MII IG Kerndatensatz-Modul Molekulares Tumorboard, published by Medizininformatik-Initiative. This guide is not an authorized publication; it is the continuous build for version 2026.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/medizininformatik-initiative/kerndatensatzmodul-molekulares-tumorboard/ and changes regularly. See the Directory of published versions
Resource Profile: MII PR MTB Behandlungsepisode
| Official URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-behandlungsepisode | Version: 2026.0.0 | |||
| Active as of 2026-02-09 | Computable Name: MII_PR_MTB_Behandlungsepisode | |||
Aktueller Krankheitszustand und bisherige Behandlungsmaßnahmen
Usages:
- Refer to this Profile: MII PR MTB Clinical Impresssion and MII PR MTB Therapieplan
- Examples for this Profile: ClinicalImpression/mii-exa-mtb-behandlungsepisode-1 and ClinicalImpression/mii-exa-mtb-kim-musterperson-behandlungsepisode
- CapabilityStatements using this Profile: MII CPS MTB CapabilityStatement
You can also check for usages in the FHIR IG Statistics
Formal Views of Profile Content
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |
  meta |
SΣ | 0..1 | Meta | Metadata about the resource |
   profile |
SΣ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
 implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
 Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
  extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression. |
 subject |
Σ | 1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed |
 Slices for effective[x] |
Σ | 1..1 | Period | Time of assessment Slice: Unordered, Closed by type:$this |
 effective[x]:effectivePeriod |
SΣ | 1..1 | Period | Zeitraum der Behandlungsepisode |
  start |
ΣC | 0..1 | dateTime | Einschlussdatum |
 end |
SΣC | 0..1 | dateTime | Abschlussdatum |
| Slices for problem |
SΣ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this |
| problem:PrimaertumorDiagnose |
SΣ | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose |
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |
  investigation:All Slices |
Content/Rules for all slices | |||
  modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
 code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
  coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
 system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund |
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie |
 Slices for extension |
Content/Rules for all slices | |||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation |
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan |
| Documentation for this format | ||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:KrankengeschichteFamilie.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:ECOG.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:NgsBericht.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:MolekularPathologieBefund.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:Einwilligung.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClinicalImpression | 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 | error | ClinicalImpression | 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 | error | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | ClinicalImpression | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClinicalImpression
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |
| meta |
S | 0..1 | Meta | Metadata about the resource |
| profile |
S | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status |
| subject |
1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed | |
| Slices for effective[x] |
1..1 | Period | Time of assessment Slice: Unordered, Open by type:$this | |
| effective[x]:effectivePeriod |
S | 1..1 | Period | Zeitraum der Behandlungsepisode |
| start |
0..1 | dateTime | Einschlussdatum | |
| end |
S | 0..1 | dateTime | Abschlussdatum |
| Slices for problem |
S | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this |
| problem:PrimaertumorDiagnose |
S | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose |
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund |
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie |
| Slices for extension |
Content/Rules for all slices | |||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation |
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
SΣ | 0..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
SΣ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | Business identifier | ||||
| status |
?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression. | ||||
| statusReason |
0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression. | |||||
| code |
Σ | 0..1 | CodeableConcept | Kind of assessment performed Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed. | ||||
| description |
Σ | 0..1 | string | Why/how the assessment was performed | ||||
| subject |
Σ | 1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed | ||||
| encounter |
Σ | 0..1 | Reference(Encounter) | Encounter created as part of | ||||
| Slices for effective[x] |
Σ | 1..1 | Period | Time of assessment Slice: Unordered, Closed by type:$this | ||||
| effective[x]:effectivePeriod |
SΣ | 1..1 | Period | Zeitraum der Behandlungsepisode | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
ΣC | 0..1 | dateTime | Einschlussdatum | ||||
| end |
SΣC | 0..1 | dateTime | Abschlussdatum | ||||
| date |
Σ | 0..1 | dateTime | When the assessment was documented | ||||
| assessor |
Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment | ||||
| previous |
0..1 | Reference(ClinicalImpression) | Reference to last assessment | |||||
| Slices for problem |
SΣ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this | ||||
| problem:PrimaertumorDiagnose |
SΣ | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose | ||||
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |||||
| investigation:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| item |
0..* | Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media) | Record of a specific investigation | |||||
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |||||
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |||||
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |||||
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |||||
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |||||
| protocol |
0..* | uri | Clinical Protocol followed | |||||
| summary |
0..1 | string | Summary of the assessment | |||||
| finding |
