HL7 Europe Base and Core FHIR IG
2.0.0 - trial-use 150

HL7 Europe Base and Core FHIR IG - Downloaded Version 2.0.0 See the Directory of published versions

## Resource Profile: ProcedureEuCore - Detailed Descriptions

Page standards status: Trial-use | Maturity Level: 2

Definitions for the procedure-eu-core resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. Procedure
Definition | An action that is or was performed on or for a patient, practitioner, device, organization, or location. For example, this can be a physical intervention on a patient like an operation, or less invasive like long term services, counseling, or hypnotherapy. This can be a quality or safety inspection for a location, organization, or device. This can be an accreditation procedure on a practitioner for licensing.
Short | An action that is being or was performed on an individual or entity
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Procedure.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Procedure.language
Definition | The base language in which the resource is written.
Short | Language of the procedureLanguage of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHALL be taken from AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 (required to `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` ) IETF language tag for a human language
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Procedure.text
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.
Short | Textual representation of the procedureText summary of the resource, for human interpretation
Comments | Contained resources do not have a 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.
Control | 0..1 This element is affected by the following invariants: dom-6
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Procedure.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
10. Procedure.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 managable, 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).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. Procedure.identifier
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.
Short | Identifier for the procedureExternal Identifiers for this procedure
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.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Procedure.status
Definition | A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
Short | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Comments | The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from EventStatus http://hl7.org/fhir/ValueSet/event-status|5.0.0 (required to `http://hl7.org/fhir/ValueSet/event-status|5.0.0` ) A code specifying the state of the procedure.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Procedure.code
Definition | Identification of the procedure or recording of "absence of relevant procedures" or of "procedures unknown". The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
Short | Identification of the procedure
Control | 10..1
Binding | The codes SHOULD be taken from For example codes, see Procedures - IPS http://hl7.org/fhir/ValueSet/procedure-code|5.0.0 (preferred to `http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips` )
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Requirements | 0..1 to account for primarily narrative only resources.
Alternate Names | type
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Procedure.subject
Definition | On whom or on what the procedure was performed. This is usually an individual human, but can also be performed on animals, groups of humans or animals, organizations or practitioners (for licensing), locations or devices (for safety inspections or regulatory authorizations). If the actual focus of the procedure is different from the subject, the focus element specifies the actual focus of the procedure.
Short | Individual or entity the procedure was performed on
Control | 1..1
Type | Reference(Patient (EU core), Patient, Group, Device, Practitioner, Organization, Location)
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | patient
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Procedure.occurrence[x]
Definition | Estimated or actual date, date-time, period, or age when the procedure did occur or is occurring. 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.
Short | When the procedure occurred or is occurring
Comments | This indicates when the procedure actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this Procedure is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
Control | 10..1
Type | Choice of: dateTime, Period, string, Age, Range, Timing
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Procedure.recorded
Definition | The date the occurrence of the procedure was first captured in the record regardless of Procedure.status (potentially after the occurrence of the event).
Short | Date when the procedure was recordedWhen the procedure was first captured in the subject's record
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Procedure.recorder
Definition | Individual who recorded the record and takes responsibility for its content.
Short | The person or organization who recorded the procedureWho recorded the procedure
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Procedure.reported[x]
Definition | Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Short | Reported rather than primary record
Control | 0..1
Type | Choice of: boolean, Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Reported data may have different rules on editing and may be visually distinguished from primary data.
Alternate Names | informer
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
Slicing | This element introduces a set of slices on `Procedure.reported[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
28. Procedure.reported[x]:reportedReference
Slice Name | reportedReference
Definition | Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Short | Reported rather than primary record.
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Practitioner, PractitionerRole, Organization), boolean
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Must Support | false
Summary | true
Requirements | Reported data may have different rules on editing and may be visually distinguished from primary data.
Alternate Names | informer
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Procedure.reason
Definition | The coded reason or reference why the procedure was performed. This may be a coded entity of some type, be present as text, or be a reference to one of several resources that justify the procedure.
Short | Why the procedure was performedThe justification that the procedure was performed
Comments | Use Procedure.reason.concept when a code sufficiently describes the reason. Use Procedure.reason.reference when referencing a resource, which allows more information to be conveyed, such as onset date. For a single Procedure.reason, if both Procedure.reason.concept and Procedure.reason.reference are present, they are expected to be consistent with each other.
