CodeX Radiation Therapy
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CodeX Radiation Therapy, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/codex-radiation-therapy/ and changes regularly. See the Directory of published versions

Resource Profile: RadiotherapyTreatedPlan - Detailed Descriptions

Draft as of 2024-04-09

Definitions for the codexrt-radiotherapy-treated-plan resource profile.

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

0. Procedure
Invariantscodexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed (status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed')
codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "Radiotherapy without respiratory motion management (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1)
codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "Radiotherapy with free breathing (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))))
CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. (category.exists() and category.coding.exists( code = '108290001' ).not())
2. Procedure.extension
SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Procedure.extension:modalityAndTechnique
    Slice NamemodalityAndTechnique
    Control0..1
    TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
    Must Supporttrue
    6. Procedure.extension:modalityAndTechnique.extension:radiotherapyEnergyOrIsotope
    Slice NameradiotherapyEnergyOrIsotope
    Control0..*
    TypeExtension(Energy or Isotope) (Extension Type: Choice of: CodeableConcept, Quantity(SimpleQuantity))
    Must Supporttrue
    8. Procedure.extension:modalityAndTechnique.extension:radiotherapyTreatmentApplicatorType
    Slice NameradiotherapyTreatmentApplicatorType
    Control0..*
    TypeExtension(Treatment Applicator Type) (Extension Type: CodeableConcept)
    Must Supporttrue
    10. Procedure.extension:imageGuidedRadiotherapyModality
    Slice NameimageGuidedRadiotherapyModality
    Control0..*
    TypeExtension(Image Guided Radiotherapy Modality) (Complex Extension)
    Must Supporttrue
    12. Procedure.extension:fractionsDelivered
    Slice NamefractionsDelivered
    Definition

    The number of delivered fractions of this treatment plan.

    ShortNumber of Fractions Delivered
    Control0..1
    TypeExtension(Number of Delivered Fractions) (Extension Type: unsignedInt)
    Must Supporttrue
    14. Procedure.extension:doseDeliveredToVolume
    Slice NamedoseDeliveredToVolume
    Control0..*
    TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
    Must Supporttrue
    16. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered
    Slice NametotalDoseDelivered
    Definition

    The total amount of radiation delivered to this volume within the scope of this plan, not including dose from any other plan.

    18. Procedure.extension:doseDeliveredToVolume.extension:fractionsDelivered
    Slice NamefractionsDelivered
    Definition

    Record the fractions delivered with this plan in the top-level extension also named fractionDelivered.

    ShortNot used in this profile.
    Control0..0
    20. Procedure.extension:doseDeliveredToVolume.extension:pointDose
    Slice NamepointDose
    Control0..1
    TypeExtension(Point Dose) (Extension Type: boolean)
    Must Supporttrue
    22. Procedure.extension:doseDeliveredToVolume.extension:primaryPlanDose
    Slice NameprimaryPlanDose
    Control0..1
    TypeExtension(Primary Plan Dose) (Extension Type: boolean)
    Must Supporttrue
    24. Procedure.extension:doseDeliveredToVolume.extension:radiobiologicMetric
    Slice NameradiobiologicMetric
    Control0..*
    TypeExtension(Radiobiologic Metric) (Extension Type: Quantity)
    Must Supporttrue
    26. Procedure.extension:radiotherapyReasonForRevisionOrAdaptation
    Slice NameradiotherapyReasonForRevisionOrAdaptation
    Control0..*
    TypeExtension(Reason for Revision or Adaptation) (Extension Type: CodeableConcept)
    Must Supporttrue
    28. Procedure.extension:respiratoryMotionManagement
    Slice NamerespiratoryMotionManagement
    Definition

    Method applied to manage respiratory motion.

    ShortRespiratory Motion Management
    Control0..*
    TypeExtension(Respiratory Motion Management) (Extension Type: CodeableConcept)
    Must Supporttrue
    30. Procedure.extension:freeBreathingMotionManagementTechnique
    Slice NamefreeBreathingMotionManagementTechnique
    Definition

    Technique to manage respiratory motion with free-breathing. Only allowed if respiratory motion management is free-breathing.

    ShortFree-Breathing Motion Management Technique
    Control0..*
    TypeExtension(Free-Breathing Motion Management Technique) (Extension Type: CodeableConcept)
    Must Supporttrue
    32. Procedure.extension:intrafractionVerification
    Slice NameintrafractionVerification
    Control0..*
    TypeExtension(Intrafraction Verification) (Complex Extension)
    Must Supporttrue
    34. Procedure.extension:radiotherapyDicomRecord
    Slice NameradiotherapyDicomRecord
    Definition

    Reference to a DICOM SOP instances representing a treatment records such as RT Beams Treatment Record or RT Ion Beams Treatment Record. One or more treatment records are expected from each treatment sessions.

    ShortDICOM Treatment Record
    Control0..*
    TypeExtension(Reference to DICOM SOP Instance) (Complex Extension)
    36. Procedure.identifier
    Definition

    SHALL have a display name with use = usual and at least one globally unique technical identifier, for example, the Conceptual Volume UID used in DICOM.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control2..?
    Must Supporttrue
    SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ use
    • 38. Procedure.identifier:displayName
      Slice NamedisplayName
      ShortThe name that is displayed to the user.
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..1
      Must Supporttrue
      40. Procedure.identifier:displayName.use
      Control1..?
      Pattern Valueusual
      42. Procedure.identifier:displayName.system
      Control1..?
      Must Supporttrue
      44. Procedure.identifier:displayName.value
      Control1..?
      Must Supporttrue
      46. Procedure.identifier:official
      Slice Nameofficial
      ShortA business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..*
      Must Supporttrue
      48. Procedure.identifier:official.use
      Control1..?
      Pattern Valueofficial
      50. Procedure.identifier:official.system
      Control1..?
      Must Supporttrue
      52. Procedure.identifier:official.value
      Control1..?
      Must Supporttrue
      54. Procedure.basedOn
      SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
      • profile @ $this.resolve()
      • 56. Procedure.basedOn:treatment-plan
        Slice Nametreatment-plan
        ShortRadiotherapy Treatment Plan that planned the treatment summarized in this Radiotherapy Treated Plan.
        Control0..1
        TypeReference(Radiotherapy Treatment Plan)
        Must Supporttrue
        58. Procedure.basedOn:plan-prescription
        Slice Nameplan-prescription
        ShortRadiotherapy Plan Prescription that prescribed the treatment summarized in this Radiotherapy Treated Plan.
        Control0..1
        TypeReference(Radiotherapy Plan Prescription)
        Must Supporttrue
        60. Procedure.partOf
        SlicingThis element introduces a set of slices on Procedure.partOf. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • profile @ $this.resolve()
        • 62. Procedure.partOf:course-summary
          Slice Namecourse-summary
          ShortRadiotherapy Course Summary that summarizes the course of which this Radiotherapy Treated Plan is a part.
          Control0..1
          TypeReference(Radiotherapy Course Summary)
          Must Supporttrue
          64. Procedure.partOf:treated-phase
          Slice Nametreated-phase
          ShortRadiotherapy Treated Phase that summarizes the phase of which this Radiotherapy Treated Plan is a part.
          Control0..1
          TypeReference(Radiotherapy Treated Phase)
          Must Supporttrue
          66. Procedure.category
          Control1..?
          BindingThe codes SHALL be taken from Radiotherapy Category Code Max Value Set
          (required to http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs)
          68. Procedure.code
          Pattern Value{
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "1255724003",
              "display" : "Radiotherapy treatment plan (regime/therapy)"
            }]
          }
          70. Procedure.subject
          TypeReference(Cancer Patient Profile)
          72. Procedure.performed[x]
          TypePeriod, dateTime, string, Range, Age
          [x] NoteSee Choice of Data Types for further information about how to use [x]
          74. Procedure.performed[x].start
          ShortThe date and time when the first therapeutic radiation was delivered.
          Must Supporttrue
          76. Procedure.performed[x].end
          ShortAn end date is expected if the status is 'stopped' or 'completed'
          Must Supporttrue
          78. Procedure.performer
          Must Supporttrue
          SlicingThis element introduces a set of slices on Procedure.performer. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • profile @ actor.resolve()
          • 80. Procedure.performer:organization
            Slice Nameorganization
            Control0..*
            Must Supporttrue
            82. Procedure.performer:organization.actor
            ShortOrganization that provided the radiotherapy treatment.
            TypeReference(US Core Organization Profile)
            84. Procedure.location
            ShortLocation where the radiotherapy treatment was performed.
            TypeReference(US Core Location Profile)
            Must Supporttrue
            86. Procedure.reasonCode
            BindingUnless not suitable, these codes SHALL be taken from Cancer Disorder Value Set
            (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs)
            Must Supporttrue
            88. Procedure.reasonReference
            Must Supporttrue
            90. Procedure.bodySite
            Definition

            Coded body structure(s) treated with this radiotherapy treatment procedure. These codes represent general locations. For additional detail, refer to the BodyStructures references in the doseDeliveredToVolume extension.