0..* | BackboneElement | Possible or likely findings and diagnoses | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| itemCodeableConcept |
0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis. | |||||
| itemReference |
0..1 | Reference(Condition | Observation | Media) | What was found | |||||
| basis |
0..1 | string | Which investigations support finding | |||||
| prognosisCodeableConcept |
0..* | CodeableConcept | Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings. | |||||
| prognosisReference |
0..* | Reference(RiskAssessment) | RiskAssessment expressing likely outcome | |||||
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |||||
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund | ||||
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation | ||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan | ||||
| note |
0..* | Annotation | Comments made about the ClinicalImpression | |||||
| Documentation for this format | ||||||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| ClinicalImpression.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.statusReason | Base | example | Not State | Unknown | |
| ClinicalImpression.code | Base | example | Not State | Unknown | |
| ClinicalImpression.investigation.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:KrankengeschichteFamilie.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:ECOG.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:NgsBericht.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:MolekularPathologieBefund.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:Einwilligung.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.finding.itemCodeableConcept | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.prognosisCodeableConcept | Base | example | Clinical Impression Prognosis | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.supportingInfo:Vortherapie.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClinicalImpression | 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 | error | ClinicalImpression | 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 | error | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | ClinicalImpression | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClinicalImpression
Summary
Mandatory: 2 elements(10 nested mandatory elements)
Must-Support: 16 elements
Structures
This structure refers to these other structures:
- MII PR Person Patient (https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient)
- MII PR Person Patient (Pseudonymisiert) (https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert)
- MII PR MTB Diagnose Primärtumor (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-diagnose-primaertumor)
- MII PR MolGen Familienanamnese (https://www.medizininformatik-initiative.de/fhir/ext/modul-molgen/StructureDefinition/familienanamnese)
- MII PR Onkologie Allgemeiner Leistungszustand ECOG (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog)
- MII PR MTB NGS-Bericht (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-ngs-bericht)
- MII PR MTB Molecular Pathology Report (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-molecular-pathology-report)
- MII PR MTB Consent (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-consent-given)
- MII PR MTB Systemische Vortherapie (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-systemische-vortherapie)
- MII PR Onkologie Strahlentherapie (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-strahlentherapie)
- MII PR Onkologie Operation (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-operation)
- MII PR Prozedur Procedure (https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Procedure)
- MII PR MTB Therapieplan (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-therapieplan)
Extensions
This structure refers to these extensions:
- https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status
- https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation
Slices
This structure defines the following Slices:
- The element 1 is sliced based on the value of ClinicalImpression.effective[x]
- The element 1 is sliced based on the value of ClinicalImpression.problem
- The element 1 is sliced based on the value of ClinicalImpression.investigation
- The element 1 is sliced based on the value of ClinicalImpression.supportingInfo
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |
| meta |
SΣ | 0..1 | Meta | Metadata about the resource |
| profile |
SΣ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored |
| status |
?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression. |
| subject |
Σ | 1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed |
| Slices for effective[x] |
Σ | 1..1 | Period | Time of assessment Slice: Unordered, Closed by type:$this |
| effective[x]:effectivePeriod |
SΣ | 1..1 | Period | Zeitraum der Behandlungsepisode |
| start |
ΣC | 0..1 | dateTime | Einschlussdatum |
| end |
SΣC | 0..1 | dateTime | Abschlussdatum |
| Slices for problem |
SΣ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this |
| problem:PrimaertumorDiagnose |
SΣ | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose |
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |
| investigation:All Slices |
Content/Rules for all slices | |||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund |
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie |
| Slices for extension |
Content/Rules for all slices | |||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation |
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan |
| Documentation for this format | ||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:KrankengeschichteFamilie.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:ECOG.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:NgsBericht.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:MolekularPathologieBefund.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:Einwilligung.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClinicalImpression | 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 | error | ClinicalImpression | 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 | error | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | ClinicalImpression | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
Differential View
This structure is derived from ClinicalImpression
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |
| meta |
S | 0..1 | Meta | Metadata about the resource |
| profile |
S | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to |
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |
| extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status |
| subject |
1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed | |
| Slices for effective[x] |
1..1 | Period | Time of assessment Slice: Unordered, Open by type:$this | |
| effective[x]:effectivePeriod |
S | 1..1 | Period | Zeitraum der Behandlungsepisode |
| start |
0..1 | dateTime | Einschlussdatum | |
| end |
S | 0..1 | dateTime | Abschlussdatum |
| Slices for problem |
S | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this |
| problem:PrimaertumorDiagnose |
S | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose |
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) |
| code |
||||
| coding |
1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund |
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie |
| Slices for extension |
Content/Rules for all slices | |||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation |
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| ClinicalImpression |
0..* | ClinicalImpression | A clinical assessment performed when planning treatments and management strategies for a patient | |||||
| id |
Σ | 0..1 | id | Logical id of this artifact | ||||
| meta |
SΣ | 0..1 | Meta | Metadata about the resource | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId |
Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated |
Σ | 0..1 | instant | When the resource version last changed | ||||
| source |
Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile |
SΣ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security |
Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag |
Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language |
0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text |
0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements | |||||
| contained |
0..* | Resource | Contained, inline Resources | |||||
| Slices for extension |
0..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
| extension:LeitlinienbehandlungStatus |
S | 0..1 | Coding | MII EX MTB Leitlinienbehandlung Status URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status | ||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier |
Σ | 0..* | Identifier | Business identifier | ||||
| status |
?!Σ | 1..1 | code | in-progress | completed | entered-in-error Binding: ClinicalImpressionStatus (required): The workflow state of a clinical impression. | ||||
| statusReason |
0..1 | CodeableConcept | Reason for current status Binding Description: (example): Codes identifying the reason for the current state of a clinical impression. | |||||
| code |
Σ | 0..1 | CodeableConcept | Kind of assessment performed Binding Description: (example): Identifies categories of clinical impressions. This is a place-holder only. It may be removed. | ||||
| description |
Σ | 0..1 | string | Why/how the assessment was performed | ||||
| subject |
Σ | 1..1 | Reference(MII PR Person Patient | MII PR Person Patient (Pseudonymisiert)) | Patient or group assessed | ||||
| encounter |
Σ | 0..1 | Reference(Encounter) | Encounter created as part of | ||||
| Slices for effective[x] |
Σ | 1..1 | Period | Time of assessment Slice: Unordered, Closed by type:$this | ||||
| effective[x]:effectivePeriod |
SΣ | 1..1 | Period | Zeitraum der Behandlungsepisode | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| start |
ΣC | 0..1 | dateTime | Einschlussdatum | ||||
| end |
SΣC | 0..1 | dateTime | Abschlussdatum | ||||
| date |
Σ | 0..1 | dateTime | When the assessment was documented | ||||
| assessor |
Σ | 0..1 | Reference(Practitioner | PractitionerRole) | The clinician performing the assessment | ||||
| previous |
0..1 | Reference(ClinicalImpression) | Reference to last assessment | |||||
| Slices for problem |
SΣ | 0..* | Reference(Condition | AllergyIntolerance) | Relevant impressions of patient state Slice: Unordered, Open by type:$this | ||||
| problem:PrimaertumorDiagnose |
SΣ | 0..1 | Reference(MII PR MTB Diagnose Primärtumor | Condition) | Primärtumor Diagnose | ||||
| Slices for investigation |
0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) Slice: Unordered, Open by value:code.coding | |||||
| investigation:All Slices |
Content/Rules for all slices | |||||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| item |
0..* | Reference(Observation | QuestionnaireResponse | FamilyMemberHistory | DiagnosticReport | RiskAssessment | ImagingStudy | Media) | Record of a specific investigation | |||||
| investigation:KrankengeschichteFamilie |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 416471007 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Family medical history | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MolGen Familienanamnese | FamilyMemberHistory) | Krankengeschichte Familie | |||||
| investigation:ECOG |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 424122007 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: ECOG performance status finding | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR Onkologie Allgemeiner Leistungszustand ECOG | Observation) | ECOG | |||||
| investigation:NgsBericht |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://snomed.info/sct | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 106221001 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Genetic finding | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB NGS-Bericht | DiagnosticReport) | NGS Report | |||||
| investigation:MolekularPathologieBefund |
S | 0..* | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 60568-3 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Pathology synoptic report | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB Molecular Pathology Report | DiagnosticReport) | Molekular Pathologie Befund | |||||
| investigation:Einwilligung |
S | 0..1 | BackboneElement | One or more sets of investigations (signs, symptoms, etc.) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| code |
1..1 | CodeableConcept | A name/code for the set Binding: InvestigationType (example): A name/code for a set of investigations. | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| coding |
Σ | 1..* | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: 105511-0 | |||||
| display |
1..1 | string | Representation defined by the system Fixed Value: Was consent given | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| item |
