Procedure R5 (FHIR) at fhirtruck

Path

Procedure

Id

Procedure

Cardinality

0 - *

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.

Comment

Constraint

dom-2 [error]

If the resource is contained in another resource, it SHALL NOT contain nested Resources

dom-3 [error]

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

dom-4 [error]

If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated

dom-5 [error]

If a resource is contained in another resource, it SHALL NOT have a security label

dom-6 [warning]

A resource should have narrative for robust management

Path

Procedure.identifier

Id

Procedure.identifier

Type

Identifier

Cardinality

0 - *

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.

Comment

This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.

Requirements

Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

use

Summary: The element appears in the summary view

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

coding

List: This element is a list and more than one value can be provided

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.instantiatesCanonical

Id

Procedure.instantiatesCanonical

Type

canonical

Cardinality

0 - *

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.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.instantiatesUri

Id

Procedure.instantiatesUri

Type

uri

Cardinality

0 - *

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.

Comment

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.basedOn

Id

Procedure.basedOn

Type

Reference

Cardinality

0 - *

Definition

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

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.basedOn.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.basedOn.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.partOf

Id

Procedure.partOf

Type

Reference

Cardinality

0 - *

Definition

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

Comment

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).

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.partOf.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.partOf.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.status

Id

Procedure.status

Type

code

Cardinality

1 - 1

Definition

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

Comment

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.

Binding

Strength

required

Description

A code specifying the state of the procedure.

ValueSet

http://hl7.org/fhir/ValueSet/event-status|5.0.0

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.statusReason

Id

Procedure.statusReason

Type

CodeableConcept

Cardinality

0 - 1

Definition

Captures the reason for the current state of the procedure.

Comment

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.

Binding

Strength

example

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/procedure-not-performed-reason

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.category

Id

Procedure.category

Type

CodeableConcept

Cardinality

0 - *

Definition

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

Comment

Binding

Strength

example

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/procedure-category

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.code

Id

Procedure.code

Type

CodeableConcept

Cardinality

0 - 1

Definition

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

Comment

Requirements

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

Binding

Strength

example

Description

A code to identify a specific procedure .

ValueSet

http://hl7.org/fhir/ValueSet/procedure-code

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.subject

Id

Procedure.subject

Type

Reference

Cardinality

1 - 1

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.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.subject.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.subject.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.focus

Id

Procedure.focus

Type

Reference

Cardinality

0 - 1

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.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.focus.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.focus.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.encounter

Id

Procedure.encounter

Type

Reference

Cardinality

0 - 1

Definition

The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.

Comment

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.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.encounter.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.encounter.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.occurrence[x]

Id

Procedure.occurrence[x]

Type

dateTime

Cardinality

0 - 1

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.

Comment

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.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.recorded

Id

Procedure.recorded

Type

dateTime

Cardinality

0 - 1

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).

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.recorder

Id

Procedure.recorder

Type

Reference

Cardinality

0 - 1

Definition

Individual who recorded the record and takes responsibility for its content.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.recorder.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.recorder.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.reported[x]

Id

Procedure.reported[x]

Type

boolean

Cardinality

0 - 1

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.

Comment

Requirements

Reported data may have different rules on editing and may be visually distinguished from primary data.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.performer

Id

Procedure.performer

Type

BackboneElement

Cardinality

0 - *

Definition

Indicates who or what performed the procedure and how they were involved.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

prc-1 [error]

Procedure.performer.onBehalfOf can only be populated when performer.actor isn't Practitioner or PractitionerRole

Path

Procedure.performer.function

Id

Procedure.performer.function

Type

CodeableConcept

Cardinality

0 - 1

Definition

Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.

Comment

Requirements

Allows disambiguation of the types of involvement of different performers.

Binding

Strength

example

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/performer-role

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.performer.actor

Id

Procedure.performer.actor

Type

Reference

Cardinality

1 - 1

Definition

Indicates who or what performed the procedure.

Comment

Requirements

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

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

prc-1

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.performer.actor.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.performer.onBehalfOf

Id

Procedure.performer.onBehalfOf

Type

Reference

Cardinality

0 - 1

Definition

The Organization the Patient, RelatedPerson, Device, CareTeam, and HealthcareService was acting on behalf of.

Comment

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.

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.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

prc-1

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.performer.onBehalfOf.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.performer.period

Id

Procedure.performer.period

Type

Period

Cardinality

0 - 1

Definition

Time period during which the performer performed the procedure.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

Path

Procedure.location

Id

Procedure.location

Type

Reference

Cardinality

0 - 1

Definition

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

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.location.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.location.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.reason

Id

Procedure.reason

Type

CodeableReference

Cardinality

0 - *

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.

Comment

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.

Binding

Strength

example

Description

A code that identifies the reason a procedure is required.