            ShortAll body structure(s) treated with this procedure.
            BindingUnless not suitable, these codes SHALL be taken from Radiotherapy Treatment Location Value Set
            (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs)
            Must Supporttrue
            92. Procedure.bodySite.extension:locationQualifier
            Slice NamelocationQualifier
            Definition

            General location qualifier (excluding laterality) for this bodySite

            ShortGeneral location qualifier (excluding laterality) for this bodySite
            Control0..*
            TypeExtension(Body Location Qualifier Extension) (Extension Type: CodeableConcept)
            94. Procedure.bodySite.extension:lateralityQualifier
            Slice NamelateralityQualifier
            Definition

            Laterality qualifier for this bodySite

            ShortLaterality qualifier for this bodySite
            Control0..1
            TypeExtension(Laterality Qualifier Extension) (Extension Type: CodeableConcept)
            96. Procedure.focalDevice
            SlicingThis element introduces a set of slices on Procedure.focalDevice. The slices are unordered and Open, and can be differentiated using the following discriminators:
            • profile @ manipulated.resolve()
            • 98. Procedure.focalDevice:seedDevice
              Slice NameseedDevice
              ShortRadiotherapy Seed Device used as part of therapy.
              Control0..*
              Must Supporttrue
              100. Procedure.focalDevice:seedDevice.manipulated
              TypeReference(Radiotherapy Seed Device)
              102. Procedure.usedReference
              Must Supporttrue
              SlicingThis element introduces a set of slices on Procedure.usedReference. The slices are unordered and Open, and can be differentiated using the following discriminators:
              • profile @ $this.resolve()
              • 104. Procedure.usedReference:treatmentDevice
                Slice NametreatmentDevice
                ShortRadiotherapy Treatment Device used as part of therapy.
                Control0..*
                TypeReference(Radiotherapy Treatment Device)
                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.

                ShortAn action that is being or was performed on a patient
                Comments

                -

                Control0..*
                Is Modifierfalse
                Must Supportfalse
                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())
                us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' ((status='completed' or status='in-progress') implies performed.exists())
                codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed (status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed')
                codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "Radiotherapy without respiratory motion management (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1)
                codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "Radiotherapy with free breathing (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))))
                CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. (category.exists() and category.coding.exists( code = '108290001' ).not())
                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
                Definition

                An Extension


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

                ShortExtensionAdditional content defined by implementations
                Comments

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

                Control0..*
                TypeExtension
                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())
                SlicingThis element introduces a set of slices on Procedure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 6. Procedure.extension:modalityAndTechnique
                  Slice NamemodalityAndTechnique
                  Definition

                  Extension capturing modality and technique of a given radiotherapy procedure. The allowed combinations of modality and technique are constrained by invariants, one per modality.

                  ShortRadiotherapy Modality And Technique Extension
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
                  Is Modifierfalse
                  Must Supporttrue
                  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())
                  TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '80347004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '169317000' or code = '1162782007'))
                  TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156506007') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '441799006' or code = '1156530009' or code = '1162782007' or code = '1156526006' or code = '168524008' or code = '1156530009' or code = '1163157007'))
                  TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '45643008') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1162782007' or code = '1156526006' or code = '168524008' or code = '1163157007'))
                  TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156505006') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156529004' or code = '1156528007' or code='1204242009'))
                  TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '10611004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156529004' or code = '1156528007' or code = '1204242009' or code = '1163157007'))
                  TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '169359004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '113120007'))
                  TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156708005') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '384692006' or code = '113120007' or code = '14473006'))
                  TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156384006') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156384006'))
                  TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '394902000') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '394902000'))
                  TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '438629002') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '384692006' or code = '1156382005' or code = '113120007' or code = '384691004' or code = '168524008' or code = '14473006'))
                  TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '440252007') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '16560241000119104' or code = '1156383000' or code = '384692006' or code = '113120007'))
                  ModalityTextRequiredForOther: Require a text literal for code other (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' and code = 'UNC') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.text.exists())
                  TechniqueTextRequiredForOther: Require a text literal for code other (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' and code = 'UNC') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.text.exists())
                  8. Procedure.extension:modalityAndTechnique.extension
                  Definition

                  An Extension


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

                  ShortExtensionAdditional content defined by implementations
                  Comments

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

                  Control10..*
                  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())
                  SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 10. Procedure.extension:modalityAndTechnique.extension:modality
                    Slice Namemodality
                    Definition

                    Extension capturing a modality of external beam or brachytherapy radiation procedures.

                    ShortRadiotherapy Modality Extension
                    Control1..1
                    TypeExtension(Radiotherapy Modality Extension) (Extension Type: CodeableConcept)
                    Is Modifierfalse
                    Must Supporttrue
                    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())
                    12. Procedure.extension:modalityAndTechnique.extension:modality.extension
                    Definition

                    An Extension


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

                    ShortExtensionAdditional content defined by implementations
                    Comments

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

                    Control0..0*
                    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())
                    SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 14. Procedure.extension:modalityAndTechnique.extension:modality.url
                      Definition

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

                      Shortidentifies the meaning of the extension
                      Comments

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

                      Control1..1
                      Typeuri
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
                      16. Procedure.extension:modalityAndTechnique.extension:modality.value[x]
                      Definition

                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                      ShortValue of extension
                      Control10..1
                      BindingThe codes SHALL be taken from For codes, see Radiotherapy Modality Value Set
                      (required to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs)
                      TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      18. Procedure.extension:modalityAndTechnique.extension:technique
                      Slice Nametechnique
                      Definition

                      Extension capturing a technique of external beam or brachytherapy radiation procedures.

                      ShortRadiotherapy Technique Extension
                      Control0..*
                      TypeExtension(Radiotherapy Technique Extension) (Extension Type: CodeableConcept)
                      Is Modifierfalse
                      Must Supporttrue
                      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())
                      20. Procedure.extension:modalityAndTechnique.extension:technique.extension
                      Definition

                      An Extension


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

                      ShortExtensionAdditional content defined by implementations
                      Comments

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

                      Control0..0*
                      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())
                      SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 22. Procedure.extension:modalityAndTechnique.extension:technique.url
                        Definition

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

                        Shortidentifies the meaning of the extension
                        Comments

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

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
                        24. Procedure.extension:modalityAndTechnique.extension:technique.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control10..1
                        BindingThe codes SHALL be taken from For codes, see Radiotherapy Technique Value Set
                        (required to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs)
                        TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        26. Procedure.extension:modalityAndTechnique.extension:radiotherapyEnergyOrIsotope
                        Slice NameradiotherapyEnergyOrIsotope
                        Definition

                        The radiation energy used for radiotherapy. The energy spectrum is characterized by the maximum energy, the maximum accelaration voltage, or the used isotope.

                        ShortRadiotherapy Energy or Isotope
                        Control0..*
                        TypeExtension(Energy or Isotope) (Extension Type: Choice of: CodeableConcept, Quantity(SimpleQuantity))
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        28. Procedure.extension:modalityAndTechnique.extension:radiotherapyTreatmentApplicatorType
                        Slice NameradiotherapyTreatmentApplicatorType
                        Definition

                        Radiotherapy Treatment Applicator Type.

