HL7 Czech K-Order Implementation Guide
0.0.3 - ci-build
HL7 Czech K-Order Implementation Guide
0.0.3 - ci-build
HL7 Czech K-Order Implementation Guide, published by HL7 Czech Republic. This guide is not an authorized publication; it is the continuous build for version 0.0.3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-cz/k-order/ and changes regularly. See the Directory of published versions
| Page standards status: Draft | Maturity Level: 1 |
Definitions for the LMEnClinicalInformationCz logical model.
Guidance on how to interpret the contents of this table can be foundhere
| 0. LMEnClinicalInformationCz | |
| Definition | Information and data communicated to the performing site that may affect execution of the order or interpretation of the results. |
| Short | A.3.1 - Clinical Information (Medical History) |
| Control | 0..* |
| Is Modifier | false |
| Logical Model | Instances of this logical model are not marked to be the target of a Reference |
| 2. LMEnClinicalInformationCz.clinicalInformationText | |
| Definition | Clinical information necessary for correct execution of the order or interpretation of the results. |
| Short | A.3.1.1 - Clinical information in free text |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 4. LMEnClinicalInformationCz.clinicalInformationCode | |
| Definition | Formalized clinical information (medical history). |
| Short | A.3.1.2 - Clinical information (medical history), formalized |
| Control | 0..1 |
| Type | CodeableConcept |
| 6. LMEnClinicalInformationCz.description | |
| Definition | Diagnoses and other clinical information affecting the course or outcome of the examination.
|
| Short | A.3.1.3 - Description of problem / diagnosis / condition |
| Control | 0..* |
| Type | CodeableConcept |
| 8. LMEnClinicalInformationCz.medication | |
| Definition | Medication block containing information on medication affecting the course or outcome of the examination or its interpretation.
|
| Short | A.3.1.4 - Medication |
| Control | 0..* |
| Type | Base |
| 10. LMEnClinicalInformationCz.medication.id | |
| Definition | Medication ID. |
| Short | A.3.1.4.1 - Medication ID |
| Control | 0..* |
| Type | Identifier |
| 12. LMEnClinicalInformationCz.medication.code | |
| Definition | Medication code. |
| Short | A.3.1.4.2 - Medication code |
| Control | 0..* |
| Type | code |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 14. LMEnClinicalInformationCz.medication.quantity | |
| Definition | Medication quantity. |
| Short | A.3.1.4.3 - Quantity |
| Control | 0..1 |
| Type | Ratio |
| 16. LMEnClinicalInformationCz.vaccination | |
| Definition | Vaccination. |
| Short | A.3.1.5 - Vaccination |
| Control | 0..* |
| Type | CodeableConcept |
| 18. LMEnClinicalInformationCz.finding | |
| Definition | Physical examination of the patient (systolic and diastolic blood pressure, heart rate, oxygen saturation, respiratory rate, current body temperature). |
| Short | A.3.1.6 - Physical finding |
| Control | 0..* |
| Type | CodeableConcept |
| 20. LMEnClinicalInformationCz.hospitalizationDate | |
| Definition | Date of patient hospitalization. |
| Short | A.3.1.7 - Date |
| Control | 0..* |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 22. LMEnClinicalInformationCz.urgentInformation | |
| Definition | Urgent information block in the same structure as in other document types (discharge report, patient summary). |
| Short | A.3.1.8 - Urgent information |
| Control | 0..1 |
| Type | Base |
| 24. LMEnClinicalInformationCz.urgentInformation.allergies | |
| Definition | Allergies and intolerances that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.1 - Allergies and intolerances |
| Control | 1..* |
| Type | CodeableConcept |
| 26. LMEnClinicalInformationCz.urgentInformation.warnings | |
| Definition | Warnings and alerts that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.2 - Warnings |
| Control | 0..* |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 28. LMEnClinicalInformationCz.additionalData | |
| Definition | A.3.1.9 - Additional formalized data |
| Short | A.3.1.9 - Additional formalized data |
| Control | 0..1 |
| Type | Base |
| 30. LMEnClinicalInformationCz.additionalData.date | |
| Definition | Date when the data was determined; provided if different from the order issue date. |
| Short | A.3.1.9.1 - Date |
| Control | 0..1 |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 32. LMEnClinicalInformationCz.additionalData.code | |
| Definition | Observation code identifying the meaning of the data item (height, weight, week of pregnancy, etc.).
