht verwenden.
+Eine Postfach-Adresse darf nicht in Verbindung mit Address.type "physical" oder "both" verwendet werden.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.district
Short description
District name (aka county)
Alternate names
County
Definition
The name of the administrative area (county).
+
Comments
District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.country
Short description
Staat
Definition
Staat (vorzugsweise als 2-Stelliger ISO-Ländercode).
+Es obliegt abgeleiteten Profilen, hier die Verwendung der ISO-Ländercodes verbindlich vorzuschreiben
+
Comments
ISO 3166 3 letter codes can be used in place of a human readable country name.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period
Short description
Time period when address was/is in use
Definition
Time period when address was/is in use.
+
Requirements
Allows addresses to be placed in historical context.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.address:Postfach.period.end
Short description
End time with inclusive boundary, if not ongoing
Definition
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
There are no (further) constraints on this element
Element id
Practitioner.gender.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Source of the definition for the extension code - a logical name or a URL.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
gender-amtlich-1: Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist %resource.where(gender='other').exists()
There are no (further) constraints on this element
Element id
Practitioner.birthDate.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Provides a reason why the expected value or elements in the element that is extended are missing.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.photo
Short description
Image of the person
Definition
Image of the person.
+
Requirements
Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.
+
Comments
When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".
There are no (further) constraints on this element
Element id
Practitioner.qualification
Short description
Certification, licenses, or training pertaining to the provision of care
Definition
The official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.
There are no (further) constraints on this element
Element id
Practitioner.qualification.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.qualification.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Practitioner.qualification.code
Short description
Coded representation of the qualification
Definition
Coded representation of the qualification.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Practitioner.qualification.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Practitioner.qualification.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Practitioner.qualification.period
Short description
Period during which the qualification is valid
Definition
Period during which the qualification is valid.
+
Requirements
Qualifications are often for a limited period of time, and can be revoked.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Practitioner.qualification.issuer
Short description
Organization that regulates and issues the qualification
Definition
Organization that regulates and issues the qualification.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Practitioner.communication
Short description
A language the practitioner can use in patient communication
Definition
A language the practitioner can use in patient communication.
+
Requirements
Knowing which language a practitioner speaks can help in facilitating communication with patients.
+
Comments
The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Folgende FHIRPath-Constraints sind im Profil zu beachten:
+
key
severity
human
expression
prac-de-1
error
Die amtliche Differenzierung der Geschlechtsangabe 'other' darf nur gefüllt sein, wenn das Geschlecht 'other' angegeben ist
gender='other' or gender.extension('http://fhir.de/StructureDefinition/gender-amtlich-de').empty()
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Anmerkungen zu den Must-Support Feldern
+
Procedure.extension:recordedDate
+
Bedeutung:
+Das Dokumentationsdatum der Prozedur MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein.
+
Procedure.status
+
Bedeutung:
+Kodierter klinischer Status der Prozedur. MUSS angegeben werden, da die Interpretation der Prozedur davon abhängt ob diese 'completed' ist oder einen anderen Status aufweist.
+
Procedure.category
+
Bedeutung:
+Zur groben Kategorisierung MUSS eine Kodierung auf Basis der OPS-Klassencodes erfolgen. Eine ConceptMap für das Mapping von OPS-Kodes -> Kategorie findet sich in den Deutschen Basisprofilen - Implementierungsleitfaden Abschnitt Terminologien. Die Angabe der Kategeorie MUSS nur für OPS-kodierte Prozeduren erfolgen.
+
Procedure.code.coding
+
Bedeutung: Codierte Prozedur. Entweder kodiert per OPS oder SNOMED CT. Bei der Kodierung per SNOMED CT ist das ValueSet ProzedurenCodes-SCT zu beachten.
+
Procedure.code.text
+
Bedeutung: Freitext-Beschreibung der Prozedur
+
Procedure.performed
+
Bedeutung: Zur zeitlichen Einordnung der Prozedur KANN das Durchführungsdatum der Prozedur dokumentiert werden. Mindestens MUSS der Beginn der Prozedur dokumentiert werden, das Ende KANN implementiert werden.
+
Procedure.subject
+
Bedeutung: Ein Patientenbezug der Prozedur MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
+
Procedure.note
+
Bedeutung: Weitere optionale Freitext-Notizen bezogen auf die durchgeführte Prozedur.
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wenn unter Procedure.code.coding mindestens eine codierte Darstellung der Prozedur angegeben wurde
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Motivation
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Die Möglichkeit, auf eine Übersicht der Prozeduren eines Patienten zuzugreifen, Patienten anhand durchgeführter oder geplanter Prozeduren zu suchen, oder zu prüfen, ob eine konkrete Prozedur bei einem Patienten durchgeführt wurde, sind wichtige Funktionen im klinischen Behandlungsablauf.
+
In FHIR werden Prozeduren mit der Procedure-Ressource repräsentiert.
+
Da die Prozeduren in klinischen Primärsystemen in der Regel in OPS-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches.
+Falls eine Prozedur zwar dokumentiert aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), ist alternativ eine Repräsentation als Freitext-Prozedur möglich.
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An action that is being or was performed on a patient
Definition
An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
proc-ISiK-1: Falls die Prozedur per OPS kodiert wird, MUSS eine SNOMED-CT kodierte Category abgebildet werden code.coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists() implies category.coding.where(system = 'http://snomed.info/sct').exists()
proc-ISiK-2: Falls eine codierte Prozedur vorliegt MUSS eine kodierte Category abgebildet werden code.coding.exists() implies category.coding.exists()
There are no (further) constraints on this element
Element id
Procedure.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Procedure.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Procedure.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Procedure.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Procedure.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Dokumentationsdatum der Prozedur, falls abweichend vom Durchführungsdatum
+
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.
There are no (further) constraints on this element
Element id
Procedure.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Procedure.identifier
Short description
External Identifiers for this procedure
Definition
Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.