                        ShortRadiotherapy Treatment Applicator Type
                        Control0..*
                        TypeExtension(Treatment Applicator Type) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        30. Procedure.extension:modalityAndTechnique.url
                        Definition

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

                        Shortidentifies the meaning of the extension
                        Comments

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

                        Control1..1
                        Typeuri
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique
                        32. Procedure.extension:modalityAndTechnique.value[x]
                        Definition

                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                        ShortValue of extension
                        Control0..01
                        TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                        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()))
                        34. Procedure.extension:imageGuidedRadiotherapyModality
                        Slice NameimageGuidedRadiotherapyModality
                        Definition

                        The modality and associated energy used for imaging in Image Guided Radiotherapy (IGRT)

                        ShortImage Guided Radiotherapy Modality
                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Image Guided Radiotherapy Modality) (Complex Extension)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities. (extension.where(url = 'energy').exists() implies (extension.where(url = 'modality').exists() and extension.where(url = 'modality').value.exists() and extension.where(url = 'modality').value.coding.all( (system = 'http://snomed.info/sct') and (code = '168537006' or code = '44491008' or code = '77477000' or code = '717193008') ) ))
                        36. Procedure.extension:fractionsDelivered
                        Slice NamefractionsDelivered
                        Definition

                        The number of delivered fractions of this treatment plan.

                        ShortNumber of Fractions Delivered
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Number of Delivered Fractions) (Extension Type: unsignedInt)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        38. Procedure.extension:doseDeliveredToVolume
                        Slice NamedoseDeliveredToVolume
                        Definition

                        Dose delivered to a given radiotherapy volume.

                        ShortRadiotherapy Dose Delivered To Volume Extension
                        Control0..*
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        40. Procedure.extension:doseDeliveredToVolume.extension
                        Definition

                        An Extension


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

                        ShortExtensionAdditional content defined by implementations
                        Comments

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

                        Control10..*
                        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())
                        SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 42. Procedure.extension:doseDeliveredToVolume.extension:volume
                          Slice Namevolume
                          Definition

                          A BodyStructure resource representing volume in the body where radiation was delivered, for example, Chest Wall Lymph Nodes.

                          ShortVolume in the body where radiation was deliveredAdditional content defined by implementations
                          Control10..1*
                          TypeExtension
                          Is Modifierfalse
                          Must Supporttrue
                          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())
                          44. Procedure.extension:doseDeliveredToVolume.extension:volume.extension
                          Definition

                          An Extension


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

                          ShortExtensionAdditional content defined by implementations
                          Comments

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

                          Control0..0*
                          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())
                          SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 46. Procedure.extension:doseDeliveredToVolume.extension:volume.url
                            Definition

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

                            Shortidentifies the meaning of the extension
                            Comments

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

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuevolume
                            48. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered
                            Slice NametotalDoseDelivered
                            Definition

                            The total amount of radiation delivered to this volume within the scope of this plan, not including dose from any other plan.

                            ShortExtensionAdditional content defined by implementations
                            Control0..1*
                            TypeExtension
                            Is Modifierfalse
                            Must Supporttrue
                            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())
                            50. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.extension
                            Definition

                            An Extension


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

                            ShortExtensionAdditional content defined by implementations
                            Comments

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

                            Control0..0*
                            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())
                            SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 52. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.url
                              Definition

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

                              Shortidentifies the meaning of the extension
                              Comments

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

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Fixed ValuetotalDoseDelivered
                              54. Procedure.extension:doseDeliveredToVolume.extension:fractionsDelivered
                              Slice NamefractionsDelivered
                              Definition

                              Record the fractions delivered with this plan in the top-level extension also named fractionDelivered.

                              ShortNot used in this profile.Additional content defined by implementations
                              Control0..0*
                              TypeExtension
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              58. Procedure.extension:doseDeliveredToVolume.extension:pointDose
                              Slice NamepointDose
                              Definition

                              This flag is true if the dose is determined at a single point. Point doses are often used to check dose at a specific point in a calculated 3D dose distribution. Since point doses mostly have a technical role, high-level summaries may decide to exclude them from displays.

                              ShortPoint Dose
                              Control0..1
                              TypeExtension(Point Dose) (Extension Type: boolean)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              60. Procedure.extension:doseDeliveredToVolume.extension:primaryPlanDose
                              Slice NameprimaryPlanDose
                              Definition

                              This flag is true if the dose is the primary plan dose in a radiotherapy treatment plan. For a single treatment plan, the primary plan dose serves as the main dose value for tracking delivered dose vs. planned dose. In summaries over multiple treatment plans, the flag indicates that the dose is a primary plan dose in any of the summarized plans.

                              ShortPrimary Plan Dose
                              Control0..1
                              TypeExtension(Primary Plan Dose) (Extension Type: boolean)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              62. Procedure.extension:doseDeliveredToVolume.extension:radiobiologicMetric
                              Slice NameradiobiologicMetric
                              Definition

                              Extension providing radiobiologic dose metric using a regular expression: BED, CGE, RBE, RBE(factor = <decimal>), EQD2Gy, EQD2Gy(a/b = <decimal>).

                              ShortRadiotherapy Biologically Effective Dose
                              Control0..*
                              TypeExtension(Radiobiologic Metric) (Extension Type: Quantity)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              64. Procedure.extension:doseDeliveredToVolume.url
                              Definition

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

                              Shortidentifies the meaning of the extension
                              Comments

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

                              Control1..1
                              Typeuri
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume
                              66. Procedure.extension:doseDeliveredToVolume.value[x]
                              Definition

                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                              ShortValue of extension
                              Control0..01
                              TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                              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()))
                              68. Procedure.extension:radiotherapyReasonForRevisionOrAdaptation
                              Slice NameradiotherapyReasonForRevisionOrAdaptation
                              Definition

                              The reason a planned or prescribed radiotherapy treatment was revised, superceded, or adapted.

                              ShortReason for Revision or Adaptation
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Reason for Revision or Adaptation) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              70. Procedure.extension:respiratoryMotionManagement
                              Slice NamerespiratoryMotionManagement
                              Definition

                              Method applied to manage respiratory motion.

                              ShortRespiratory Motion Management
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Respiratory Motion Management) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              72. Procedure.extension:freeBreathingMotionManagementTechnique
                              Slice NamefreeBreathingMotionManagementTechnique
                              Definition

                              Technique to manage respiratory motion with free-breathing. Only allowed if respiratory motion management is free-breathing.

                              ShortFree-Breathing Motion Management Technique
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Free-Breathing Motion Management Technique) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              74. Procedure.extension:intrafractionVerification
                              Slice NameintrafractionVerification
                              Definition

                              Verification of the patient or target position during a treatment fraction.

                              ShortIntrafraction Verification
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Intrafraction Verification) (Complex Extension)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure. (extension.where(url = 'qualifier').exists() implies (extension.where(url = 'procedure').exists() and extension.where(url = 'procedure').value.exists() and extension.where(url = 'procedure').value.coding.all( (system = 'http://snomed.info/sct') and (code = '168537006') ) ))
                              76. Procedure.extension:radiotherapyDicomRecord
                              Slice NameradiotherapyDicomRecord
                              Definition

                              Reference to a DICOM SOP instances representing a treatment records such as RT Beams Treatment Record or RT Ion Beams Treatment Record. One or more treatment records are expected from each treatment sessions.

                              ShortDICOM Treatment Record
                              Control0..*
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Reference to DICOM SOP Instance) (Complex Extension)
                              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())
                              78. 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())
                              80. Procedure.identifier
                              Definition

                              SHALL have a display name with use = usual and at least one globally unique technical identifier, for example, the Conceptual Volume UID used in DICOM.


                              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)
                              Control20..*
                              TypeIdentifier
                              Is Modifierfalse
                              Must Supporttrue
                              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()))
                              SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
                              • value @ use
                              • 82. Procedure.identifier:displayName
                                Slice NamedisplayName
                                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.

                                ShortThe name that is displayed to the user.External 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)
                                Control10..1*
                                TypeIdentifier
                                Is Modifierfalse
                                Must Supporttrue
                                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()))
                                84. Procedure.identifier:displayName.use
                                Definition

                                The purpose of this identifier.

                                Shortusual | official | temp | secondary | old (If known)
                                Comments

                                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                Control10..1
                                BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                Identifies the purpose for this identifier, if known .

                                Typecode
                                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                Pattern Valueusual
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                86. Procedure.identifier:displayName.system
                                Definition

                                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                ShortThe namespace for the identifier value
                                Comments

                                Identifier.system is always case sensitive.