|
| Short | A.3.1.9.2 - Code |
| Control | 1..1 |
| Type | CodeableConcept |
| 34. LMEnClinicalInformationCz.additionalData.value | |
| Definition | Value of the data item including measurement unit. |
| Short | A.3.1.9.3 - Value |
| Control | 0..1 |
| Type | Narrative |
Guidance on how to interpret the contents of this table can be foundhere
| 0. LMEnClinicalInformationCz | |
| Definition | Information and data communicated to the performing site that may affect execution of the order or interpretation of the results. |
| Short | A.3.1 - Clinical Information (Medical History) |
| Logical Model | Instances of this logical model are not marked to be the target of a Reference |
| 2. LMEnClinicalInformationCz.clinicalInformationText | |
| Definition | Clinical information necessary for correct execution of the order or interpretation of the results. |
| Short | A.3.1.1 - Clinical information in free text |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 4. LMEnClinicalInformationCz.clinicalInformationCode | |
| Definition | Formalized clinical information (medical history). |
| Short | A.3.1.2 - Clinical information (medical history), formalized |
| Control | 0..1 |
| Type | CodeableConcept |
| 6. LMEnClinicalInformationCz.description | |
| Definition | Diagnoses and other clinical information affecting the course or outcome of the examination.
|
| Short | A.3.1.3 - Description of problem / diagnosis / condition |
| Control | 0..* |
| Type | CodeableConcept |
| 8. LMEnClinicalInformationCz.medication | |
| Definition | Medication block containing information on medication affecting the course or outcome of the examination or its interpretation.
|
| Short | A.3.1.4 - Medication |
| Control | 0..* |
| Type | Base |
| 10. LMEnClinicalInformationCz.medication.id | |
| Definition | Medication ID. |
| Short | A.3.1.4.1 - Medication ID |
| Control | 0..* |
| Type | Identifier |
| 12. LMEnClinicalInformationCz.medication.code | |
| Definition | Medication code. |
| Short | A.3.1.4.2 - Medication code |
| Control | 0..* |
| Type | code |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 14. LMEnClinicalInformationCz.medication.quantity | |
| Definition | Medication quantity. |
| Short | A.3.1.4.3 - Quantity |
| Control | 0..1 |
| Type | Ratio |
| 16. LMEnClinicalInformationCz.vaccination | |
| Definition | Vaccination. |
| Short | A.3.1.5 - Vaccination |
| Control | 0..* |
| Type | CodeableConcept |
| 18. LMEnClinicalInformationCz.finding | |
| Definition | Physical examination of the patient (systolic and diastolic blood pressure, heart rate, oxygen saturation, respiratory rate, current body temperature). |
| Short | A.3.1.6 - Physical finding |
| Control | 0..* |
| Type | CodeableConcept |
| 20. LMEnClinicalInformationCz.hospitalizationDate | |
| Definition | Date of patient hospitalization. |
| Short | A.3.1.7 - Date |
| Control | 0..* |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 22. LMEnClinicalInformationCz.urgentInformation | |
| Definition | Urgent information block in the same structure as in other document types (discharge report, patient summary). |
| Short | A.3.1.8 - Urgent information |
| Control | 0..1 |
| Type | Base |
| 24. LMEnClinicalInformationCz.urgentInformation.allergies | |
| Definition | Allergies and intolerances that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.1 - Allergies and intolerances |
| Control | 1..* |
| Type | CodeableConcept |
| 26. LMEnClinicalInformationCz.urgentInformation.warnings | |
| Definition | Warnings and alerts that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.2 - Warnings |
| Control | 0..* |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 28. LMEnClinicalInformationCz.additionalData | |
| Definition | A.3.1.9 - Additional formalized data |
| Short | A.3.1.9 - Additional formalized data |
| Control | 0..1 |
| Type | Base |
| 30. LMEnClinicalInformationCz.additionalData.date | |
| Definition | Date when the data was determined; provided if different from the order issue date. |
| Short | A.3.1.9.1 - Date |
| Control | 0..1 |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 32. LMEnClinicalInformationCz.additionalData.code | |
| Definition | Observation code identifying the meaning of the data item (height, weight, week of pregnancy, etc.).