+
Requirements
Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
+
Comments
This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
servd: Identifier
workflow: Event.identifier
w5: FiveWs.identifier
v2: Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4
There are no (further) constraints on this element
Element id
Procedure.instantiatesUri
Short description
Instantiates external protocol or definition
Definition
The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
+
Comments
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
There are no (further) constraints on this element
Element id
Procedure.basedOn
Short description
A request for this procedure
Alternate names
fulfills
Definition
A reference to a resource that contains details of the request for this procedure.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.basedOn
rim: .outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code
There are no (further) constraints on this element
Element id
Procedure.partOf
Short description
Part of referenced event
Alternate names
container
Definition
A larger event of which this particular procedure is a component or step.
+
Comments
The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.partOf
rim: .inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
+
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.
There are no (further) constraints on this element
Element id
Procedure.statusReason
Short description
Reason for current status
Alternate names
Suspended Reason, Cancelled Reason
Definition
Captures the reason for the current state of the procedure.
+
Comments
This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
There are no (further) constraints on this element
Element id
Procedure.category
Short description
Classification of the procedure
Definition
A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.category.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.category.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Procedure.category.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
+
Requirements
0..1 to account for primarily narrative only resources.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
sct-ops-1: Falls die Prozedur kodiert vorliegt, SOLL mindestens ein OPS oder SNOMED-CT Code angegeben werden. Liegt die Prozedur nicht kodiert vor SOLL Freitext angegeben werden. coding.exists() implies coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()
proc-ISiK-3: Entweder MUSS eine kodierte Prozedur vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt. coding.exists().not() implies text.exists()
There are no (further) constraints on this element
Element id
Procedure.code.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
A reference to a code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Optional Extension Element - found in all resources.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.system
Short description
Canonische CodeSystem URL für OPS
Definition
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.version
Short description
Die Jahresversion des OPS Kataloges. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Definition
Bie Verwendung von OPS ist die Angabe der Version zwingend erforderlich.
+Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von OPS ein neues Codesystem darstellt.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.code
Short description
Der OPS-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).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.code.coding:OPS.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.code
Short description
Symbol in syntax defined by the system
Definition
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Procedure.code.coding:SNOMED-CT.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Procedure.code.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Procedure.subject
Short description
Who the procedure was performed on
Alternate names
patient
Definition
The person, animal or group on which the procedure was performed.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.subject.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.subject.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Procedure.subject.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Procedure.subject.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Procedure.subject.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Procedure.encounter
Short description
Encounter created as part of
Definition
The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
+
Comments
This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performed[x]
Short description
When the procedure was performed
Definition
Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.
+
Comments
Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
+
Constraints
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
There are no (further) constraints on this element
Element id
Procedure.recorder
Short description
Who recorded the procedure
Definition
Individual who recorded the record and takes responsibility for its content.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.asserter
Short description
Person who asserts this procedure
Definition
Individual who is making the procedure statement.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performer.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.performer.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Procedure.performer.function
Short description
Type of performance
Definition
Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.
+
Requirements
Allows disambiguation of the types of involvement of different performers.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.performer.actor
Short description
The reference to the practitioner
Definition
The practitioner who was involved in the procedure.
+
Requirements
A reference to Device supports use cases, such as pacemakers.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.performer.onBehalfOf
Short description
Organization the device or practitioner was acting for
Definition
The organization the device or practitioner was acting on behalf of.
+
Requirements
Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.location
Short description
Where the procedure happened
Definition
The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.
+
Requirements
Ties a procedure to where the records are likely kept.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.reasonCode
Short description
Coded reason procedure performed
Definition
The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.
+
Comments
Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
There are no (further) constraints on this element
Element id
Procedure.reasonReference
Short description
The justification that the procedure was performed
Definition
The justification of why the procedure was performed.
+
Comments
It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use).
+Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.bodySite
Short description
Target body sites
Definition
Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
+
Comments
If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.
There are no (further) constraints on this element
Element id
Procedure.report
Short description
Any report resulting from the procedure
Definition
This could be a histology result, pathology report, surgical report, etc.
+
Comments
There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.complication
Short description
Complication following the procedure
Definition
Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
+
Comments
If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.
There are no (further) constraints on this element
Element id
Procedure.complicationDetail
Short description
A condition that is a result of the procedure
Definition
Any complications that occurred during the procedure, or in the immediate post-performance period.
+
Requirements
This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Procedure.followUp
Short description
Instructions for follow up
Definition
If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.note
Short description
Additional information about the procedure
Definition
Any other notes and comments about the procedure.
+
Comments
For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).
There are no (further) constraints on this element
Element id
Procedure.focalDevice
Short description
Manipulated, implanted, or removed device
Definition
A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.action
Short description
Kind of change to device
Definition
The kind of change that happened to the device during the procedure.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Procedure.focalDevice.manipulated
Short description
Device that was changed
Definition
The device that was manipulated (changed) during the procedure.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
rim: .participation[typeCode=DEV].role[classCode=MANU] or
+.participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
Falls die Prozedur kodiert vorliegt, SOLL mindestens ein OPS oder SNOMED-CT Code angegeben werden. Liegt die Prozedur nicht kodiert vor SOLL Freitext angegeben werden.
coding.exists() implies coding.where(system = 'http://snomed.info/sct').exists() or coding.where(system = 'http://fhir.de/CodeSystem/bfarm/ops').exists()
+
proc-ISiK-3
error
Entweder MUSS eine kodierte Prozedur vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.
coding.exists().not() implies text.exists()
+
+
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+
+
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+
+
+
+
+ Implementierungsleitfaden ISiK-Basismodul
+
+
+
+
+
+
+
+
+
+
+
+
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+
+
+
+
+
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+
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+
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+
+
Im Rahmen der ISiK-Veröffentlichungen wird das Semantic Versioning verwendet.
+
Die erste Ziffer X bezeichnet ein Major-Release und regelt die Gültigkeit von Releases. Die dritte Ziffer Y (Release x.0.y) bezeichnet eine technische Korrektur und versioniert kleinere Änderungen (Packages) während eines Jahres, z. B. 1.0.1.