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

                                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                88. Procedure.identifier:displayName.value
                                Definition

                                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                ShortThe value that is unique
                                Comments

                                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                Control10..1
                                Typestring
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Summarytrue
                                Example<br/><b>General</b>:123456
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                90. Procedure.identifier:official
                                Slice Nameofficial
                                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.

                                ShortA business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.External 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)
                                Control10..*
                                TypeIdentifier
                                Is Modifierfalse
                                Must Supporttrue
                                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()))
                                92. Procedure.identifier:official.use
                                Definition

                                The purpose of this identifier.

                                Shortusual | official | temp | secondary | old (If known)
                                Comments

                                Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                Control10..1
                                BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.0.1
                                (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                Identifies the purpose for this identifier, if known .

                                Typecode
                                Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Requirements

                                Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                Pattern Valueofficial
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                94. Procedure.identifier:official.system
                                Definition

                                Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                ShortThe namespace for the identifier value
                                Comments

                                Identifier.system is always case sensitive.

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

                                There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                96. Procedure.identifier:official.value
                                Definition

                                The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                ShortThe value that is unique
                                Comments

                                If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                Control10..1
                                Typestring
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Summarytrue
                                Example<br/><b>General</b>:123456
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                98. 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()))
                                SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                • profile @ $this.resolve()
                                • 100. Procedure.basedOn:treatment-plan
                                  Slice Nametreatment-plan
                                  Definition

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

                                  ShortRadiotherapy Treatment Plan that planned the treatment summarized in this Radiotherapy Treated Plan.A request for this procedure
                                  Control0..1*
                                  TypeReference(Radiotherapy Treatment Plan, CarePlan, ServiceRequest)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Alternate Namesfulfills
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  102. Procedure.basedOn:plan-prescription
                                  Slice Nameplan-prescription
                                  Definition

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

                                  ShortRadiotherapy Plan Prescription that prescribed the treatment summarized in this Radiotherapy Treated Plan.A request for this procedure
                                  Control0..1*
                                  TypeReference(Radiotherapy Plan Prescription, CarePlan, ServiceRequest)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Summarytrue
                                  Alternate Namesfulfills
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  104. 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()))
                                  SlicingThis element introduces a set of slices on Procedure.partOf. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                  • profile @ $this.resolve()
                                  • 106. Procedure.partOf:course-summary
                                    Slice Namecourse-summary
                                    Definition

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

                                    ShortRadiotherapy Course Summary that summarizes the course of which this Radiotherapy Treated Plan is a part.Part of referenced event
                                    Comments

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

                                    Control0..1*
                                    TypeReference(Radiotherapy Course Summary, Procedure, Observation, MedicationAdministration)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Alternate Namescontainer
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    108. Procedure.partOf:treated-phase
                                    Slice Nametreated-phase
                                    Definition

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

                                    ShortRadiotherapy Treated Phase that summarizes the phase of which this Radiotherapy Treated Plan is a part.Part of referenced event
                                    Comments

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

                                    Control0..1*
                                    TypeReference(Radiotherapy Treated Phase, Procedure, Observation, MedicationAdministration)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Alternate Namescontainer
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    110. 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
                                    This element is affected by the following invariants: us-core-7
                                    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)
                                    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()))
                                    112. 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
                                    BindingThe codes SHALL be taken from For example codes, see Radiotherapy Category Code Max Value Sethttp://hl7.org/fhir/ValueSet/procedure-category
                                    (required to http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    114. 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 US Core Procedure Codeshttp://hl7.org/fhir/ValueSet/procedure-code
                                    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

                                    Codes describing the type of Procedure


                                    A code to identify a specific procedure .

                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Requirements

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

                                    Alternate Namestype
                                    Pattern Value{
                                      "coding" : [{
                                        "system" : "http://snomed.info/sct",
                                        "code" : "1255724003",
                                        "display" : "Radiotherapy treatment plan (regime/therapy)"
                                      }]
                                    }
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    116. Procedure.subject
                                    Definition

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

                                    ShortWho the procedure was performed on
                                    Control1..1
                                    TypeReference(Cancer Patient Profile, 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()))
                                    118. 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.

                                    Control0..1
                                    This element is affected by the following invariants: us-core-7
                                    TypePeriod, dateTime, string, Range, Age
                                    [x] NoteSee Choice of Data Types for further information about how to use [x]
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    120. Procedure.performed[x].start
                                    Definition

                                    The start of the period. The boundary is inclusive.

                                    ShortThe date and time when the first therapeutic radiation was delivered.Starting time with inclusive boundary
                                    Comments

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

                                    Control0..1
                                    This element is affected by the following invariants: per-1
                                    TypedateTime
                                    Is Modifierfalse
                                    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()))
                                    122. Procedure.performed[x].end
                                    Definition

                                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                    ShortAn end date is expected if the status is 'stopped' or 'completed'End time with inclusive boundary, if not ongoing
                                    Comments

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

                                    Control0..1
                                    This element is affected by the following invariants: per-1
                                    TypedateTime
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Must Supporttrue
                                    Summarytrue
                                    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    124. Procedure.performer
                                    Definition

                                    Limited to "real" people rather than equipment.

                                    ShortThe people who performed the procedure
                                    Control0..*
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    SlicingThis element introduces a set of slices on Procedure.performer. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                    • profile @ actor.resolve()
                                    • 126. 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())
                                      128. 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()))
                                      130. Procedure.performer:organization
                                      Slice Nameorganization
                                      Definition

                                      Limited to "real" people rather than equipment.

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

                                      The practitioner who was involved in the procedure.

                                      ShortOrganization that provided the radiotherapy treatment.The reference to the practitioner
                                      Control1..1
                                      TypeReference(US Core Organization Profile, 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()))
                                      136. Procedure.location
                                      Definition

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

                                      ShortLocation where the radiotherapy treatment was performed.Where the procedure happened
                                      Control0..1
                                      TypeReference(US Core Location Profile, Location)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      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()))
                                      138. 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..*
                                      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Cancer Disorder Value Sethttp://hl7.org/fhir/ValueSet/procedure-reason
                                      (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      140. 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(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()))
                                      142. Procedure.bodySite
                                      Definition

                                      Coded body structure(s) treated with this radiotherapy treatment procedure. These codes represent general locations. For additional detail, refer to the BodyStructures references in the doseDeliveredToVolume extension.


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

                                      ShortAll body structure(s) treated with this procedure.Target body sites
                                      Comments

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

                                      Control0..*
                                      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Radiotherapy Treatment Location Value Sethttp://hl7.org/fhir/ValueSet/body-site
                                      (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs)
                                      TypeCodeableConcept
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Summarytrue
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      144. Procedure.bodySite.extension:locationQualifier
                                      Slice NamelocationQualifier
                                      Definition

                                      General location qualifier (excluding laterality) for this bodySite

                                      ShortGeneral location qualifier (excluding laterality) for this bodySite
                                      Control0..*
                                      TypeExtension(Body Location Qualifier Extension) (Extension Type: CodeableConcept)
                                      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())
                                      146. Procedure.bodySite.extension:lateralityQualifier
                                      Slice NamelateralityQualifier
                                      Definition

                                      Laterality qualifier for this bodySite

                                      ShortLaterality qualifier for this bodySite
                                      Control0..1
                                      TypeExtension(Laterality Qualifier Extension) (Extension Type: CodeableConcept)
                                      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())
                                      148. 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()))
                                      SlicingThis element introduces a set of slices on Procedure.focalDevice. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                      • profile @ manipulated.resolve()
                                      • 150. 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())
                                        152. 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()))
                                        154. Procedure.focalDevice:seedDevice
                                        Slice NameseedDevice
                                        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.

                                        ShortRadiotherapy Seed Device used as part of therapy.Manipulated, implanted, or removed device
                                        Control0..*
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        156. Procedure.focalDevice:seedDevice.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())
                                        158. Procedure.focalDevice:seedDevice.manipulated
                                        Definition

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

                                        ShortDevice that was changed
                                        Control1..1
                                        TypeReference(Radiotherapy Seed Device, Device)
                                        Is Modifierfalse
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        160. 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
                                        Must Supporttrue
                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                        Summaryfalse
                                        Requirements

                                        Used for tracking contamination, etc.

