Australian Digital Health Agency FHIR Implementation Guide
1.2.0-ci-build - draft Australia flag

Australian Digital Health Agency FHIR Implementation Guide, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/ci-fhir-r4/ and changes regularly. See the Directory of published versions

Resource Profile: ADHAProcedureCore - Detailed Descriptions

Active as of 2024-09-12

Definitions for the dh-procedure-core-1 resource profile.

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

0. Procedure
Invariantsinv-dh-pro-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
2. Procedure.status
Must Supporttrue
4. Procedure.statusReason
Must Supporttrue
6. Procedure.category
Control1..?
Must Supporttrue
8. Procedure.code
Control1..?
BindingUnless not suitable, these codes SHALL be taken from Procedure .
(extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
Must Supporttrue
10. Procedure.subject
TypeReference(ADHA Core Patient)
Must Supporttrue
Invariantsinv-dh-pro-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
12. Procedure.encounter
TypeReference(ADHA Core Encounter)
Must Supporttrue
14. Procedure.performed[x]
Control1..?
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Must Supporttrue
16. Procedure.recorder
Control1..?
This element is affected by the following invariants: inv-dh-pro-03
TypeReference(ADHA Authoring PractitionerRole, ADHA Core Patient, ADHA Authoring RelatedPerson)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Invariantsinv-dh-pro-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
18. Procedure.asserter
TypeReference(ADHA Core PractitionerRole, ADHA Core Patient, ADHA Core RelatedPerson)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
20. Procedure.reasonCode
Must Supporttrue
22. Procedure.reasonReference[x]
TypeReference(ADHA Core Condition, ADHA Core Observation, ADHA Core Procedure, ADHA Core DocumentReference)
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
24. Procedure.bodySite
BindingUnless not suitable, these codes SHALL be taken from Body Site .
(extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
Must Supporttrue
Invariantsinv-dh-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
26. Procedure.note
Must Supporttrue

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

0. Procedure
Definition

An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

ShortA procedure in an Australian healthcare contextAn action that is being or was performed on a patient
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
inv-dh-pro-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
2. Procedure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Procedure.extension:targetBodyStructure
Slice NametargetBodyStructure
Definition

The target body site used for this procedure. Multiple locations are allowed.

ShortThe target point for this procedure
Control0..*
TypeExtension(Procedure Target Body Structure) (Extension Type: Reference(BodyStructure))
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Procedure.modifierExtension
Definition

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

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

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

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Procedure.status
Definition

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

Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Comments

The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Control1..1
BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

A code specifying the state of the procedure.

Typecode
Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Procedure.statusReason
Definition

Captures the reason for the current state of the procedure.

ShortReason for current status
Comments

This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

Control0..1
BindingFor example codes, see ProcedureNotPerformedReason(SNOMED-CT)http://hl7.org/fhir/ValueSet/procedure-not-performed-reason
(example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

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

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Alternate NamesSuspended Reason, Cancelled Reason
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Procedure.category
Definition

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

ShortClassification of the procedure
Control10..1
BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-category
(example to http://hl7.org/fhir/ValueSet/procedure-category)

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

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Procedure.code
Definition

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

ShortIdentification of the procedure
Control10..1
BindingUnless not suitable, these codes SHALL be taken from For example codes, see Procedure .http://hl7.org/fhir/ValueSet/procedure-code
(extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

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

Alternate Namestype
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Procedure.subject
Definition

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

ShortWho the procedure was performed on
Control1..1
This element is affected by the following invariants: inv-dh-pro-02
TypeReference(ADHA Core Patient, Patient, Group)
Is Modifierfalse
Must Supporttrue
Summarytrue
Alternate Namespatient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
inv-dh-pro-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
18. Procedure.encounter
Definition

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

ShortEncounter created as part of
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Control0..1
TypeReference(ADHA Core Encounter, Encounter)
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Procedure.performed[x]
Definition

Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

ShortWhen the procedure was performed
Comments

Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

Control10..1
TypeChoice of: dateTime, Period, string, Age, Range
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Procedure.recorder
Definition

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

ShortWho recorded the procedure
Control10..1
This element is affected by the following invariants: inv-dh-pro-03
TypeReference(ADHA Authoring PractitionerRole, ADHA Core Patient, ADHA Authoring RelatedPerson, Patient, RelatedPerson, Practitioner, PractitionerRole)
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
inv-dh-pro-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
24. Procedure.asserter
Definition

Individual who is making the procedure statement.