+
Version: 1.0.10
+
Datum: 28.06.2023
+
+
Patient Example (Beispiel - erfordert keine Anpassung von Seiten der Implementierung)
+-Fixed identifier-Slicing of Type VersichertenId-GKV (MR entfernt)
+
+
+
Version: 1.0.9
+
Datum: 22.03.2023
+
+
Änderungen am IG
+
+
Hinweis Inkompatibilität zu KBV Basisprofile bei Patient.Address.country
+
Einschränkung der Umsetzungspflicht für Suchparameter vom Typ "Token" auf Datentypen "code", "Coding" oder "CodeableConcept"
In einigen Profilen wurden Reference-Elemente erweitert auf die Kernspezifikation (entspricht allgemeinem Design-Prinzip), damit die Profile auch außerhalb des ISiK-Kontextes nutzbar sind. Betroffene Profile sind:
+
+
ISiKVersicherungsverhaeltnisGesetzlich
+
+
Reference auf Kernspezifikation-Profil RelatedPerson statt ISiKAngehoreiger
+
Reference auf Kernspezifikation-Profil Patient statt ISiKPatient
+
+
+
ISiKVersicherungsverhaeltnisSelbstzahler
+
+
Reference auf Kernspezifikation-Profil Patient statt ISiKPatient
+
Reference auf Kernspezifikation-Profil RleatedPerson statt ISiKAngehoeriger
+
+
+
ISiKBerichtSubSysteme
+
+
Reference auf Kernspezifikation-Profil Patient statt ISiKPatient
+
Reference auf Kernspezifikation-Profil Encounter statt ISiKKontaktGesundheitseinrichtung
+
+
+
ISiKAngehoeriger
+
+
Reference auf Kernspezifikation-Profil Patient statt ISiKPatient
+
+
+
+
Weitere Änderungen:
+
+
ISiKVersicherungsverhaeltnisGesetzlich
+
+
Coverage.beneficiary.identifier URL in patternidentifier.system ersetzt
+
+
+
weitere Änderungen an Implementierungsleitfaden (informativ)
+
+
+
+
Version: 1.0.7
+
Datum: 21.12.2022
+
+
Beispiel für BerichtBundle erzeugt
+
PersonInGesundheitsberuf MS von Identifier EFN entfernt
+
Weitere Änderungen an IG oder Beschreibung, die keine Strukturänderungen an Profilen entsprechen
+
+
+
Version: 1.0.6
+
Datum: 31.10.2022
+
+
Angehöriger
+
+
Line Extensions Strasse, Hausnummer und Adresszusatz sind nun Must Support
+
+
+
BerichtBundle wurde wiederhergestellt
+
BerichtBundle für Subsysteme
+
+
id ist nun 0..1 und Must Support
+
identifier, identifier.system, identifier.value sind nun Must Support
+
status ist nun Must Support
+
type und type.coding sind nun Must Support
+
Die Codesysteme LOINC, KDL und IHE im Element type.coding sind nun Must Support
+
category ist nun Must Support
+
Die Codesysteme LOINC und IHE im Element category.coding sind nun Must Support
+
author ist nun Must Support
+
+
+
Kontakt
+
+
Aufnahmegrund Extension ist mit den Elementen ErsteUndZweiteStelleDritteStelle undVierteStelle Must Support
+
serviceType ist nun 0..1
+
reference ist nun Must Support
+
admitSource ist nun 0..1
+
+
+
Patient
+
+
Der Identifier Versichertennummer-GKV wird zu VersichertenId-GKV
+
+
+
Invarianten wurden verbessert
+
+
+
Version: 1.0.5
+
Datum: 30.09.2022
+
+
Stadtteil Extension ist bei ISiKAngehoeriger, ISiKPersonenImGesundheitsBeruf und ISiKPatient nun Must Support.
+
Bei ISiKVersicherungsverhaeltnisSelbstzahler sind die Elemente relatedPerson.status, relatedPerson.type, relatedPerson.type.coding,relatedPerson.type.coding.system und relatedPerson.type.coding.code nun Must Support
+
+
+
Version: 1.0.4
+
Datum: 31.05.2022
+
+
Die Kardinalität des Elements id ist nun 0..1 in den Ressourcen Patient, Encounter, Condition, Coverage, Bundle und Procedure.
+
+
+
Version: 1.0.3
+
Datum: 07.02.2022
+
+
Update der Deutschen Basisprofile auf die Version 1.2.0
+
Fix Type Slicing in Condition.extension:ReferenzPrimaerdiagnose.value[x]
+
onset-date als Kann-Suchparameter für Condition entfernt, da dieses Element nicht als Must-Support gekennzeichnet ist
+
address als Kann-Suchparameter für Practitioner entfernt, da dieses Element nicht als Must-Support gekennzeichnet ist
+
Korrektur .source-Elemente in FHIRPath Constraints
+
Korrektur von .definition im CapabilityStatement für Suchparameter Encounter-location, Encounter-part-of, Encounter-service-provider
+
Harmonisierung Constraint sct-ops-1 mit der dazugehörigen menschenlesbaren Beschreibung
+
+
+
Version: 1.0.2
+
Datum: 07.10.2021
+
+
Update der Deutschen Basisprofile auf die Version 1.1.0
+
Korrektur der Invarianten 'isik-pat-1', 'relatedp-de-1' und 'proc-ISiK-1'
Fehlendes Must-Support Flag für Pflichtfeld RelatedPerson.patient hinzugefügt
+
+
+
Version: 1.0.1
+
Datum: 27.08.2021
+
+
Korrektur der Suchinteraktion für das Datenobjekt "Condition": Condition.onset[x] enthält kein Must-Support-Flag, daher ist die Suche nach "onset-date" keine Pflicht. Der Suchparameter wurde nun als optional markiert.
+
Beschreibung von Encounter.status enthielt Teile der Beschreibung von Condition.status. Diese wurden nun gelöscht.