                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        SlicingThis element introduces a set of slices on Procedure.usedReference. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                        • profile @ $this.resolve()
                                        • 162. Procedure.usedReference:treatmentDevice
                                          Slice NametreatmentDevice
                                          Definition

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

                                          ShortRadiotherapy Treatment Device used as part of therapy.Items used during procedure
                                          Comments

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

                                          Control0..*
                                          TypeReference(Radiotherapy Treatment Device, Device, Medication, Substance)
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Requirements

                                          Used for tracking contamination, etc.

                                          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

                                          -

                                          ShortAn action that is being or was performed on a patient
                                          Comments

                                          -

                                          Control0..*
                                          Is Modifierfalse
                                          Must Supportfalse
                                          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())
                                          us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' ((status='completed' or status='in-progress') implies performed.exists())
                                          codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed (status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed')
                                          codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "Radiotherapy without respiratory motion management (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1)
                                          codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "Radiotherapy with free breathing (regime/therapy)" (extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://hl7.org/fhir/us/codex-radiation-therapy/CodeSystem/snomed-requested-cs'))))
                                          CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. (category.exists() and category.coding.exists( code = '108290001' ).not())
                                          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 are unordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 16. Procedure.extension:modalityAndTechnique
                                            Slice NamemodalityAndTechnique
                                            Definition

                                            Extension capturing modality and technique of a given radiotherapy procedure. The allowed combinations of modality and technique are constrained by invariants, one per modality.

                                            ShortRadiotherapy Modality And Technique Extension
                                            Control0..1
                                            This element is affected by the following invariants: ele-1
                                            TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
                                            Is Modifierfalse
                                            Must Supporttrue
                                            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())
                                            TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '80347004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '169317000' or code = '1162782007'))
                                            TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156506007') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '441799006' or code = '1156530009' or code = '1162782007' or code = '1156526006' or code = '168524008' or code = '1156530009' or code = '1163157007'))
                                            TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '45643008') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1162782007' or code = '1156526006' or code = '168524008' or code = '1163157007'))
                                            TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156505006') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156529004' or code = '1156528007' or code='1204242009'))
                                            TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '10611004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156529004' or code = '1156528007' or code = '1204242009' or code = '1163157007'))
                                            TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '169359004') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '113120007'))
                                            TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156708005') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '384692006' or code = '113120007' or code = '14473006'))
                                            TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '1156384006') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '1156384006'))
                                            TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '394902000') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '394902000'))
                                            TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '438629002') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '384692006' or code = '1156382005' or code = '113120007' or code = '384691004' or code = '168524008' or code = '14473006'))
                                            TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://snomed.info/sct' and code = '440252007') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(code = 'UNC' or code = '16560241000119104' or code = '1156383000' or code = '384692006' or code = '113120007'))
                                            ModalityTextRequiredForOther: Require a text literal for code other (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.coding.exists(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' and code = 'UNC') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality').value.text.exists())
                                            TechniqueTextRequiredForOther: Require a text literal for code other (extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.exists() and extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.coding.exists(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor' and code = 'UNC') implies extension.where(url = 'http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique').value.text.exists())
                                            18. Procedure.extension:modalityAndTechnique.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
                                            20. Procedure.extension:modalityAndTechnique.extension
                                            Definition

                                            An Extension

                                            ShortExtension
                                            Control1..*
                                            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.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 22. Procedure.extension:modalityAndTechnique.extension:modality
                                              Slice Namemodality
                                              Definition

                                              Extension capturing a modality of external beam or brachytherapy radiation procedures.

                                              ShortRadiotherapy Modality Extension
                                              Control1..1
                                              TypeExtension(Radiotherapy Modality Extension) (Extension Type: CodeableConcept)
                                              Is Modifierfalse
                                              Must Supporttrue
                                              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())
                                              24. Procedure.extension:modalityAndTechnique.extension:modality.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
                                              26. Procedure.extension:modalityAndTechnique.extension:modality.extension
                                              Definition

                                              An Extension

                                              ShortExtension
                                              Control0..0
                                              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.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 28. Procedure.extension:modalityAndTechnique.extension:modality.url
                                                Definition

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

                                                Shortidentifies the meaning of the extension
                                                Comments

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

                                                Control1..1
                                                Typeuri
                                                Is Modifierfalse
                                                XML FormatIn the XML format, this property is represented as an attribute.
                                                Summaryfalse
                                                Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
                                                30. Procedure.extension:modalityAndTechnique.extension:modality.value[x]
                                                Definition

                                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                ShortValue of extension
                                                Control1..1
                                                BindingThe codes SHALL be taken from Radiotherapy Modality Value Set
                                                (required to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs)
                                                TypeCodeableConcept
                                                [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                Is Modifierfalse
                                                Summaryfalse
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                32. Procedure.extension:modalityAndTechnique.extension:technique
                                                Slice Nametechnique
                                                Definition

                                                Extension capturing a technique of external beam or brachytherapy radiation procedures.

                                                ShortRadiotherapy Technique Extension
                                                Control0..*
                                                TypeExtension(Radiotherapy Technique Extension) (Extension Type: CodeableConcept)
                                                Is Modifierfalse
                                                Must Supporttrue
                                                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())
                                                34. Procedure.extension:modalityAndTechnique.extension:technique.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
                                                36. Procedure.extension:modalityAndTechnique.extension:technique.extension
                                                Definition

                                                An Extension

                                                ShortExtension
                                                Control0..0
                                                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.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 38. Procedure.extension:modalityAndTechnique.extension:technique.url
                                                  Definition

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

                                                  Shortidentifies the meaning of the extension
                                                  Comments

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

                                                  Control1..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
                                                  40. Procedure.extension:modalityAndTechnique.extension:technique.value[x]
                                                  Definition

                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                  ShortValue of extension
                                                  Control1..1
                                                  BindingThe codes SHALL be taken from Radiotherapy Technique Value Set
                                                  (required to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs)
                                                  TypeCodeableConcept
                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  42. Procedure.extension:modalityAndTechnique.extension:radiotherapyEnergyOrIsotope
                                                  Slice NameradiotherapyEnergyOrIsotope
                                                  Definition

                                                  The radiation energy used for radiotherapy. The energy spectrum is characterized by the maximum energy, the maximum accelaration voltage, or the used isotope.

                                                  ShortRadiotherapy Energy or Isotope
                                                  Control0..*
                                                  TypeExtension(Energy or Isotope) (Extension Type: Choice of: CodeableConcept, Quantity(SimpleQuantity))
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  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())
                                                  44. Procedure.extension:modalityAndTechnique.extension:radiotherapyTreatmentApplicatorType
                                                  Slice NameradiotherapyTreatmentApplicatorType
                                                  Definition

                                                  Radiotherapy Treatment Applicator Type.

                                                  ShortRadiotherapy Treatment Applicator Type
                                                  Control0..*
                                                  TypeExtension(Treatment Applicator Type) (Extension Type: CodeableConcept)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  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())
                                                  46. Procedure.extension:modalityAndTechnique.url
                                                  Definition

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

                                                  Shortidentifies the meaning of the extension
                                                  Comments

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

                                                  Control1..1
                                                  Typeuri
                                                  Is Modifierfalse
                                                  XML FormatIn the XML format, this property is represented as an attribute.
                                                  Summaryfalse
                                                  Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique
                                                  48. Procedure.extension:modalityAndTechnique.value[x]
                                                  Definition

                                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                  ShortValue of extension
                                                  Control0..0
                                                  TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                                                  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()))
                                                  50. Procedure.extension:imageGuidedRadiotherapyModality
                                                  Slice NameimageGuidedRadiotherapyModality
                                                  Definition

                                                  The modality and associated energy used for imaging in Image Guided Radiotherapy (IGRT)

                                                  ShortImage Guided Radiotherapy Modality
                                                  Control0..*
                                                  This element is affected by the following invariants: ele-1
                                                  TypeExtension(Image Guided Radiotherapy Modality) (Complex Extension)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  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())
                                                  IGRTEnergyAllowed: Energy is only allowed for X-Ray, Fluorograph, or CT Modalities. (extension.where(url = 'energy').exists() implies (extension.where(url = 'modality').exists() and extension.where(url = 'modality').value.exists() and extension.where(url = 'modality').value.coding.all( (system = 'http://snomed.info/sct') and (code = '168537006' or code = '44491008' or code = '77477000' or code = '717193008') ) ))
                                                  52. Procedure.extension:fractionsDelivered
                                                  Slice NamefractionsDelivered
                                                  Definition

                                                  The number of delivered fractions of this treatment plan.