ShortPerson who asserts this procedure
Control0..1
This element is affected by the following invariants: inv-dh-pro-01
TypeReference(ADHA Core PractitionerRole, ADHA Core Patient, ADHA Core RelatedPerson, Patient, RelatedPerson, Practitioner, PractitionerRole)
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Procedure.reasonCode
Definition

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

ShortCoded reason procedure performed
Comments

Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

Control0..*
BindingFor example codes, see ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reason
(example to http://hl7.org/fhir/ValueSet/procedure-reason)

A code that identifies the reason a procedure is required.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Procedure.reasonReference
Definition

The justification of why the procedure was performed.

ShortThe justification that the procedure was performed
Comments

It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

Control0..*
TypeReference(ADHA Core Condition, ADHA Core Observation, ADHA Core Procedure, ADHA Core DocumentReference, Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Procedure.bodySite
Definition

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

ShortTarget body sites
Comments

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

Control0..*
This element is affected by the following invariants: inv-dh-pro-04
BindingUnless not suitable, these codes SHALL be taken from For example codes, see Body Site .http://hl7.org/fhir/ValueSet/body-site
(extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
inv-dh-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
32. Procedure.note
Definition

Any other notes and comments about the procedure.

ShortAdditional information about the procedure
Control0..*
TypeAnnotation
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

0. Procedure
Definition

An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

ShortA procedure in an Australian healthcare context
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
inv-dh-pro-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
2. Procedure.id
Definition

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

ShortLogical id of this artifact
Comments

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

Control0..1
Typeid
Is Modifierfalse
Summarytrue
4. Procedure.meta
Definition

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

ShortMetadata about the resource
Control0..1
TypeMeta
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Procedure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Procedure.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

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

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages)

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Procedure.text
Definition

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

ShortText summary of the resource, for human interpretation
Comments

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

Control0..1
TypeNarrative
Is Modifierfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Procedure.contained
Definition

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

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

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

An Extension

ShortExtension
Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. Procedure.extension:targetBodyStructure
    Slice NametargetBodyStructure
    Definition

    The target body site used for this procedure. Multiple locations are allowed.

    ShortThe target point for this procedure
    Control0..*
    TypeExtension(Procedure Target Body Structure) (Extension Type: Reference(BodyStructure))
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. Procedure.modifierExtension
    Definition

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

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

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

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    20. Procedure.identifier
    Definition

    Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.

    ShortExternal Identifiers for this procedure
    Comments

    This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. Procedure.instantiatesCanonical
    Definition

    The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.

    ShortInstantiates FHIR protocol or definition
    Control0..*
    Typecanonical(PlanDefinition, ActivityDefinition, Measure, OperationDefinition, Questionnaire)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. Procedure.instantiatesUri
    Definition

    The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.

    ShortInstantiates external protocol or definition
    Comments

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

    Control0..*
    Typeuri
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. Procedure.basedOn
    Definition

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

    ShortA request for this procedure
    Control0..*
    TypeReference(CarePlan, ServiceRequest)
    Is Modifierfalse
    Summarytrue
    Alternate Namesfulfills
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. Procedure.partOf
    Definition

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

    ShortPart of referenced event
    Comments

    The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).

    Control0..*
    TypeReference(Procedure, Observation, MedicationAdministration)
    Is Modifierfalse
    Summarytrue
    Alternate Namescontainer
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Procedure.status
    Definition

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

    Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
    Comments

    The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

    This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from EventStatus
    (required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

    A code specifying the state of the procedure.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. Procedure.statusReason
    Definition

    Captures the reason for the current state of the procedure.

    ShortReason for current status
    Comments

    This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

    Control0..1
    BindingFor example codes, see ProcedureNotPerformedReason(SNOMED-CT)
    (example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

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

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Alternate NamesSuspended Reason, Cancelled Reason
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. Procedure.category
    Definition

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

    ShortClassification of the procedure
    Control1..1
    BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)
    (example to http://hl7.org/fhir/ValueSet/procedure-category)

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

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. Procedure.code
    Definition

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

    ShortIdentification of the procedure
    Control1..1
    BindingUnless not suitable, these codes SHALL be taken from Procedure .
    (extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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

    Alternate Namestype
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. Procedure.subject
    Definition

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

    ShortWho the procedure was performed on
    Control1..1
    This element is affected by the following invariants: inv-dh-pro-02
    TypeReference(ADHA Core Patient)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Alternate Namespatient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    inv-dh-pro-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
    40. Procedure.encounter
    Definition

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

    ShortEncounter created as part of
    Comments

    This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

    Control0..1
    TypeReference(ADHA Core Encounter)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. Procedure.performed[x]
    Definition

    Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

    ShortWhen the procedure was performed
    Comments

    Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

    Control1..1
    TypeChoice of: dateTime, Period, string, Age, Range
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. Procedure.recorder
    Definition

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

    ShortWho recorded the procedure
    Control1..1
    This element is affected by the following invariants: inv-dh-pro-03
    TypeReference(ADHA Authoring PractitionerRole, ADHA Core Patient, ADHA Authoring RelatedPerson)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    inv-dh-pro-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
    46. Procedure.asserter
    Definition

    Individual who is making the procedure statement.