1..1 | Reference(MII PR MTB Consent) | Einwilligung | |||||
| protocol |
0..* | uri | Clinical Protocol followed | |||||
| summary |
0..1 | string | Summary of the assessment | |||||
| finding |
0..* | BackboneElement | Possible or likely findings and diagnoses | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension |
?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| itemCodeableConcept |
0..1 | CodeableConcept | What was found Binding: Condition/Problem/DiagnosisCodes (example): Identification of the Condition or diagnosis. | |||||
| itemReference |
0..1 | Reference(Condition | Observation | Media) | What was found | |||||
| basis |
0..1 | string | Which investigations support finding | |||||
| prognosisCodeableConcept |
0..* | CodeableConcept | Estimate of likely outcome Binding: ClinicalImpressionPrognosis (example): Prognosis or outlook findings. | |||||
| prognosisReference |
0..* | Reference(RiskAssessment) | RiskAssessment expressing likely outcome | |||||
| Slices for supportingInfo |
0..* | Reference(Resource) | Information supporting the clinical impression Slice: Unordered, Open by profile:$this.resolve() | |||||
| supportingInfo:Vorbefund |
S | 0..* | Reference(DiagnosticReport | Observation) | Vorbefund | ||||
| supportingInfo:Vortherapie |
S | 0..* | Reference(MII PR MTB Systemische Vortherapie | MII PR Onkologie Strahlentherapie | MII PR Onkologie Operation | MII PR Prozedur Procedure) | Vortherapie | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:LeitlinieDokumentation |
S | 0..1 | (Complex) | Leitlinie Dokumentation URL: https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation | ||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Logical reference, when literal reference is not known | ||||
| display |
Σ | 0..1 | string | Text alternative for the resource | ||||
| supportingInfo:Therapieplan |
S | 0..1 | Reference(MII PR MTB Therapieplan | CarePlan) | Therapieplan | ||||
| note |
0..* | Annotation | Comments made about the ClinicalImpression | |||||
| Documentation for this format | ||||||||
Terminology Bindings
| Path | Status | Usage | ValueSet | Version | Source |
| ClinicalImpression.meta.security | Base | extensible | SecurityLabels | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.meta.tag | Base | example | Common Tags | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.status | Base | required | Clinical Impression Status | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.statusReason | Base | example | Not State | Unknown | |
| ClinicalImpression.code | Base | example | Not State | Unknown | |
| ClinicalImpression.investigation.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:KrankengeschichteFamilie.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:ECOG.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:NgsBericht.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:MolekularPathologieBefund.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.investigation:Einwilligung.code | Base | example | Investigation Type | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.finding.itemCodeableConcept | Base | example | Condition/Problem/Diagnosis Codes | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.prognosisCodeableConcept | Base | example | Clinical Impression Prognosis | 📍4.0.1 | FHIR Std. |
| ClinicalImpression.supportingInfo:Vortherapie.type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std. |
Constraints
| Id | Grade | Path(s) | Description | Expression |
| dom-2 | error | ClinicalImpression | If the resource is contained in another resource, it SHALL NOT contain nested Resources |
contained.contained.empty()
|
| dom-3 | error | ClinicalImpression | 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 | error | ClinicalImpression | 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 | error | ClinicalImpression | If a resource is contained in another resource, it SHALL NOT have a security label |
contained.meta.security.empty()
|
| dom-6 | best practice | ClinicalImpression | A resource should have narrative for robust management |
text.`div`.exists()
|
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children |
hasValue() or (children().count() > id.count())
|
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both |
extension.exists() != value.exists()
|
This structure is derived from ClinicalImpression
Summary
Mandatory: 2 elements(10 nested mandatory elements)
Must-Support: 16 elements
Structures
This structure refers to these other structures:
- MII PR Person Patient (https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient)
- MII PR Person Patient (Pseudonymisiert) (https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert)
- MII PR MTB Diagnose Primärtumor (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-diagnose-primaertumor)
- MII PR MolGen Familienanamnese (https://www.medizininformatik-initiative.de/fhir/ext/modul-molgen/StructureDefinition/familienanamnese)
- MII PR Onkologie Allgemeiner Leistungszustand ECOG (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog)
- MII PR MTB NGS-Bericht (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-ngs-bericht)
- MII PR MTB Molecular Pathology Report (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-molecular-pathology-report)
- MII PR MTB Consent (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-consent-given)
- MII PR MTB Systemische Vortherapie (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-systemische-vortherapie)
- MII PR Onkologie Strahlentherapie (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-strahlentherapie)
- MII PR Onkologie Operation (https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-operation)
- MII PR Prozedur Procedure (https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Procedure)
- MII PR MTB Therapieplan (https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-therapieplan)
Extensions
This structure refers to these extensions:
- https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinienbehandlung-status
- https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation
Slices
This structure defines the following Slices:
- The element 1 is sliced based on the value of ClinicalImpression.effective[x]
- The element 1 is sliced based on the value of ClinicalImpression.problem
- The element 1 is sliced based on the value of ClinicalImpression.investigation
- The element 1 is sliced based on the value of ClinicalImpression.supportingInfo
Other representations of profile: CSV, Excel, Schematron