                                                  ShortNumber of Fractions Delivered
                                                  Control0..1
                                                  This element is affected by the following invariants: ele-1
                                                  TypeExtension(Number of Delivered Fractions) (Extension Type: unsignedInt)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  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.extension:doseDeliveredToVolume
                                                  Slice NamedoseDeliveredToVolume
                                                  Definition

                                                  Dose delivered to a given radiotherapy volume.

                                                  ShortRadiotherapy Dose Delivered To Volume Extension
                                                  Control0..*
                                                  This element is affected by the following invariants: ele-1
                                                  TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  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.extension:doseDeliveredToVolume.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
                                                  58. Procedure.extension:doseDeliveredToVolume.extension
                                                  Definition

                                                  An Extension

                                                  ShortExtension
                                                  Control1..*
                                                  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.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 60. Procedure.extension:doseDeliveredToVolume.extension:volume
                                                    Slice Namevolume
                                                    Definition

                                                    A BodyStructure resource representing volume in the body where radiation was delivered, for example, Chest Wall Lymph Nodes.

                                                    ShortVolume in the body where radiation was delivered
                                                    Control1..1
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    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())
                                                    62. Procedure.extension:doseDeliveredToVolume.extension:volume.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
                                                    64. Procedure.extension:doseDeliveredToVolume.extension:volume.extension
                                                    Definition

                                                    An Extension

                                                    ShortExtension
                                                    Control0..0
                                                    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.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 66. Procedure.extension:doseDeliveredToVolume.extension:volume.url
                                                      Definition

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

                                                      Shortidentifies the meaning of the extension
                                                      Comments

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

                                                      Control1..1
                                                      Typeuri
                                                      Is Modifierfalse
                                                      XML FormatIn the XML format, this property is represented as an attribute.
                                                      Summaryfalse
                                                      Fixed Valuevolume
                                                      68. Procedure.extension:doseDeliveredToVolume.extension:volume.value[x]
                                                      Definition

                                                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                      ShortValue of extension
                                                      Control0..1
                                                      TypeReference(Radiotherapy Volume Profile)
                                                      [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                      Is Modifierfalse
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      70. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered
                                                      Slice NametotalDoseDelivered
                                                      Definition

                                                      The total amount of radiation delivered to this volume within the scope of this plan, not including dose from any other plan.

                                                      ShortExtension
                                                      Control0..1
                                                      TypeExtension
                                                      Is Modifierfalse
                                                      Must Supporttrue
                                                      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())
                                                      72. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.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
                                                      74. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.extension
                                                      Definition

                                                      An Extension

                                                      ShortExtension
                                                      Control0..0
                                                      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.extension.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                      • value @ url
                                                      • 76. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.url
                                                        Definition

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

                                                        Shortidentifies the meaning of the extension
                                                        Comments

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

                                                        Control1..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        Fixed ValuetotalDoseDelivered
                                                        78. Procedure.extension:doseDeliveredToVolume.extension:totalDoseDelivered.value[x]
                                                        Definition

                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                        ShortValue of extension
                                                        Control0..1
                                                        TypeQuantity
                                                        [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Pattern Value{
                                                          "system" : "http://unitsofmeasure.org",
                                                          "code" : "cGy"
                                                        }
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        80. Procedure.extension:doseDeliveredToVolume.extension:fractionsDelivered
                                                        Slice NamefractionsDelivered
                                                        Definition

                                                        Record the fractions delivered with this plan in the top-level extension also named fractionDelivered.

                                                        ShortNot used in this profile.
                                                        Control0..0
                                                        TypeExtension
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        86. Procedure.extension:doseDeliveredToVolume.extension:pointDose
                                                        Slice NamepointDose
                                                        Definition

                                                        This flag is true if the dose is determined at a single point. Point doses are often used to check dose at a specific point in a calculated 3D dose distribution. Since point doses mostly have a technical role, high-level summaries may decide to exclude them from displays.

                                                        ShortPoint Dose
                                                        Control0..1
                                                        TypeExtension(Point Dose) (Extension Type: boolean)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        88. Procedure.extension:doseDeliveredToVolume.extension:primaryPlanDose
                                                        Slice NameprimaryPlanDose
                                                        Definition

                                                        This flag is true if the dose is the primary plan dose in a radiotherapy treatment plan. For a single treatment plan, the primary plan dose serves as the main dose value for tracking delivered dose vs. planned dose. In summaries over multiple treatment plans, the flag indicates that the dose is a primary plan dose in any of the summarized plans.

                                                        ShortPrimary Plan Dose
                                                        Control0..1
                                                        TypeExtension(Primary Plan Dose) (Extension Type: boolean)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        90. Procedure.extension:doseDeliveredToVolume.extension:radiobiologicMetric
                                                        Slice NameradiobiologicMetric
                                                        Definition

                                                        Extension providing radiobiologic dose metric using a regular expression: BED, CGE, RBE, RBE(factor = <decimal>), EQD2Gy, EQD2Gy(a/b = <decimal>).

                                                        ShortRadiotherapy Biologically Effective Dose
                                                        Control0..*
                                                        TypeExtension(Radiobiologic Metric) (Extension Type: Quantity)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        92. Procedure.extension:doseDeliveredToVolume.url
                                                        Definition

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

                                                        Shortidentifies the meaning of the extension
                                                        Comments

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

                                                        Control1..1
                                                        Typeuri
                                                        Is Modifierfalse
                                                        XML FormatIn the XML format, this property is represented as an attribute.
                                                        Summaryfalse
                                                        Fixed Valuehttp://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume
                                                        94. Procedure.extension:doseDeliveredToVolume.value[x]
                                                        Definition

                                                        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                                        ShortValue of extension
                                                        Control0..0
                                                        TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                                                        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()))
                                                        96. Procedure.extension:radiotherapyReasonForRevisionOrAdaptation
                                                        Slice NameradiotherapyReasonForRevisionOrAdaptation
                                                        Definition

                                                        The reason a planned or prescribed radiotherapy treatment was revised, superceded, or adapted.

                                                        ShortReason for Revision or Adaptation
                                                        Control0..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Reason for Revision or Adaptation) (Extension Type: CodeableConcept)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        98. Procedure.extension:respiratoryMotionManagement
                                                        Slice NamerespiratoryMotionManagement
                                                        Definition

                                                        Method applied to manage respiratory motion.

                                                        ShortRespiratory Motion Management
                                                        Control0..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Respiratory Motion Management) (Extension Type: CodeableConcept)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        100. Procedure.extension:freeBreathingMotionManagementTechnique
                                                        Slice NamefreeBreathingMotionManagementTechnique
                                                        Definition

                                                        Technique to manage respiratory motion with free-breathing. Only allowed if respiratory motion management is free-breathing.

                                                        ShortFree-Breathing Motion Management Technique
                                                        Control0..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Free-Breathing Motion Management Technique) (Extension Type: CodeableConcept)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        102. Procedure.extension:intrafractionVerification
                                                        Slice NameintrafractionVerification
                                                        Definition

                                                        Verification of the patient or target position during a treatment fraction.

                                                        ShortIntrafraction Verification
                                                        Control0..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Intrafraction Verification) (Complex Extension)
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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())
                                                        IntrafractionVerificationQualifierAllowed: Qualifier is only allowed for X-Ray procedure. (extension.where(url = 'qualifier').exists() implies (extension.where(url = 'procedure').exists() and extension.where(url = 'procedure').value.exists() and extension.where(url = 'procedure').value.coding.all( (system = 'http://snomed.info/sct') and (code = '168537006') ) ))
                                                        104. Procedure.extension:radiotherapyDicomRecord
                                                        Slice NameradiotherapyDicomRecord
                                                        Definition

                                                        Reference to a DICOM SOP instances representing a treatment records such as RT Beams Treatment Record or RT Ion Beams Treatment Record. One or more treatment records are expected from each treatment sessions.

                                                        ShortDICOM Treatment Record
                                                        Control0..*
                                                        This element is affected by the following invariants: ele-1
                                                        TypeExtension(Reference to DICOM SOP Instance) (Complex Extension)
                                                        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())
                                                        106. 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())
                                                        108. Procedure.identifier
                                                        Definition

                                                        SHALL have a display name with use = usual and at least one globally unique technical identifier, for example, the Conceptual Volume UID used in DICOM.