Das Binding an Procedure.code:OPS enthielt ein Binding an ein ValueSet mit falscher Canonical-URL.
+
Korrektur der Interaktionen auf Coverage: Für Coverage.payor für das Profil ISiKVersicherungsverhaeltnisGesetzlich muss nur die Suche mittels des identifier-Modifiers unterstützt werden, jedoch nicht die Suche auf die dazugehörige Referenz.
+
Hinweis hinzugefügt, dass sowohl für die Implementierung von ISiK, als auch für den anschließenden Betrieb eines ISiK-konformen Systems eine SNOMED-Lizenz notwendig ist.
+
Die FHIRPath-Constraints relatedp-de-1 und pat-de-1 resultierten in einem falschen Ergebnis falls das "gender"-Element innerhalb des Datenobjektes "Patient" bzw. "Practitioner" nicht gesetzt war.
+
Hinweise hinzugefügt für die korrekte Implementierung einer OperationOutcome falls ein Bericht eines Subsystems eine nicht-existierende Referenz auf ein "Patient"- oder "Encounter"-Datenobjekt enthält.
Korrektur von verpflichtenden Suchparametern im CapabilityStatement mit Hinblick auf Must-Support-Flags in den Datenobjekt-Profilen
+
Anpassung der ISiK-Profile an die Version v1.0.0-rc4 der Deutschen Basisprofile
+
+
+
Version: 1.0.0 CC1
+
Datum: 25.05.2021
+
Übergreifende Festlegungen
+
+
Hinweis angepasst, dass HTTPS im produktiven Einsatz verpflichtend ist
+
Hinweis präzisiert, dass die eingesetzte Software eines Drittherstellers nur im Rahmen des Bestätigungsverfahrens zu einem Bestandteil des Primärsystems wird
+
Canoncial der ImplementationGuide-Ressource für ISiK harmonisiert mit den Schema der restlichen Canonicals
+
:not und :text Modifier waren als Modifier für String-Suchparameter anstelle von Token-Suchparameter definiert
+
Anpassung der ISiK-Profile an die Version v1.0.0-rc1 der Deutschen Basisprofile:
+
+
Im Vergleich zu der Version 1.0.0-alpha9 ergeben sich in den deutschen Basisprofile folgende Änderungen:
+
+
ValueSet Binding in Lebensphase-Extension korrigiert
+
Übersetzung von marital-status ("S") korrigiert
+
BSNR und LANR aus CodeSystem-identifier-type-de gelöscht (sind bereits in HL7 v2 Table 0203 enthalten)
+
Constraint gender-amtlich-1 in die Extension gender-amtlich direkt eingefügt
+
Verweis auf own-prefix Extension in Extension-humanname-namenszusatz korrigiert
+
Anpassung der ICD-10-GM-Extensions und des Coding-Datentyp-Profils zur korrekten Abbildung von Mehrfachkodierungen
+
+
+
+
\ No newline at end of file
diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_BestaetigungsrelevanteSysteme.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_BestaetigungsrelevanteSysteme.html
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+ Implementierungsleitfaden ISiK-Basismodul
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Bestätigungsrelevante Systeme
+
Hier folgt die Festlegung der Deutschen Krankenhausgesellschaft e. V. wie hier aufgeführt
+
Festlegung der Deutschen Krankenhausgesellschaft e. V. aus dem Jahr 2022
+
Die im Folgenden definierten Subsysteme müssen gemäß § 373 Abs. 2 SGB V nach
+zweijähriger Übergangsfrist im Krankenhaus um die Schnittstelle erweitert sein, die
+das ISIK-Modul bzw. die Datenobjekte der gematik jeweils beschreiben. Die Festlegung der Systeme zu den einzelnen ISiK-Modulen ist um Erläuterungen in eckigen
+Klammern ergänzt.
+
ISiK-Basismodul (Stufe 1 und Stufe 2)
+
+
Krankenhaus-Informationssystem (KIS)
+
+
ISiK-Modul Vitalwerte und Körpermaße
+
+
KIS mit Funktion elektronische Kurve bzw. entsprechendes KIS-Modul
+
Patientendaten-Managementsystem (PDMS) [z.B. für Intensivbereiche]
+
Elektronische Kurve [z.B. für die Verwendung auf Normal-Stationen]
+
+
ISiK-Modul Dokumentenaustausch
+
+
KIS
+
Dokumentenmanagementsystem (DMS)
+
Archivsystem
+
Telekonsil-Modul gemäß § 31a BMV-Ä [Ziel ist die clientseitige Implementierung für die Suche nach Dokumenten anhand von Metadaten,
+Verarbeitung von Suchergebnissen und Dokumentenzugriff zur Verwendung in Telekonsilien], hierbei keine Umsetzung einer Funktion zum Abruf von Dokumenten aus dem Telekonsil-Modul
+
KIM-Client-Anwendungssoftware [die Anwendungsintegration, nicht der
+KIM-Client, Implementierung für die Ablage von Dokumenten aus KIM-Nachrichten und den Versand von Dokumenten mit KIM-Nachrichten],
+hierbei keine Umsetzung einer Funktion zum Abruf von Dokumenten aus
+der KIM-Client-Anwendungssoftware
+
+
ISiK-Modul Medication
+
+
KIS
+
PDMS [Anwendungsfallbeispiel: Medikationsdaten in das KIS übertragen bei Verlegung vom Intensivbereich auf Normal-Station]
+
Software für digitales Medikationsmanagement [z.B. für die Umsetzung
+von KHZG Fördertatbestand 5]
+
E-Therapieplan-System für Zytostatika-Behandlung mit Verarbeitung
+von Verordnungs- und Medikationsinformationen [teilweise Grundlage
+für onkologische Verordnungsdaten], gemäß diesen Festlegungen keine
+Umsetzung des ISIK-Datenobjekts MedikationsVerabreichung notwendig
+
Herstellungssystem mit Verarbeitung von Verordnungs- und Medikationsinformationen [in KH-Apotheke, z.B. für Zytostatika], gemäß diesen
+Festlegungen keine Umsetzung des ISIK-Datenobjekts MedikationsVerabreichung notwendig
+
E-Rezept-Modul für Herstellungen [eRezept an Fachdienst in TI übertragen]
+
Taxierungssoftware [in KH-Apotheke]
+
+
ISiK-Modul Terminplanung [z.B. für die Umsetzung von KHZG Fördertatbestand 2]
+
+
KIS
+
Patientenportal-Terminmodul
+
+
Hinweise und Rückfragen zu den bestätigungsrelevante Systemen können an die DKG-Geschäftsstelle gerichtet werden.
