minimal Common Oncology Data Elements (mCODE) Implementation Guide, published by HL7 International / Clinical Interoperability Council. This guide is not an authorized publication; it is the continuous build for version 4.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-mCODE-ig/ and changes regularly. See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <https://loinc.org/rdf/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:DiagnosticReport ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "us-core-diagnosticreport-lab-jenny-m"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: DiagnosticReport us-core-diagnosticreport-lab-jenny-m</b></p><a name=\"us-core-diagnosticreport-lab-jenny-m\"> </a><a name=\"hcus-core-diagnosticreport-lab-jenny-m\"> </a><a name=\"us-core-diagnosticreport-lab-jenny-m-en-US\"> </a><h2><span title=\"Codes:{http://loinc.org 22637-3}\">Pathology report final diagnosis Narrative</span> (<span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0074 LAB}\">Laboratory</span>) </h2><table class=\"grid\"><tr><td>Subject</td><td>Jenny M Female, DoB: 1965-01-01 ( Medical Record Number: MRN1234 (use: usual, ))</td></tr><tr><td>When For</td><td>2018-04-01 00:00:00+0000</td></tr><tr><td>Reported</td><td>2018-04-05 00:00:00+0000</td></tr><tr><td>Performer</td><td> <a href=\"Practitioner-us-core-practitioner-owen-oncologist.html\">Practitioner Owen Oncologist </a></td></tr></table><p><b>Report Details</b></p><table class=\"grid\"><tr><td><b>Code</b></td><td><b>Value</b></td><td><b>Flags</b></td><td><b>When For</b></td></tr><tr><td><a href=\"Observation-us-core-observation-lab-tumor-invasion-jenny-m.html\"><span title=\"Codes:{http://snomed.info/sct 370052007}\">Status of invasion by tumor</span></a></td><td><span title=\"Codes:{http://snomed.info/sct 260385009}\">Negative (qualifier value)</span></td><td>Final</td><td/></tr><tr><td><a href=\"Observation-us-core-observation-lab-tumor-margins-jenny-m.html\"><span title=\"Codes:{http://loinc.org 44669-0}\">Margin involvement in Breast tumor</span></a></td><td><span title=\"Codes:{http://loinc.org LA27151-2}\">Uninvolved by invasive carcinoma</span></td><td>Final</td><td/></tr><tr><td><a href=\"Observation-us-core-observation-lab-sentinel-nodes-jenny-m.html\"><span title=\"Codes:{http://loinc.org 92832-5}\">Sentinel lymph nodes with metastasis [#] in Cancer specimen</span></a></td><td/><td>Final</td><td/></tr><tr><td><a href=\"Observation-tumor-size-jenny-m.html\"><span title=\"Codes:{http://loinc.org 21889-1}\">Size Tumor</span></a></td><td/><td>Final</td><td/></tr><tr><td><a href=\"Observation-us-core-observation-lab-tumor-dcis-jenny-m.html\"><span title=\"Codes:{http://loinc.org 85336-6}\">DCIS intraductal extension in Breast cancer specimen Qualitative by Light microscopy</span></a></td><td><span title=\"Codes:{http://loinc.org LA27261-9}\">DCIS present with extensive intraductal component (EIC)</span></td><td>Final</td><td/></tr><tr><td><a href=\"Observation-tumor-marker-test-her2-jenny-m.html\"><span title=\"Codes:{http://loinc.org 48676-1}\">HER2 [Interpretation] in Tissue</span></a></td><td><span title=\"Codes:{http://loinc.org LA6577-6}\">Negative</span></td><td>Final</td><td>2018-03-10</td></tr><tr><td><a href=\"Observation-tumor-marker-test-er-jenny-m.html\"><span title=\"Codes:{http://loinc.org 85337-4}\">Estrogen receptor Ag [Presence] in Breast cancer specimen by Immune stain</span></a></td><td><span title=\"Codes:{http://loinc.org LA6576-8}\">Positive</span></td><td>Final</td><td>2018-03-10</td></tr><tr><td><a href=\"Observation-tumor-marker-test-pr-jenny-m.html\"><span title=\"Codes:{http://loinc.org 85339-0}\">Progesterone receptor Ag [Presence] in Breast cancer specimen by Immune stain</span></a></td><td><span title=\"Codes:{http://loinc.org LA6577-6}\">Negative</span></td><td>Final</td><td>2018-03-10</td></tr><tr><td><a href=\"Observation-us-core-observation-lab-tumor-grade-jenny-m.html\"><span title=\"Codes:{http://loinc.org 44648-4}\">Histologic grade [Score] in Breast cancer specimen by Nottingham</span></a></td><td><span title=\"Codes:{http://loinc.org LA27824-4}\">Nottingham grade 2</span></td><td>Final</td><td/></tr></table></div>"
] ; #
fhir:status [ fhir:v "final"] ; #
fhir:category ( [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0074"^^xsd:anyURI ] ;
fhir:code [ fhir:v "LAB" ] ] )
] ) ; #
fhir:code [
( fhir:coding [
a loinc:22637-3 ;
fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
fhir:code [ fhir:v "22637-3" ] ;
fhir:display [ fhir:v "Pathology report final diagnosis Narrative" ] ] )
] ; #
fhir:subject [
fhir:reference [ fhir:v "Patient/cancer-patient-jenny-m" ]
] ; #
fhir:effective [ fhir:v "2018-04-01T00:00:00Z"^^xsd:dateTime] ; #
fhir:issued [ fhir:v "2018-04-05T00:00:00Z"^^xsd:dateTime] ; #
fhir:performer ( [
fhir:reference [ fhir:v "Practitioner/us-core-practitioner-owen-oncologist" ]
] ) ; #
fhir:resultsInterpreter ( [
fhir:reference [ fhir:v "Practitioner/us-core-practitioner-peter-pathologist" ]
] ) ; #
fhir:specimen ( [
fhir:reference [ fhir:v "Specimen/tumor-specimen-left-breast-jenny-m" ]
] ) ; #
fhir:result ( [
fhir:reference [ fhir:v "Observation/us-core-observation-lab-tumor-invasion-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/us-core-observation-lab-tumor-margins-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/us-core-observation-lab-sentinel-nodes-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/tumor-size-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/us-core-observation-lab-tumor-dcis-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/tumor-marker-test-her2-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/tumor-marker-test-er-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/tumor-marker-test-pr-jenny-m" ]
] [
fhir:reference [ fhir:v "Observation/us-core-observation-lab-tumor-grade-jenny-m" ]
] ) . #
IG © 2019+ HL7 International / Clinical Interoperability Council. Package hl7.fhir.us.mcode#4.0.0 based on FHIR 4.0.1. Generated 2024-12-03
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change