                                                        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)
                                                        Control2..*
                                                        TypeIdentifier
                                                        Is Modifierfalse
                                                        Must Supporttrue
                                                        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()))
                                                        SlicingThis element introduces a set of slices on Procedure.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                        • value @ use
                                                        • 110. Procedure.identifier:displayName
                                                          Slice NamedisplayName
                                                          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.

                                                          ShortThe name that is displayed to the user.
                                                          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)
                                                          Control1..1
                                                          TypeIdentifier
                                                          Is Modifierfalse
                                                          Must Supporttrue
                                                          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()))
                                                          112. Procedure.identifier:displayName.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
                                                          114. Procedure.identifier:displayName.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())
                                                          SlicingThis element introduces a set of slices on Procedure.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 116. Procedure.identifier:displayName.use
                                                            Definition

                                                            The purpose of this identifier.

                                                            Shortusual | official | temp | secondary | old (If known)
                                                            Comments

                                                            Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                            Control1..1
                                                            BindingThe codes SHALL be taken from IdentifierUse
                                                            (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                            Identifies the purpose for this identifier, if known .

                                                            Typecode
                                                            Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            Requirements

                                                            Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                            Pattern Valueusual
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            118. Procedure.identifier:displayName.type
                                                            Definition

                                                            A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                            ShortDescription of identifier
                                                            Comments

                                                            This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                            Control0..1
                                                            BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                            (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                            A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                            TypeCodeableConcept
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Requirements

                                                            Allows users to make use of identifiers when the identifier system is not known.

                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            120. Procedure.identifier:displayName.system
                                                            Definition

                                                            Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                            ShortThe namespace for the identifier value
                                                            Comments

                                                            Identifier.system is always case sensitive.

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

                                                            There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                            Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            122. Procedure.identifier:displayName.value
                                                            Definition

                                                            The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                            ShortThe value that is unique
                                                            Comments

                                                            If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                            Control1..1
                                                            Typestring
                                                            Is Modifierfalse
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Must Supporttrue
                                                            Summarytrue
                                                            Example<br/><b>General</b>:123456
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            124. Procedure.identifier:displayName.period
                                                            Definition

                                                            Time period during which identifier is/was valid for use.

                                                            ShortTime period when id is/was valid for use
                                                            Control0..1
                                                            TypePeriod
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            126. Procedure.identifier:displayName.assigner
                                                            Definition

                                                            Organization that issued/manages the identifier.

                                                            ShortOrganization that issued id (may be just text)
                                                            Comments

                                                            The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                            Control0..1
                                                            TypeReference(Organization)
                                                            Is Modifierfalse
                                                            Summarytrue
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                            128. Procedure.identifier:official
                                                            Slice Nameofficial
                                                            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.

                                                            ShortA business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
                                                            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)
                                                            Control1..*
                                                            TypeIdentifier
                                                            Is Modifierfalse
                                                            Must Supporttrue
                                                            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()))
                                                            130. Procedure.identifier:official.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
                                                            132. Procedure.identifier:official.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())
                                                            SlicingThis element introduces a set of slices on Procedure.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                            • value @ url
                                                            • 134. Procedure.identifier:official.use
                                                              Definition

                                                              The purpose of this identifier.

                                                              Shortusual | official | temp | secondary | old (If known)
                                                              Comments

                                                              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

                                                              Control1..1
                                                              BindingThe codes SHALL be taken from IdentifierUse
                                                              (required to http://hl7.org/fhir/ValueSet/identifier-use|4.0.1)

                                                              Identifies the purpose for this identifier, if known .

                                                              Typecode
                                                              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              Requirements

                                                              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

                                                              Pattern Valueofficial
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              136. Procedure.identifier:official.type
                                                              Definition

                                                              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

                                                              ShortDescription of identifier
                                                              Comments

                                                              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

                                                              Control0..1
                                                              BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
                                                              (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

                                                              A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

                                                              TypeCodeableConcept
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Requirements

                                                              Allows users to make use of identifiers when the identifier system is not known.

                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              138. Procedure.identifier:official.system
                                                              Definition

                                                              Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

                                                              ShortThe namespace for the identifier value
                                                              Comments

                                                              Identifier.system is always case sensitive.

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

                                                              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

                                                              Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              140. Procedure.identifier:official.value
                                                              Definition

                                                              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

                                                              ShortThe value that is unique
                                                              Comments

                                                              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

                                                              Control1..1
                                                              Typestring
                                                              Is Modifierfalse
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Must Supporttrue
                                                              Summarytrue
                                                              Example<br/><b>General</b>:123456
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              142. Procedure.identifier:official.period
                                                              Definition

                                                              Time period during which identifier is/was valid for use.

                                                              ShortTime period when id is/was valid for use
                                                              Control0..1
                                                              TypePeriod
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              144. Procedure.identifier:official.assigner
                                                              Definition

                                                              Organization that issued/manages the identifier.

                                                              ShortOrganization that issued id (may be just text)
                                                              Comments

                                                              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

                                                              Control0..1
                                                              TypeReference(Organization)
                                                              Is Modifierfalse
                                                              Summarytrue
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                              146. 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()))
                                                              148. 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()))
                                                              150. 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()))
                                                              SlicingThis element introduces a set of slices on Procedure.basedOn. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                              • profile @ $this.resolve()
                                                              • 152. Procedure.basedOn:treatment-plan
                                                                Slice Nametreatment-plan
                                                                Definition

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

                                                                ShortRadiotherapy Treatment Plan that planned the treatment summarized in this Radiotherapy Treated Plan.
                                                                Control0..1
                                                                TypeReference(Radiotherapy Treatment Plan)
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Alternate Namesfulfills
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                154. Procedure.basedOn:plan-prescription
                                                                Slice Nameplan-prescription
                                                                Definition

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

                                                                ShortRadiotherapy Plan Prescription that prescribed the treatment summarized in this Radiotherapy Treated Plan.
                                                                Control0..1
                                                                TypeReference(Radiotherapy Plan Prescription)
                                                                Is Modifierfalse
                                                                Must Supporttrue
                                                                Summarytrue
                                                                Alternate Namesfulfills
                                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                156. 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()))
                                                                SlicingThis element introduces a set of slices on Procedure.partOf. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                • profile @ $this.resolve()
                                                                • 158. Procedure.partOf:course-summary
                                                                  Slice Namecourse-summary
                                                                  Definition

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

                                                                  ShortRadiotherapy Course Summary that summarizes the course of which this Radiotherapy Treated Plan is a part.
                                                                  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..1
                                                                  TypeReference(Radiotherapy Course Summary)
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Alternate Namescontainer
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  160. Procedure.partOf:treated-phase
                                                                  Slice Nametreated-phase
                                                                  Definition

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

                                                                  ShortRadiotherapy Treated Phase that summarizes the phase of which this Radiotherapy Treated Plan is a part.
                                                                  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..1
                                                                  TypeReference(Radiotherapy Treated Phase)
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Alternate Namescontainer
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  162. 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
                                                                  This element is affected by the following invariants: us-core-7
                                                                  BindingThe codes SHALL be taken from EventStatus
                                                                  (required to http://hl7.org/fhir/ValueSet/event-status)
                                                                  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()))
                                                                  164. 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
                                                                  Summarytrue
                                                                  Alternate NamesSuspended Reason, Cancelled Reason
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  166. 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
                                                                  BindingThe codes SHALL be taken from Radiotherapy Category Code Max Value Set
                                                                  (required to http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs)
                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  168. 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 US Core Procedure Codes
                                                                  (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

                                                                  Codes describing the type of Procedure

                                                                  TypeCodeableConcept
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Requirements

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

                                                                  Alternate Namestype
                                                                  Pattern Value{
                                                                    "coding" : [{
                                                                      "system" : "http://snomed.info/sct",
                                                                      "code" : "1255724003",
                                                                      "display" : "Radiotherapy treatment plan (regime/therapy)"
                                                                    }]
                                                                  }
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  170. Procedure.subject
                                                                  Definition

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

                                                                  ShortWho the procedure was performed on
                                                                  Control1..1
                                                                  TypeReference(Cancer Patient Profile)
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Alternate Namespatient
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  172. 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(Encounter)
                                                                  Is Modifierfalse
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  174. 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.