|
| Short | A.3.1.9.2 - Code |
| Control | 1..1 |
| Type | CodeableConcept |
| 34. LMEnClinicalInformationCz.additionalData.value | |
| Definition | Value of the data item including measurement unit. |
| Short | A.3.1.9.3 - Value |
| Control | 0..1 |
| Type | Narrative |
Guidance on how to interpret the contents of this table can be foundhere
| 0. LMEnClinicalInformationCz | |
| Definition | Information and data communicated to the performing site that may affect execution of the order or interpretation of the results. |
| Short | A.3.1 - Clinical Information (Medical History) |
| Control | 0..* |
| Is Modifier | false |
| Logical Model | Instances of this logical model are not marked to be the target of a Reference |
| 2. LMEnClinicalInformationCz.clinicalInformationText | |
| Definition | Clinical information necessary for correct execution of the order or interpretation of the results. |
| Short | A.3.1.1 - Clinical information in free text |
| Control | 0..1 |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 4. LMEnClinicalInformationCz.clinicalInformationCode | |
| Definition | Formalized clinical information (medical history). |
| Short | A.3.1.2 - Clinical information (medical history), formalized |
| Control | 0..1 |
| Type | CodeableConcept |
| 6. LMEnClinicalInformationCz.description | |
| Definition | Diagnoses and other clinical information affecting the course or outcome of the examination.
|
| Short | A.3.1.3 - Description of problem / diagnosis / condition |
| Control | 0..* |
| Type | CodeableConcept |
| 8. LMEnClinicalInformationCz.medication | |
| Definition | Medication block containing information on medication affecting the course or outcome of the examination or its interpretation.
|
| Short | A.3.1.4 - Medication |
| Control | 0..* |
| Type | Base |
| 10. LMEnClinicalInformationCz.medication.id | |
| Definition | Medication ID. |
| Short | A.3.1.4.1 - Medication ID |
| Control | 0..* |
| Type | Identifier |
| 12. LMEnClinicalInformationCz.medication.code | |
| Definition | Medication code. |
| Short | A.3.1.4.2 - Medication code |
| Control | 0..* |
| Type | code |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 14. LMEnClinicalInformationCz.medication.quantity | |
| Definition | Medication quantity. |
| Short | A.3.1.4.3 - Quantity |
| Control | 0..1 |
| Type | Ratio |
| 16. LMEnClinicalInformationCz.vaccination | |
| Definition | Vaccination. |
| Short | A.3.1.5 - Vaccination |
| Control | 0..* |
| Type | CodeableConcept |
| 18. LMEnClinicalInformationCz.finding | |
| Definition | Physical examination of the patient (systolic and diastolic blood pressure, heart rate, oxygen saturation, respiratory rate, current body temperature). |
| Short | A.3.1.6 - Physical finding |
| Control | 0..* |
| Type | CodeableConcept |
| 20. LMEnClinicalInformationCz.hospitalizationDate | |
| Definition | Date of patient hospitalization. |
| Short | A.3.1.7 - Date |
| Control | 0..* |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 22. LMEnClinicalInformationCz.urgentInformation | |
| Definition | Urgent information block in the same structure as in other document types (discharge report, patient summary). |
| Short | A.3.1.8 - Urgent information |
| Control | 0..1 |
| Type | Base |
| 24. LMEnClinicalInformationCz.urgentInformation.allergies | |
| Definition | Allergies and intolerances that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.1 - Allergies and intolerances |
| Control | 1..* |
| Type | CodeableConcept |
| 26. LMEnClinicalInformationCz.urgentInformation.warnings | |
| Definition | Warnings and alerts that may affect execution of the order or interpretation of the results. |
| Short | A.3.1.8.2 - Warnings |
| Control | 0..* |
| Type | string |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 28. LMEnClinicalInformationCz.additionalData | |
| Definition | A.3.1.9 - Additional formalized data |
| Short | A.3.1.9 - Additional formalized data |
| Control | 0..1 |
| Type | Base |
| 30. LMEnClinicalInformationCz.additionalData.date | |
| Definition | Date when the data was determined; provided if different from the order issue date. |
| Short | A.3.1.9.1 - Date |
| Control | 0..1 |
| Type | dateTime |
| Primitive Value | This primitive element may be present, or absent, or replaced by an extension |
| 32. LMEnClinicalInformationCz.additionalData.code | |
| Definition | Observation code identifying the meaning of the data item (height, weight, week of pregnancy, etc.).
|
| Short | A.3.1.9.2 - Code |
| Control | 1..1 |
| Type | CodeableConcept |
| 34. LMEnClinicalInformationCz.additionalData.value | |
| Definition | Value of the data item including measurement unit. |
| Short | A.3.1.9.3 - Value |
| Control | 0..1 |
| Type | Narrative |