Control | 0..*
Binding | For example codes, see ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason|5.0.0 (example to `http://hl7.org/fhir/ValueSet/procedure-reason|5.0.0` ) A code that identifies the reason a procedure is required.
Type | CodeableReference(Condition (EU core), Observation, Procedure (EU core), DiagnosticReport, DocumentReference, Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. Procedure.bodySite
Definition | Anatomical location which is the focus of the problem. Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
Short | Target body sites
Comments | If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure.
Control | 0..*
Binding | The codes SHOULD be taken from For example codes, see SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site|5.0.0 (preferred to `http://hl7.org/fhir/ValueSet/body-site` )
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) eu-bodysite-1: Either a body site code or a reference to a BodyStructure resource SHALL be used, but not both. (`(coding.empty() and text.empty()) or extension('http://hl7.org/fhir/StructureDefinition/bodySite').empty()`)
34. Procedure.bodySite.extension:bodySite
Slice Name | bodySite
Definition | Record details about the anatomical location of a specimen or body part. This resource may be used when a coded concept does not provide the necessary detail needed for the use case.
Short | Target anatomic location or structure
Control | 0..1
Type | Extension(BodyStructure Reference) (Extension Type: Reference(BodyStructure))
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
36. Procedure.bodySite.extension:bodySite.extension
Definition | An 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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | ExtensionAdditional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `Procedure.bodySite.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
38. Procedure.bodySite.extension:bodySite.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/bodySite`
40. Procedure.bodySite.extension:bodySite.value[x]
Definition | Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | Value of extension
Control | 10..1 This element is affected by the following invariants: ext-1
Type | Reference(BodyStructure (EU core)), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, RatioRange, Coding, SampledData, id, positiveInt, Distance, Availability, integer64, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ExtendedContactDetail, CodeableConcept, ParameterDefinition, dateTime, code, string, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, CodeableReference, Signature, unsignedInt, time
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Procedure.outcome
Definition | The outcome of the procedure - did it resolve the reasons for the procedure being performed?
Short | Outcome of the procedureThe result of procedure
Comments | If outcome contains narrative text only, it can be captured using the CodeableConcept.text.
Control | 0..1
Binding | For example codes, see ProcedureOutcomeCodesSNOMEDCT http://hl7.org/fhir/ValueSet/procedure-outcome|5.0.0 (example to `http://hl7.org/fhir/ValueSet/procedure-outcome|5.0.0` ) An outcome of a procedure - whether it was resolved or otherwise.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. Procedure.complication
Definition | Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
Short | Complication following the procedure
Comments | If complications are only expressed by the narrative text, they can be captured using the CodeableReference.concept.text.
Control | 0..*
Binding | For example codes, see ConditionProblemDiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code|5.0.0 (example to `http://hl7.org/fhir/ValueSet/condition-code|5.0.0` ) Codes describing complications that resulted from a procedure.
Type | CodeableReference(Condition (EU core), Condition)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. Procedure.note
Definition | Any other notes and comments about the procedure.
Short | Additional information about the procedure.
Control | 0..*
Type | Annotation
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. Procedure.focalDevice
Definition | A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
Short | Device implanted, removed or otherwise manipulatedManipulated, implanted, or removed device
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. Procedure.focalDevice.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, there is a strict set of governance applied to the definition and use of extensions. Though 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
52. Procedure.focalDevice.manipulated
Definition | The device that was manipulated (changed) during the procedure.
Short | Device that was changed
Control | 1..1
Type | Reference(Device)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. Procedure.used
Definition | Identifies medications, devices and any other substance used as part of the procedure.
Short | Device used to perform the procedureItems used during procedure
Comments | For devices actually implanted or removed, use Procedure.focalDevice.manipulated.
Control | 0..*
Binding | For example codes, see DeviceType http://hl7.org/fhir/ValueSet/device-type|5.0.0 (example to `http://hl7.org/fhir/ValueSet/device-type|5.0.0` ) Codes describing items used during a procedure.