+
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Methodik.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Methodik.html
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+ Implementierungsleitfaden ISiK-Basismodul
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+
Methodik
+
Anforderungen als Ausdruck normativer Festlegungen werden durch die dem RFC2119 entsprechenden, in Großbuchstaben geschriebenen deutschen Schlüsselworte MUSS, DARF NICHT, SOLL, SOLL NICHT, KANN gekennzeichnet sowie ihre Pluralformen gekennzeichnet.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Must-Support-Flags.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Must-Support-Flags.html
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+
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+ Implementierungsleitfaden ISiK-Basismodul
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Must-Support-Flags
+
Die Verwendung des Must-Support-Flags an Profil-Elementen hat im Kontext dieses Leitfadens folgende Bedeutung:
+
+
Im Kontext der Erstellung von FHIR-Ressourcen
+
Wenn die entsprechende Information in einem der Testszenarien bekannt ist, dann MUSS das Feld in der erstellten Ressource gefüllt sein. Ist die Information nicht bekannt, KANN es leer bleiben.
+
+
Im Kontext der Verarbeitung von FHIR-Ressourcen
+
Wenn die entsprechende Information in einer Ressource vorhanden ist, so MUSS diese vom verarbeitenden System ausgewertet, persistiert und dem Anwender dargestellt werden können.
+
Sollte ein Hersteller Bedarf an einer Änderung der Must-Support Vorgaben der ISiK Profile haben, MUSS er von den Profilen ableiten, auf denen die ISiK Profile basieren. Angaben dazu finden sich für jedes Datenobjekt im Kapitel Kompatibilität. In diesem Fall MUSS der Hersteller auch dafür sorgen, dass seine abgeleiteten Profile weiterhin kompatibel mit den ISiK Profilen bleiben.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Repraesentationsformate.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Repraesentationsformate.html
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+
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+ Implementierungsleitfaden ISiK-Basismodul
+
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Repräsentationsformate
+
Der FHIR-Standard beschreibt drei verschiedene Repräsentationsformate: XML, JSON und RDF (Turtle).
+Im Rahmen der ISiK-Spezifikation MÜSSEN bestätigungsrelevante Systeme (Server) die Formate XML und JSON unterstützen.
+
Client-seitige Implementierungen haben die Wahl zwischen XML- und JSON-Repräsentation, müssen jedoch in den HTTP Accept- und Content-Type-Headern entsprechend ausweisen, welche Repräsentation gewählt wurde.
+
Wenn ein Client im Accept-Header ein vom Server nicht unterstütztes Format anfordert, so MUSS der Server mit dem Fehlercode 406 not acceptable antworten.
+Wenn ein Client im Content-Type-Header ein vom Server nicht unterstütztes Format sendet, so MUSS der Server mit dem Fehlercode 415 unsupported media type antworten.
+
Es ist zu beachten, dass die Header Content-Type und Accept noch weitere FHIR-spezifische und allgemeine Parameter enthalten können. Siehe beispielsweise https://www.hl7.org/fhir/http.html#version-parameter. Das Vorhandensein dieser Parameter darf nicht zu einem Fehler führen.
+
Anfragen, in denen eine andere FHIR-Version als die hier vereinbarte Version 4.0 angefordert wird, müssen mit Fehlercode 406 - not acceptable beantwortet werden.
+
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Rest.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Rest.html
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+ Implementierungsleitfaden ISiK-Basismodul
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+
REST-API
+
Read-Interaktionen
+
Instanzen von Datenobjekten, die die REST-Interaktion "READ" fordern MÜSSEN per HTTP GET auf [BASE_URL]/[resourceType]/[ID] abgerufen werden können.
+Siehe: https://www.hl7.org/fhir/http.html#read
+
Search-Interaktionen
+
Die Suche MUSS sowohl mittels HTTP GET als auch HTTP POST (vgl. FHIR RESTful Search - Introduction) unterstützt werden. Die URL-Parameter komplexer Suchanfragen können personenbezogene Merkmale enthalten, daher ist im Echtbetrieb die Suche mittels HTTP POST in Verbindung mit TLS-Verschlüsselung vorzuziehen.
+
Sicherheitsaspekte
+
Alle REST-Interaktionen müssen sowohl mittels HTTP als auch HTTPS (TLS-Verschlüsselung) unterstützt werden. Vorgaben zur TLS-Verschlüsselung sind dem nachfolgenden Link für die FHIR Security Check List zu entnehmen.
+Im Echtbetrieb MUSS die Kommunikation ausschließlich per HTTPS erfolgen.
+Weiterhin sind geeignete Maßnahmen zur Risiko-Minimierung (z.B. Benutzerautorisierung / -authentifikation) zu treffen, siehe https://build.fhir.org/security.html#6.1.0.
+Diese sind in Stufe 1 des ISiK Basismoduls jedoch nicht bestätigungsrelevant.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Suchparameter.html b/IG/1.0.10/ImplementationGuide-markdown-UebergreifendeFestlegungen_Suchparameter.html
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+ Implementierungsleitfaden ISiK-Basismodul
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Allgemeine Hinweise zu Suchparametern
+
Innerhalb der jeweiligen Abschnitte 'Interaktionen' (Siehe Datenobjekte) werden für alle innerhalb dieses Implementierungsleitfadens spezifizierten FHIR-Ressourcen Suchparameter bestimmt welche im Bestätigungsverfahrens ISiK unterstützt werden MÜSSEN.