    ShortPerson who asserts this procedure
    Control0..1
    This element is affected by the following invariants: inv-dh-pro-01
    TypeReference(ADHA Core PractitionerRole, ADHA Core Patient, ADHA Core RelatedPerson)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. Procedure.performer
    Definition

    Limited to "real" people rather than equipment.

    ShortThe people who performed the procedure
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. Procedure.performer.id
    Definition

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

    ShortUnique id for inter-element referencing
    Control0..1
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    52. Procedure.performer.extension
    Definition

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

    ShortAdditional content defined by implementations
    Comments

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

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    54. Procedure.performer.modifierExtension
    Definition

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

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

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

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    56. Procedure.performer.function
    Definition

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

    ShortType of performance
    Control0..1
    BindingFor example codes, see ProcedurePerformerRoleCodes
    (example to http://hl7.org/fhir/ValueSet/performer-role)

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

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Requirements

    Allows disambiguation of the types of involvement of different performers.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    58. Procedure.performer.actor
    Definition

    The practitioner who was involved in the procedure.

    ShortThe reference to the practitioner
    Control1..1
    TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
    Is Modifierfalse
    Summarytrue
    Requirements

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    60. Procedure.performer.onBehalfOf
    Definition

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

    ShortOrganization the device or practitioner was acting for
    Control0..1
    TypeReference(Organization)
    Is Modifierfalse
    Summaryfalse
    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.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    62. Procedure.location
    Definition

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

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

    Ties a procedure to where the records are likely kept.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    64. Procedure.reasonCode
    Definition

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

    ShortCoded reason procedure performed
    Comments

    Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

    Control0..*
    BindingFor example codes, see ProcedureReasonCodes
    (example to http://hl7.org/fhir/ValueSet/procedure-reason)

    A code that identifies the reason a procedure is required.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    66. Procedure.reasonReference
    Definition

    The justification of why the procedure was performed.

    ShortThe justification that the procedure was performed
    Comments

    It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

    Control0..*
    TypeReference(ADHA Core Condition, ADHA Core Observation, ADHA Core Procedure, ADHA Core DocumentReference)
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    68. Procedure.bodySite
    Definition

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

    ShortTarget body sites
    Comments

    If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

    Control0..*
    This element is affected by the following invariants: inv-dh-pro-04
    BindingUnless not suitable, these codes SHALL be taken from Body Site .
    (extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    inv-dh-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
    70. Procedure.outcome
    Definition

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

    ShortThe result of procedure
    Comments

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

    Control0..1
    BindingFor example codes, see ProcedureOutcomeCodes(SNOMEDCT)
    (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

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

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    72. Procedure.report
    Definition

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

    ShortAny report resulting from the procedure
    Comments

    There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

    Control0..*
    TypeReference(DiagnosticReport, DocumentReference, Composition)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    74. Procedure.complication
    Definition

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

    ShortComplication following the procedure
    Comments

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

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

    Codes describing complications that resulted from a procedure.

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    76. Procedure.complicationDetail
    Definition

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

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

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    78. Procedure.followUp
    Definition

    If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.

    ShortInstructions for follow up
    Control0..*
    BindingFor example codes, see ProcedureFollowUpCodes(SNOMEDCT)
    (example to http://hl7.org/fhir/ValueSet/procedure-followup)

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

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    80. Procedure.note
    Definition

    Any other notes and comments about the procedure.

    ShortAdditional information about the procedure
    Control0..*
    TypeAnnotation
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    82. Procedure.focalDevice
    Definition

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

    ShortManipulated, implanted, or removed device
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    84. Procedure.focalDevice.id
    Definition

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

    ShortUnique id for inter-element referencing
    Control0..1
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    86. Procedure.focalDevice.extension
    Definition

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

    ShortAdditional content defined by implementations
    Comments

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

    Control0..*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    88. Procedure.focalDevice.modifierExtension
    Definition

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

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

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

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    90. Procedure.focalDevice.action
    Definition

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

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

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

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    92. Procedure.focalDevice.manipulated
    Definition

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

    ShortDevice that was changed
    Control1..1
    TypeReference(Device)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    94. Procedure.usedReference
    Definition

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

    ShortItems used during procedure
    Comments

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

    Control0..*
    TypeReference(Device, Medication, Substance)
    Is Modifierfalse
    Summaryfalse
    Requirements

    Used for tracking contamination, etc.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    96. Procedure.usedCode
    Definition

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

    ShortCoded items used during the procedure
    Comments

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

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

    Codes describing items used during a procedure.

    TypeCodeableConcept
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))