Type | CodeableReference(Device, Medication (EU core), Substance, BiologicallyDerivedProduct, Device, Medication, Substance, BiologicallyDerivedProduct)
Is Modifier | false
Must Support | false
Summary | false
Requirements | Used for tracking contamination, etc.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

0. Procedure
2. Procedure.language
Short | Language of the procedure
4. Procedure.text
Short | Textual representation of the procedure
6. Procedure.identifier
Short | Identifier for the procedure
Note | This is a business identifier, not a resource identifier (see discussion)
8. Procedure.code
Definition | Identification of the procedure or recording of "absence of relevant procedures" or of "procedures unknown".
Control | 1..?
Binding | The codes SHOULD be taken from Procedures - IPS (preferred to `http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips` )
10. Procedure.subject
Type | Reference(Patient (EU core))
12. Procedure.occurrence[x]
Control | 1..?
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
14. Procedure.recorded
Short | Date when the procedure was recorded
16. Procedure.recorder
Short | The person or organization who recorded the procedure
18. Procedure.reported[x]
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Slicing | This element introduces a set of slices on `Procedure.reported[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
20. Procedure.reported[x]:reportedReference
Slice Name | reportedReference
Short | Reported rather than primary record.
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
22. Procedure.performer
24. Procedure.performer.actor
Type | Reference(PractitionerRole (EU core), Practitioner (EU core), Device, Patient (EU core), RelatedPerson, Organization (EU core))
26. Procedure.performer.onBehalfOf
Type | Reference(Organization (EU core))
28. Procedure.reason
Short | Why the procedure was performed
Type | CodeableReference(Condition (EU core), Observation, Procedure (EU core), DiagnosticReport, DocumentReference)
30. Procedure.bodySite
Definition | Anatomical location which is the focus of the problem.
Binding | The codes SHOULD be taken from SNOMEDCTBodyStructures (preferred to `http://hl7.org/fhir/ValueSet/body-site` )
Invariants | eu-bodysite-1: Either a body site code or a reference to a BodyStructure resource SHALL be used, but not both. (`(coding.empty() and text.empty()) or extension('http://hl7.org/fhir/StructureDefinition/bodySite').empty()`)
32. Procedure.bodySite.extension:bodySite
Slice Name | bodySite
Control | 0..1
Type | Extension(BodyStructure Reference) (Extension Type: Reference(BodyStructure))
34. Procedure.bodySite.extension:bodySite.value[x]
Type | Reference(BodyStructure (EU core))
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
36. Procedure.outcome
Short | Outcome of the procedure
38. Procedure.complication
Type | CodeableReference(Condition (EU core))
40. Procedure.note
Short | Additional information about the procedure.
42. Procedure.focalDevice
Short | Device implanted, removed or otherwise manipulated
44. Procedure.used
Short | Device used to perform the procedure
Type | CodeableReference(Device, Medication (EU core), Substance, BiologicallyDerivedProduct)

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

0. Procedure
Definition | An action that is or was performed on or for a patient, practitioner, device, organization, or location. For example, this can be a physical intervention on a patient like an operation, or less invasive like long term services, counseling, or hypnotherapy. This can be a quality or safety inspection for a location, organization, or device. This can be an accreditation procedure on a practitioner for licensing.
Short | An action that is being or was performed on an individual or entity
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).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-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. Procedure.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
Control | 0..1
Type | id
Is Modifier | false
Must Support | false
Summary | true
4. Procedure.meta
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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. Procedure.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. Procedure.language
Definition | The base language in which the resource is written.
Short | Language of the procedure
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).
Control | 0..1
Binding | The codes SHALL be taken from AllLanguages (required to `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` ) IETF language tag for a human language
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. Procedure.text
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.
Short | Textual representation of the procedure
Comments | Contained resources do not have a 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.
Control | 0..1 This element is affected by the following invariants: dom-6
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. Procedure.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. Procedure.extension
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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
16. Procedure.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 managable, 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).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. Procedure.identifier
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.
Short | Identifier for the procedure
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.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. Procedure.instantiatesCanonical
Definition | The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Short | Instantiates FHIR protocol or definition
Control | 0..*
Type | canonical(PlanDefinition, ActivityDefinition, Measure, OperationDefinition, Questionnaire)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. Procedure.instantiatesUri
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.
Short | Instantiates external protocol or definition
Comments | This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Control | 0..*
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
24. Procedure.basedOn
Definition | A reference to a resource that contains details of the request for this procedure.