+
Es MUSS sichergestellt werden, dass nicht unterstützte oder leere Suchparameter nicht zu einem Fehler führen. Siehe FHIR RESTful Search - Handling Errors. Alle unterstützten und verwendeten Suchparameter sind im Self-Link des Suchbundles korrekt anzugeben.
+
Alle Suchparameter in FHIR entsprechen einem von neun definierten Such-Parameter-Typen:
+
+
Number
+
Date/DateTime
+
String
+
Token
+
Reference
+
Composite
+
Quantity
+
URI
+
Special
+
+
Des Weiteren werden zusätzlich sogenannte 'Modifier' pro Suchparameter-Typ definiert. Eine Übersicht findet sich unter "Search Modifiers".
+
Für die im Rahmen dieses Leitfadens relevanten Typen gelten folgende allgemeinen Festlegungen:
+
Date/DateTime
+
Die Präfixe lt,le,gt,ge,eq MÜSSEN für jeden Suchparameter vom Typ 'date/dateTime' unterstützt werden.
+
Beispiele:
+
[base]/Patient?birthDate=ge2000-01-01
+Suche nach allen Patienten mit einem Geburtsdatum 2000-01-01T00:00 oder später.
+
[base]/Patient?birthDate=eq2000-01-01
+Suche nach allen Patienten mit einem Geburtsdatum von 2000-01-01T00:00 bis (aber nicht einschließlich) 2000-02-01T00:00
Der Modifier :contains MUSS für alle spezifizierten Suchparameter vom Typ 'String' unterstützt werden.
+
Beispiele:
+
[base]/Patient?address:contains=Berlin
+Diese Suchanfrage gibt alle Patienten zurück zum Client, welche in einem Adress-Bestandteil den String 'Berlin' enthält (z.B. alle Berliner Adressen unabhängig von konkreten Bezirken).
+
Token
+
Der Modifier :not MUSS für alle spezifizierten Suchparameter vom Typ 'Token' unterstützt werden, sofern diese auf die Datentypen "code", "Coding" oder "CodeableConcept" verwendet werden.
+
Der Modifier :text MUSS für alle spezifizierten Suchparameter vom Typ 'Token' unterstützt werden, sofern diese auf die Datentypen "Coding" oder "CodeableConcept" verwendet werden.
+
Beispiele:
+
[base]/Condition?code:text=Freitext
+Diese Suche gibt alle Condition-Ressourcen zurück zum Client, welche innerhalb Condition.code.text das Wort "Freitext" enthält. Es ist zu beachten, dass hier ein partielles Matching erfolgen MUSS (es ist implizit der Modifier :contains anzunehmen).
+
[base]/Condition?code:not=Test
+Diese Suche gibt alle Condition-Ressourcen zurück zum Client, welche innerhalb Condition.code.coding NICHT den Code 'Test' enthält. Es ist zu beachten, dass dies auch alle Ressourcen beinhaltet, die keinen kodierten Wert für Condition.code enthalten.
+
Reference
+
Der Modifier :identifier MUSS für alle spezifizierten Suchparameter vom Typ 'Reference' unterstützt werden.
+
Beispiele:
+
[base]/Coverage?Payor:identifier=http://fhir.de/sid/arge-ik/iknr|123456
+Diese Suche gibt alle Coverage-Ressourcen zurück zum Client, welche innerhalb Coverage.payor eine logische Referenz auf den Versicherer mit der IK-Nummer "123456" enthält.
+
Für Suchparameter vom Typ 'Reference' MÜSSEN die Festlegungen für Chaining und Reverse Chaining verpflichtend implementiert werden. Chaining und Reverse Chaining für die Suchparameter "patient", "subject" und "encounter" (definiert auf den jeweiligen Datenobjekten) MÜSSEN über alle Ebenen und Datenobjekte hinweg (potentiell in Kombination) untersützt werden. Für alle weiteren Reference-Suchparameter KANN Chaining und Reverse Chaining implementiert werden.
+
Beispiele:
+
[base]/Procedure?subject.name=Test
+Diese Suche gibt alle Prozeduren zurück zum Client, welche innerhalb Procedure.subject auf einen Patienten verweist mit dem Namen "Test".
+
[base]/Condition?encounter.subject.name=Test
+Diese Suche gibt alle Diagnosen zurück zum Client, welche eine Encounter Reference besitzen und innerhalb Encounter.subject auf einen Patienten verweist mit dem Namen "Test".
+
[base]/Patient?_has:Procedure:patient:code=1234-5
+Diese Suche gibt alle Patienten zurück zum Client, welche innerhalb Procedure.subject auf einen Patienten verweisen und einen Code mit dem Wert '1234-5' in Procedure.code enthalten.
+
[base]/Patient?_has:Procedure:patient:encounter.identifier=12345
+Diese Suche gibt alle Patienten zurück zum Client, welche innerhalb Procedure.subject auf einen Patienten verweisen und einen deren Procedure auf einen Encounter verweist z.B. mit der Aufnahmenummer '1234-5'.
+
[base]/Procedure?_has:Encounter:diagnosis:diagnosis:Condition.code=http://fhir.de/CodeSystem/bfarm/icd-10-gm|F16.1
+Diese Suche gibt alle Prozeduren zurück zum Client, welche innerhalb Encounter.diagnosis.condition auf einen Encounter verweisen, der wiederrum mit einer Condition verlinkt ist mit dem ICD-10-GM Code 'F16.1'.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_AnmerkungenZuDenMustSupportFeldern.html b/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_AnmerkungenZuDenMustSupportFeldern.html
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Anmerkungen zu den Must-Support Feldern
+
Das Profil ISiKVersicherungsverhaeltnisGesetzlich
+
Coverage.identifier:KrankenversichertenID
+
Bedeutung: Der unveränderliche, 10-stellige Teil der Krankenversichertennummer zur Identifikation des Versicherten, die Krankenversicherten-ID.