                                                                  Control0..1
                                                                  This element is affected by the following invariants: us-core-7
                                                                  TypePeriod
                                                                  [x] NoteSee Choice of Data Types for further information about how to use [x]
                                                                  Is Modifierfalse
                                                                  Must Supporttrue
                                                                  Summarytrue
                                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                  176. Procedure.performed[x].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
                                                                  178. Procedure.performed[x].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())
                                                                  SlicingThis element introduces a set of slices on Procedure.performed[x].extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                  • value @ url
                                                                  • 180. Procedure.performed[x].start
                                                                    Definition

                                                                    The start of the period. The boundary is inclusive.

                                                                    ShortThe date and time when the first therapeutic radiation was delivered.
                                                                    Comments

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

                                                                    Control0..1
                                                                    This element is affected by the following invariants: per-1
                                                                    TypedateTime
                                                                    Is Modifierfalse
                                                                    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()))
                                                                    182. Procedure.performed[x].end
                                                                    Definition

                                                                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                                                    ShortAn end date is expected if the status is 'stopped' or 'completed'
                                                                    Comments

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

                                                                    Control0..1
                                                                    This element is affected by the following invariants: per-1
                                                                    TypedateTime
                                                                    Is Modifierfalse
                                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    184. Procedure.recorder
                                                                    Definition

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

                                                                    ShortWho recorded the procedure
                                                                    Control0..1
                                                                    TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    186. Procedure.asserter
                                                                    Definition

                                                                    Individual who is making the procedure statement.

                                                                    ShortPerson who asserts this procedure
                                                                    Control0..1
                                                                    TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                                                                    Is Modifierfalse
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    188. Procedure.performer
                                                                    Definition

                                                                    Limited to "real" people rather than equipment.

                                                                    ShortThe people who performed the procedure
                                                                    Control0..*
                                                                    TypeBackboneElement
                                                                    Is Modifierfalse
                                                                    Must Supporttrue
                                                                    Summarytrue
                                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                    SlicingThis element introduces a set of slices on Procedure.performer. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                    • profile @ actor.resolve()
                                                                    • 190. 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
                                                                      192. 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())
                                                                      194. 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())
                                                                      196. 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()))
                                                                      198. 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()))
                                                                      200. 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()))
                                                                      202. Procedure.performer:organization
                                                                      Slice Nameorganization
                                                                      Definition

                                                                      Limited to "real" people rather than equipment.

                                                                      ShortThe people who performed the procedure
                                                                      Control0..*
                                                                      TypeBackboneElement
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      204. Procedure.performer:organization.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
                                                                      206. Procedure.performer:organization.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())
                                                                      208. Procedure.performer:organization.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())
                                                                      210. Procedure.performer:organization.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()))
                                                                      212. Procedure.performer:organization.actor
                                                                      Definition

                                                                      The practitioner who was involved in the procedure.

                                                                      ShortOrganization that provided the radiotherapy treatment.
                                                                      Control1..1
                                                                      TypeReference(US Core Organization Profile)
                                                                      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()))
                                                                      214. Procedure.performer:organization.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()))
                                                                      216. Procedure.location
                                                                      Definition

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

                                                                      ShortLocation where the radiotherapy treatment was performed.
                                                                      Control0..1
                                                                      TypeReference(US Core Location Profile)
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      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()))
                                                                      218. 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..*
                                                                      BindingUnless not suitable, these codes SHALL be taken from Cancer Disorder Value Set
                                                                      (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs)
                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      220. 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(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()))
                                                                      222. Procedure.bodySite
                                                                      Definition

                                                                      Coded body structure(s) treated with this radiotherapy treatment procedure. These codes represent general locations. For additional detail, refer to the BodyStructures references in the doseDeliveredToVolume extension.

                                                                      ShortAll body structure(s) treated with this procedure.
                                                                      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..*
                                                                      BindingUnless not suitable, these codes SHALL be taken from Radiotherapy Treatment Location Value Set
                                                                      (extensible to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs)
                                                                      TypeCodeableConcept
                                                                      Is Modifierfalse
                                                                      Must Supporttrue
                                                                      Summarytrue
                                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                      224. Procedure.bodySite.id
                                                                      Definition

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

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

                                                                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though 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())
                                                                      SlicingThis element introduces a set of slices on Procedure.bodySite.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                      • value @ url
                                                                      • 228. Procedure.bodySite.extension:locationQualifier
                                                                        Slice NamelocationQualifier
                                                                        Definition

                                                                        General location qualifier (excluding laterality) for this bodySite

                                                                        ShortGeneral location qualifier (excluding laterality) for this bodySite
                                                                        Control0..*
                                                                        TypeExtension(Body Location Qualifier Extension) (Extension Type: CodeableConcept)
                                                                        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())
                                                                        230. Procedure.bodySite.extension:lateralityQualifier
                                                                        Slice NamelateralityQualifier
                                                                        Definition

                                                                        Laterality qualifier for this bodySite

                                                                        ShortLaterality qualifier for this bodySite
                                                                        Control0..1
                                                                        TypeExtension(Laterality Qualifier Extension) (Extension Type: CodeableConcept)
                                                                        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())
                                                                        232. Procedure.bodySite.coding
                                                                        Definition

                                                                        A reference to a code defined by a terminology system.

                                                                        ShortCode defined by a terminology system
                                                                        Comments

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

                                                                        Control0..*
                                                                        TypeCoding
                                                                        Is Modifierfalse
                                                                        Summarytrue
                                                                        Requirements

                                                                        Allows for alternative encodings within a code system, and translations to other code systems.

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

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

                                                                        ShortPlain text representation of the concept
                                                                        Comments

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

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

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

                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        236. 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()))
                                                                        238. 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()))
                                                                        240. 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()))
                                                                        242. 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()))
                                                                        244. 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()))
                                                                        246. Procedure.note
                                                                        Definition

                                                                        Any other notes and comments about the procedure.

                                                                        ShortAdditional information about the procedure
                                                                        Control0..*
                                                                        TypeAnnotation
                                                                        Is Modifierfalse
                                                                        Summaryfalse
                                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                        248. 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()))
                                                                        SlicingThis element introduces a set of slices on Procedure.focalDevice. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                        • profile @ manipulated.resolve()
                                                                        • 250. 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
                                                                          252. 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())
                                                                          254. 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())
                                                                          256. 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()))
                                                                          258. 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()))
                                                                          260. Procedure.focalDevice:seedDevice
                                                                          Slice NameseedDevice
                                                                          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.

                                                                          ShortRadiotherapy Seed Device used as part of therapy.
                                                                          Control0..*
                                                                          TypeBackboneElement
                                                                          Is Modifierfalse
                                                                          Must Supporttrue
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          262. Procedure.focalDevice:seedDevice.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
                                                                          264. Procedure.focalDevice:seedDevice.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())
                                                                          266. Procedure.focalDevice:seedDevice.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())
                                                                          268. Procedure.focalDevice:seedDevice.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()))
                                                                          270. Procedure.focalDevice:seedDevice.manipulated
                                                                          Definition

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

                                                                          ShortDevice that was changed
                                                                          Control1..1
                                                                          TypeReference(Radiotherapy Seed Device)
                                                                          Is Modifierfalse
                                                                          Summaryfalse
                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          272. 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
                                                                          Must Supporttrue
                                                                          Must Support TypesNo must-support rules about the choice of types/profiles
                                                                          Summaryfalse
                                                                          Requirements

                                                                          Used for tracking contamination, etc.

                                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                          SlicingThis element introduces a set of slices on Procedure.usedReference. The slices are unordered and Open, and can be differentiated using the following discriminators:
                                                                          • profile @ $this.resolve()
                                                                          • 274. Procedure.usedReference:treatmentDevice
                                                                            Slice NametreatmentDevice
                                                                            Definition

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

                                                                            ShortRadiotherapy Treatment Device used as part of therapy.
                                                                            Comments

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

                                                                            Control0..*
                                                                            TypeReference(Radiotherapy Treatment Device)
                                                                            Is Modifierfalse
                                                                            Must Supporttrue
                                                                            Summaryfalse
                                                                            Requirements

                                                                            Used for tracking contamination, etc.

                                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                                            276. 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()))