Short | A request for this procedure
Control | 0..*
Type | Reference(CarePlan, ServiceRequest)
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | fulfills
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. Procedure.partOf
Definition | A larger event of which this particular procedure is a component or step.
Short | Part of referenced event
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).
Control | 0..*
Type | Reference(Procedure, Observation, MedicationAdministration)
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | container
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. Procedure.status
Definition | A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
Short | preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Comments | The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from EventStatus (required to `http://hl7.org/fhir/ValueSet/event-status|5.0.0` ) A code specifying the state of the procedure.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. Procedure.statusReason
Definition | Captures the reason for the current state of the procedure.
Short | Reason for current status
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.
Control | 0..1
Binding | For example codes, see ProcedureNotPerformedReasonSNOMEDCT (example to `http://hl7.org/fhir/ValueSet/procedure-not-performed-reason|5.0.0` ) A code that identifies the reason a procedure was not performed.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | Suspended Reason, Cancelled Reason
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. Procedure.category
Definition | A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
Short | Classification of the procedure
Control | 0..*
Binding | For example codes, see ProcedureCategoryCodesSNOMEDCT (example to `http://hl7.org/fhir/ValueSet/procedure-category|5.0.0` ) A code that classifies a procedure for searching, sorting and display purposes.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. Procedure.code
Definition | Identification of the procedure or recording of "absence of relevant procedures" or of "procedures unknown".
Short | Identification of the procedure
Control | 1..1
Binding | The codes SHOULD be taken from Procedures - IPS (preferred to `http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips` )
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Requirements | 0..1 to account for primarily narrative only resources.
Alternate Names | type
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Procedure.subject
Definition | On whom or on what the procedure was performed. This is usually an individual human, but can also be performed on animals, groups of humans or animals, organizations or practitioners (for licensing), locations or devices (for safety inspections or regulatory authorizations). If the actual focus of the procedure is different from the subject, the focus element specifies the actual focus of the procedure.
Short | Individual or entity the procedure was performed on
Control | 1..1
Type | Reference(Patient (EU core))
Is Modifier | false
Must Support | false
Summary | true
Alternate Names | patient
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. Procedure.focus
Definition | Who is the target of the procedure when it is not the subject of record only. If focus is not present, then subject is the focus. If focus is present and the subject is one of the targets of the procedure, include subject as a focus as well. If focus is present and the subject is not included in focus, it implies that the procedure was only targeted on the focus. For example, when a caregiver is given education for a patient, the caregiver would be the focus and the procedure record is associated with the subject (e.g. patient). For example, use focus when recording the target of the education, training, or counseling is the parent or relative of a patient.
Short | Who is the target of the procedure when it is not the subject of record only
Control | 0..1
Type | Reference(Patient, Group, RelatedPerson, Practitioner, Organization, CareTeam, PractitionerRole, Specimen)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. Procedure.encounter
Definition | The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
Short | The Encounter during which this Procedure was created
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.
Control | 0..1
Type | Reference(Encounter)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. Procedure.occurrence[x]
Definition | Estimated or actual date, date-time, period, or age when the procedure did occur or is occurring. 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.
Short | When the procedure occurred or is occurring
Comments | This indicates when the procedure actually occurred or is occurring, not when it was asked/requested/ordered to occur. For the latter, look at the occurence element of the Request this Procedure is "basedOn". The status code allows differentiation of whether the timing reflects a historic event or an ongoing event. Ongoing events should not include an upper bound in the Period or Timing.bounds. Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
Control | 1..1
Type | Choice of: dateTime, Period, string, Age, Range, Timing
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. Procedure.recorded
Definition | The date the occurrence of the procedure was first captured in the record regardless of Procedure.status (potentially after the occurrence of the event).
Short | Date when the procedure was recorded
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. Procedure.recorder
Definition | Individual who recorded the record and takes responsibility for its content.
Short | The person or organization who recorded the procedure
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. Procedure.reported[x]
Definition | Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Short | Reported rather than primary record
Control | 0..1
Type | Choice of: boolean, Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Reported data may have different rules on editing and may be visually distinguished from primary data.
Alternate Names | informer
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `Procedure.reported[x]`. The slices areUnordered and Open, and can be differentiated using the following discriminators: type @ $this
50. Procedure.reported[x]:reportedReference
Slice Name | reportedReference
Definition | Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the source of the report.