ValueSet

http://hl7.org/fhir/ValueSet/procedure-reason

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

concept

CodeableConcept

Reference to a concept (by class)

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

reference

Reference

Reference to a resource (by instance)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.reason.CodeableReference.reference.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.bodySite

Id

Procedure.bodySite

Type

CodeableConcept

Cardinality

0 - *

Definition

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

Comment

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](http://hl7.org/fhir/extensions/StructureDefinition-procedure-targetBodyStructure.html).

Binding

Strength

example

Description

SNOMED CT Body site concepts

ValueSet

http://hl7.org/fhir/ValueSet/body-site

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.outcome

Id

Procedure.outcome

Type

CodeableConcept

Cardinality

0 - 1

Definition

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

Comment

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

Binding

Strength

example

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/procedure-outcome

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.report

Id

Procedure.report

Type

Reference

Cardinality

0 - *

Definition

This could be a histology result, pathology report, surgical report, etc.

Comment

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.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.report.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.report.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource

Path

Procedure.complication

Id

Procedure.complication

Type

CodeableReference

Cardinality

0 - *

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.

Comment

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

Binding

Strength

example

Description

Codes describing complications that resulted from a procedure.

ValueSet

http://hl7.org/fhir/ValueSet/condition-code

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

concept

CodeableConcept

Reference to a concept (by class)

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

reference

Reference

Reference to a resource (by instance)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.complication.CodeableReference.reference.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.followUp

Id

Procedure.followUp

Type

CodeableConcept

Cardinality

0 - *

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.

Comment

Binding

Strength

example

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/procedure-followup

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.note

Id

Procedure.note

Type

Annotation

Cardinality

0 - *

Definition

Any other notes and comments about the procedure.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

author[x]

Reference

Individual responsible for the annotation

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.note.Annotation.author[x].Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

time

dateTime

When the annotation was made

Path

Procedure.focalDevice

Id

Procedure.focalDevice

Type

BackboneElement

Cardinality

0 - *

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.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Path

Procedure.focalDevice.action

Id

Procedure.focalDevice.action

Type

CodeableConcept

Cardinality

0 - 1

Definition

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

Comment

Binding

Strength

preferred

Description

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

ValueSet

http://hl7.org/fhir/ValueSet/device-action

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

Path

Procedure.focalDevice.manipulated

Id

Procedure.focalDevice.manipulated

Type

Reference

Cardinality

1 - 1

Definition

The device that was manipulated (changed) during the procedure.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.focalDevice.manipulated.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.used

Id

Procedure.used

Type

CodeableReference

Cardinality

0 - *

Definition

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

Comment

For devices actually implanted or removed, use Procedure.focalDevice.manipulated.

Requirements

Used for tracking contamination, etc.

Binding

Strength

example

Description

Codes describing items used during a procedure.

ValueSet

http://hl7.org/fhir/ValueSet/device-type

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

concept

CodeableConcept

Reference to a concept (by class)

coding

Coding

Code defined by a terminology system

system

uri

Identity of the terminology system

version

string

Version of the system - if relevant

code

Symbol in syntax defined by the system

display

string

Representation defined by the system

userSelected

boolean

If this coding was chosen directly by the user

reference

Reference

Reference to a resource (by instance)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.used.CodeableReference.reference.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

assigner

Reference

Organization that issued id (may be just text)

display

string

Text alternative for the resource

Path

Procedure.supportingInfo

Id

Procedure.supportingInfo

Type

Reference

Cardinality

0 - *

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.

Comment

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.supportingInfo.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

use

code

usual | official | temp | secondary | old (If known)

type

CodeableConcept

Description of identifier

system

uri

The namespace for the identifier value

value

string

The value that is unique

period

Period

Time period when id is/was valid for use

start

dateTime

Starting time with inclusive boundary

end

dateTime

End time with inclusive boundary, if not ongoing

assigner

Reference

Organization that issued id (may be just text)

reference

string

Literal reference, Relative, internal or absolute URL

type

uri

Type the reference refers to (e.g. "Patient") - must be a resource in resources

identifier

Identifier

Logical reference, when literal reference is not known

Path

Procedure.supportingInfo.Reference.identifier.Identifier.assigner.Reference.identifier

Id

Reference.identifier

Type

Identifier

Cardinality

0 - 1

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.

Comment

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). This element only allows for a single identifier. In the case where additional identifers are required, use the [http://hl7.org/fhir/StructureDefinition/additionalIdentifier](http://hl7.org/fhir/extensions/StructureDefinition-additionalIdentifier.html) extension.

Constraint

ele-1 [error]

All FHIR elements must have a @value or children

Condition

ref-2

display

string

Text alternative for the resource

display

string

Text alternative for the resource