+Hinweise: Dieser identifier ist zur eindeutigen Identifikation des gesetzlich Versicherten nötig, in den von diesem Profil unterstützten Anwendungsszenarien, siehe Beschreibung der Deutschen Basisprofile.
+
Coverage.status
+
Bedeutung: Der Status einer Instanz des Profils ISiKVersicherungsverhaeltnisGesetzlich.
+
Hinweise: Das Element status macht deutlich, ob diese Instanz genutzt werden kann oder ob sie bspw. als ungültig oder falsch gekennzeichnet ist, siehe FHIR Kernspezifikaton.
+
Coverage.type
+
Bedeutung: Das Element type kennzeichnet die Art der Versicherung.
+
+
+
+
\ No newline at end of file
diff --git a/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_Motivation.html b/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_Motivation.html
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Motivation
+
ISiK unterstützt Anwendungsszenarien, in denen durch das Krankenhaus erbrachte Leistungen erfasst oder gegenüber Kostenträgern abgerechnet werden. In diesen Anwendungsszenarien wird das Versicherungsverhältnis verwendet, um bspw. den Versicherungsstatus oder die Rechnungsanschrift der Versicherung zu ermitteln.
+
In FHIR werden Versicherungsverhältnisse mit der Coverage-Ressource repräsentiert.
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diff --git a/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_Profil.html b/IG/1.0.10/ImplementationGuide-markdown-Versicherungsverhaeltnis_Profil.html
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Kostenübernahme im Rahmen eines gesetzlichen Versicherungsverhältnisses in Deutschland.
+
Comments
The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
There are no (further) constraints on this element
Element id
Coverage.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Coverage.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Coverage.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Coverage.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Coverage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Coverage.identifier:KrankenversichertenID.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Coverage.status
Short description
active | cancelled | draft | entered-in-error
Definition
The status of the resource instance.
+
Requirements
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
+
Comments
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt
+
Requirements
The order of application of coverages is dependent on the types of coverage.
+
Comments
28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dortigen Codes nicht passen.
There are no (further) constraints on this element
Element id
Coverage.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Coverage.type.coding.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.type.coding.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
There are no (further) constraints on this element
Element id
Coverage.policyHolder
Short description
Owner of the policy
Definition
The party who 'owns' the insurance policy.
+
Requirements
This provides employer information in the case of Worker's Compensation and other policies.
+
Comments
Es gibt derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Pattern
{
+ "system": "http://fhir.de/sid/gkv/kvid-10"
+}
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
This is the party who receives treatment for which the costs are reimbursed under the coverage.
+
Comments
Die Angabe der 10-stelligen Krankenversichertennummer ist verpflichtend. Durch die Referenz auf eine Patient-Resource können weitere Informationen zum Patienten hinterlegt werden.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.beneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Pattern
{
+ "system": "http://fhir.de/sid/gkv/kvid-10"
+}
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
Die Angabe des Namens des Versicherten dient der geeigenten Darstellung für den Benutzer und hat keine technische Bedeutung.
+
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.
There are no (further) constraints on this element
Element id
Coverage.period
Short description
Coverage start and end dates
Definition
Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
+
Requirements
Some insurers require the submission of the coverage term.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.period.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
+
Comments
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
+
Meaning when missing
If the end of the period is missing, it means that the period is ongoing
Gibt den Kostenträger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namens als Display ist zwingend erforderlich.
+Die Referenz auf eine Resource vom Typ Organization, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional.
+Sofern eine zweite Referenz auf einen Kostenträger existiert, so handelt es sich hierbei um den abrechnenden Kostenträger
+
Requirements
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
+
Comments
Die Angabe der IK-Nummer des Versicherers in payor.identifier ist verpflichtend. Weitere Angaben zum Versicherer (Name, Adresse) können in einer Organization-Resource hinterlegt werden, auf die hier referenziert wird.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage.payor.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.type
Short description
Description of identifier
Definition
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
+
Requirements
Allows users to make use of identifiers when the identifier system is not known.
+
Comments
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.system
Short description
The namespace for the identifier value
Definition
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
+
Requirements
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.value
Short description
The value that is unique
Definition
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
+
Comments
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.period
Short description
Time period when id is/was valid for use
Definition
Time period during which identifier is/was valid for use.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.payor.identifier.assigner
Short description
Organization that issued id (may be just text)
Definition
Organization that issued/manages the identifier.
+
Comments
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
v2: CX.4 / (CX.4,CX.9,CX.10)
rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
There are no (further) constraints on this element
Element id
Coverage.payor.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.type
Short description
Type of class such as 'group' or 'plan'
Definition
The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
+
Requirements
The insurer issued label for a specific health card value.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.order
Short description
Relative order of the coverage
Definition
The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
+
Requirements
Used in managing the coordination of benefits.
+
Comments
Es git derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Für die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann.
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
There are no (further) constraints on this element
Element id
Coverage.network
Short description
Insurer network
Definition
Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden
+
Requirements
Used in referral for treatment and in claims processing.
+
Comments
Es gibt derzeit in DE keine Verwendung für dieses Attribut
+(Konsens Interop-Forum 12.6.2017)
+Falls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary
Short description
Patient payments for services/products
Alternate names
CoPay, Deductible, Exceptions
Definition
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
+
Requirements
Required by providers to manage financial transaction with the patient.
+
Comments
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.type
Short description
Exception category
Definition
The code for the specific exception.
+
Requirements
Needed to identify the exception associated with the amount for the patient.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.period
Short description
The effective period of the exception
Definition
The timeframe during when the exception is in force.
+
Requirements
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.subrogation
Short description
Reimbursement to insurer
Definition
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
+
Requirements
See definition for when to be used.
+
Comments
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
There are no (further) constraints on this element
Element id
Coverage.contract
Short description
Contract details
Definition
The policy(s) which constitute this insurance coverage.