Short | Reported rather than primary record.
Control | 0..1
Type | Reference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Must Support | false
Summary | true
Requirements | Reported data may have different rules on editing and may be visually distinguished from primary data.
Alternate Names | informer
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. Procedure.performer
Definition | Indicates who or what performed the procedure and how they were involved.
Short | Who performed the procedure and what they did
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) prc-1: Procedure.performer.onBehalfOf can only be populated when performer.actor isn't Practitioner or PractitionerRole (`onBehalfOf.exists() and actor.resolve().exists() implies actor.resolve().where($this is Practitioner or $this is PractitionerRole).empty()`)
54. Procedure.performer.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
56. Procedure.performer.extension
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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
58. Procedure.performer.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, there is a strict set of governance applied to the definition and use of extensions. Though 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
60. Procedure.performer.function
Definition | Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.
Short | Type of performance
Control | 0..1
Binding | For example codes, see ProcedurePerformerRoleCodes (example to `http://hl7.org/fhir/ValueSet/performer-role|5.0.0` ) A code that identifies the role of a performer of the procedure.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Requirements | Allows disambiguation of the types of involvement of different performers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. Procedure.performer.actor
Definition | Indicates who or what performed the procedure.
Short | Who performed the procedure
Control | 1..1 This element is affected by the following invariants: prc-1
Type | Reference(PractitionerRole (EU core), Practitioner (EU core), Device, Patient (EU core), RelatedPerson, Organization (EU core))
Is Modifier | false
Must Support | false
Summary | true
Requirements | A reference to Device supports use cases, such as pacemakers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. Procedure.performer.onBehalfOf
Definition | The Organization the Patient, RelatedPerson, Device, CareTeam, and HealthcareService was acting on behalf of.
Short | Organization the device or practitioner was acting for
Comments | Organization, Patient, RelatedPerson, Device, CareTeam, and HealthcareService can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.
Control | 0..1 This element is affected by the following invariants: prc-1
Type | Reference(Organization (EU core))
Is Modifier | false
Must Support | false
Summary | false
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. Procedure.performer.period
Definition | Time period during which the performer performed the procedure.
Short | When the performer performed the procedure
Control | 0..1
Type | Period
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. Procedure.location
Definition | The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.
Short | Where the procedure happened
Control | 0..1
Type | Reference(Location)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. Procedure.reason
Definition | The coded reason or reference why the procedure was performed. This may be a coded entity of some type, be present as text, or be a reference to one of several resources that justify the procedure.
Short | Why the procedure was performed
Comments | Use Procedure.reason.concept when a code sufficiently describes the reason. Use Procedure.reason.reference when referencing a resource, which allows more information to be conveyed, such as onset date. For a single Procedure.reason, if both Procedure.reason.concept and Procedure.reason.reference are present, they are expected to be consistent with each other.
Control | 0..*
Binding | For example codes, see ProcedureReasonCodes (example to `http://hl7.org/fhir/ValueSet/procedure-reason|5.0.0` ) A code that identifies the reason a procedure is required.
Type | CodeableReference(Condition (EU core), Observation, Procedure (EU core), DiagnosticReport, DocumentReference)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. Procedure.bodySite
Definition | Anatomical location which is the focus of the problem.
Short | Target body sites
Comments | If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension http://hl7.org/fhir/StructureDefinition/procedure-targetBodyStructure.
Control | 0..*
Binding | The codes SHOULD be taken from SNOMEDCTBodyStructures (preferred to `http://hl7.org/fhir/ValueSet/body-site` )
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) eu-bodysite-1: Either a body site code or a reference to a BodyStructure resource SHALL be used, but not both. (`(coding.empty() and text.empty()) or extension('http://hl7.org/fhir/StructureDefinition/bodySite').empty()`)
74. Procedure.bodySite.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
76. Procedure.bodySite.extension
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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Procedure.bodySite.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
78. Procedure.bodySite.extension:bodySite
Slice Name | bodySite
Definition | Record details about the anatomical location of a specimen or body part. This resource may be used when a coded concept does not provide the necessary detail needed for the use case.
Short | Target anatomic location or structure
Control | 0..1
Type | Extension(BodyStructure Reference) (Extension Type: Reference(BodyStructure))
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
80. Procedure.bodySite.extension:bodySite.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
82. Procedure.bodySite.extension:bodySite.extension
Definition | An Extension
Short | Extension
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `Procedure.bodySite.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
84. Procedure.bodySite.extension:bodySite.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies the meaning of the extension
Comments | The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/bodySite`
86. Procedure.bodySite.extension:bodySite.value[x]
Definition | Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | Value of extension
Control | 1..1 This element is affected by the following invariants: ext-1
Type | Reference(BodyStructure (EU core))
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
88. Procedure.bodySite.coding
Definition | A reference to a code defined by a terminology system.
Short | Code defined by a terminology system
Comments | Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Control | 0..*
Type | Coding
Is Modifier | false
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
90. Procedure.bodySite.text
Definition | A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Short | Plain text representation of the concept
Comments | Very often the text is the same as a displayName of one of the codings.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. Procedure.outcome
Definition | The outcome of the procedure - did it resolve the reasons for the procedure being performed?
Short | Outcome of the procedure
Comments | If outcome contains narrative text only, it can be captured using the CodeableConcept.text.
Control | 0..1
Binding | For example codes, see ProcedureOutcomeCodesSNOMEDCT (example to `http://hl7.org/fhir/ValueSet/procedure-outcome|5.0.0` ) An outcome of a procedure - whether it was resolved or otherwise.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
94. Procedure.report
Definition | This could be a histology result, pathology report, surgical report, etc.
Short | Any report resulting from the procedure
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.
Control | 0..*
Type | Reference(DiagnosticReport, DocumentReference, Composition)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. Procedure.complication
Definition | Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
Short | Complication following the procedure
Comments | If complications are only expressed by the narrative text, they can be captured using the CodeableReference.concept.text.
Control | 0..*
Binding | For example codes, see ConditionProblemDiagnosisCodes (example to `http://hl7.org/fhir/ValueSet/condition-code|5.0.0` ) Codes describing complications that resulted from a procedure.
Type | CodeableReference(Condition (EU core))
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
98. Procedure.followUp
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.
Short | Instructions for follow up
Control | 0..*
Binding | For example codes, see ProcedureFollowUpCodesSNOMEDCT (example to `http://hl7.org/fhir/ValueSet/procedure-followup|5.0.0` ) Specific follow up required for a procedure e.g. removal of sutures.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
100. Procedure.note
Definition | Any other notes and comments about the procedure.
Short | Additional information about the procedure.
Control | 0..*
Type | Annotation
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
102. Procedure.focalDevice
Definition | A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
Short | Device implanted, removed or otherwise manipulated
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
104. Procedure.focalDevice.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
106. Procedure.focalDevice.extension
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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
108. Procedure.focalDevice.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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 managable, there is a strict set of governance applied to the definition and use of extensions. Though 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
110. Procedure.focalDevice.action
Definition | The kind of change that happened to the device during the procedure.
Short | Kind of change to device
Control | 0..1
Binding | The codes SHOULD be taken from ProcedureDeviceActionCodes (preferred to `http://hl7.org/fhir/ValueSet/device-action|5.0.0` ) A kind of change that happened to the device during the procedure.
Type | CodeableConcept
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. Procedure.focalDevice.manipulated
Definition | The device that was manipulated (changed) during the procedure.
Short | Device that was changed
Control | 1..1
Type | Reference(Device)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. Procedure.used
Definition | Identifies medications, devices and any other substance used as part of the procedure.
Short | Device used to perform the procedure
Comments | For devices actually implanted or removed, use Procedure.focalDevice.manipulated.
Control | 0..*
Binding | For example codes, see DeviceType (example to `http://hl7.org/fhir/ValueSet/device-type|5.0.0` ) Codes describing items used during a procedure.
Type | CodeableReference(Device, Medication (EU core), Substance, BiologicallyDerivedProduct)
Is Modifier | false
Must Support | false
Summary | false
Requirements | Used for tracking contamination, etc.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. Procedure.supportingInfo
Definition | Other resources from the patient record that may be relevant to the procedure. The information from these resources was either used to create the instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available.
Short | Extra information relevant to the procedure
Control | 0..*
Type | Reference(Resource)
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)