+
Requirements
To reference the legally binding contract between the policy holder and the insurer.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage
Short description
Insurance or medical plan or a payment agreement
Definition
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
+
Comments
The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.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 or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-6: A resource should have narrative for robust management text.`div`.exists()
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
There are no (further) constraints on this element
Element id
Coverage.meta
Short description
Metadata about the resource
Definition
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
There are no (further) constraints on this element
Element id
Coverage.implicitRules
Short description
A set of rules under which this content was created
Definition
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
+
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
There are no (further) constraints on this element
Element id
Coverage.language
Short description
Language of the resource content
Definition
The base language in which the resource is written.
+
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).
There are no (further) constraints on this element
Element id
Coverage.text
Short description
Text summary of the resource, for human interpretation
Alternate names
narrative, html, xhtml, display
Definition
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
+
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 information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
+
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
There are no (further) constraints on this element
Element id
Coverage.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.modifierExtension
Short description
Extensions that cannot be ignored
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.identifier
Short description
Business Identifier for the coverage
Definition
A unique identifier assigned to this coverage.
+
Requirements
Allows coverages to be distinguished and referenced.
+
Comments
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.status
Short description
active | cancelled | draft | entered-in-error
Definition
The status of the resource instance.
+
Requirements
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
+
Comments
This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
There are no (further) constraints on this element
Element id
Coverage.type
Short description
Coverage category such as medical or accident
Definition
The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
+
Requirements
The order of application of coverages is dependent on the types of coverage.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
There are no (further) constraints on this element
Element id
Coverage.type.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding
Short description
Code defined by a terminology system
Definition
A reference to a code defined by a terminology system.
+
Requirements
Allows for alternative encodings within a code system, and translations to other code systems.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.coding.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
The identification of the code system that defines the meaning of the symbol in the code.
+
Requirements
Need to be unambiguous about the source of the definition of the symbol.
+
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 reference to some definition that establishes the system clearly and unambiguously.
There are no (further) constraints on this element
Element id
Coverage.type.coding.version
Short description
Version of the system - if relevant
Definition
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
+
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.
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
+
Requirements
Need to refer to a particular code in the system.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.type.coding.userSelected
Short description
If this coding was chosen directly by the user
Definition
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
+
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.
+
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.
There are no (further) constraints on this element
Element id
Coverage.type.text
Short description
Plain text representation of the concept
Definition
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
+
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.
+
Comments
Very often the text is the same as a displayName of one of the codings.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber
Short description
Subscriber to the policy
Definition
The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
+
Requirements
This is the party who is entitled to the benfits under the policy.
+
Comments
May be self or a parent in the case of dependants.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.subscriber.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.subscriber.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Coverage.subscriber.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.subscriber.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary
Short description
Plan beneficiary
Definition
The party who benefits from the insurance coverage; the patient when products and/or services are provided.
+
Requirements
This is the party who receives treatment for which the costs are reimbursed under the coverage.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
workflow: Event.subject
w5: FiveWs.subject[x]
cdanetv4: D01 through D09
v2: IN1-16, 18, 19-name of insured, address, date of birth
There are no (further) constraints on this element
Element id
Coverage.beneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.reference
Short description
Literal reference, Relative, internal or absolute URL
Definition
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
+
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.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.type
Short description
Type the reference refers to (e.g. "Patient")
Definition
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.
+
The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
+
Comments
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
There are no (further) constraints on this element
Element id
Coverage.beneficiary.identifier
Short description
Logical reference, when literal reference is not known
Definition
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
+
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.
+
Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
Mappings
rim: n/a
v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
There are no (further) constraints on this element
Element id
Coverage.beneficiary.display
Short description
Text alternative for the resource
Definition
Plain text narrative that identifies the resource in addition to the resource reference.
+
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.
There are no (further) constraints on this element
Element id
Coverage.period
Short description
Coverage start and end dates
Definition
Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
+
Requirements
Some insurers require the submission of the coverage term.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
+
Requirements
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
+
Comments
May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).
+For selfpay it may provide multiple paying persons and/or organizations.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
There are no (further) constraints on this element
Element id
Coverage.class.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.class.type
Short description
Type of class such as 'group' or 'plan'
Definition
The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
+
Requirements
The insurer issued label for a specific health card value.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.order
Short description
Relative order of the coverage
Definition
The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
+
Requirements
Used in managing the coordination of benefits.
+
Comments
32 bit number; for values larger than this, use decimal
There are no (further) constraints on this element
Element id
Coverage.network
Short description
Insurer network
Definition
The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
+
Requirements
Used in referral for treatment and in claims processing.
+
Comments
Note that FHIR strings SHALL NOT exceed 1MB in size
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary
Short description
Patient payments for services/products
Alternate names
CoPay, Deductible, Exceptions
Definition
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
+
Requirements
Required by providers to manage financial transaction with the patient.
+
Comments
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.modifierExtension
Short description
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.extension
Short description
Additional content defined by implementations
Alternate names
extensions, user content
Definition
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
+
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.
Extensions that cannot be ignored even if unrecognized
Alternate names
extensions, user content, modifiers
Definition
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
+
Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
+
Requirements
Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
+
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.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.type
Short description
Exception category
Definition
The code for the specific exception.
+
Requirements
Needed to identify the exception associated with the amount for the patient.
+
Comments
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
There are no (further) constraints on this element
Element id
Coverage.costToBeneficiary.exception.period
Short description
The effective period of the exception
Definition
The timeframe during when the exception is in force.
+
Requirements
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
+
Comments
A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").
+
Period is not used for a duration (a measure of elapsed time). See Duration.
There are no (further) constraints on this element
Element id
Coverage.subrogation
Short description
Reimbursement to insurer
Definition
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
+
Requirements
See definition for when to be used.
+
Comments
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
There are no (further) constraints on this element
Element id
Coverage.contract
Short description
Contract details
Definition
The policy(s) which constitute this insurance coverage.
+
Requirements
To reference the legally binding contract between the policy holder and the insurer.
+
Comments
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
ele-1: All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ref-1: SHALL have a contained resource if a local reference is provided reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
rim: n/a
rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
+