SDOH Clinical Care
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SDOH Clinical Care, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 2.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-sdoh-clinicalcare/ and changes regularly. See the Directory of published versions

Resource Profile: SDOHCCProcedure - Detailed Descriptions

Page standards status: Trial-use

Definitions for the SDOHCC-Procedure resource profile.

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

0. Procedure
Definition

For procedures that address SDOH conditions, SDOH observations, or SDOH goals.

ShortAn action that addresses an SDOH condition, observation, or goal.
Comments

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

2. Procedure.extension
SlicingThis element introduces a set of slices on Procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
    • 4. Procedure.extension:pertainsToGoal
    Slice NamepertainsToGoal
    Definition

    Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to provide food vouchers pertainsToGoal of achieving food security.

    ShortPertains to SDOH goal
    Control0..*
    TypeExtension(ServiceRequest Pertains To Goal) (Extension Type: Reference(Goal))
    Must Supporttrue
    Requirements

    Indicates that the procedure is related to the referenced SDOHCC Goal.

    6. Procedure.extension:pertainsToGoal.value[x]
    Definition

    Value of extension must reference a Goal resource.

    TypeReference(SDOHCC Goal)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Must Supporttrue
    Requirements

    Indicates that the procedure is related to the referenced SDOHCC Goal.

    8. Procedure.basedOn
    Must Supporttrue
    SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ resolve()
      • 10. Procedure.basedOn:SupportedBasedOn
      Slice NameSupportedBasedOn
      Definition

      A reference to an SDOHCC service request that contains details of the request for this procedure.

      ShortAn SDOH service request for this procedure
      Control0..*
      TypeReference(SDOHCC ServiceRequest)
      Must Supporttrue
      Requirements

      When a procedure is based on an SDOH ServiceRequest, Procedure.basedOn should reference instances that comply with the SDOHCC ServiceRequest profile. However, references to other instance types are also possible.

      12. Procedure.category
      Definition

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

      14. Procedure.category.coding
      Must Supporttrue
      SlicingThis element introduces a set of slices on Procedure.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ $this
        • 16. Procedure.category.coding:SDOH
        Slice NameSDOH
        Definition

        An SDOH category assigned to the procedure.

        Shorte.g., food-insecurity | transportation-insecurity
        Control0..1
        BindingThe codes SHALL be taken from SDOHCC ValueSet SDOH Category
        (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

        Codes for high-level SDOH categories.

        Must Supporttrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.
        Codes from this value set can be used to assign an SDOH category (e.g., food-insecurity, transportation-insecurity, etc.) to a procedure. It is recommended that SDOH category codes be used to facilitate searching for SDOH procedures that address SDOH conditions, observations, service requests, or goals.

        18. Procedure.code
        Definition

        The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded.

        BindingThe codes SHALL be taken from US Core Procedure Codes
        (required to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

        Codes describing the type of Procedure

        Additional BindingsPurposeUsage
        Digital Access Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-access
        Digital Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-literacy
        Less Than High School Education Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): educational-attainment
        Elder Abuse Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): elder-abuse
        Unemployment Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): employment-status
        Financial Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): financial-insecurity
        Food Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): food-insecurity
        Health Insurance Coverage Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): health-insurance-coverage-status
        Homelessness Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): homelessness
        Housing Instability Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): housing-instability
        Inadequate Housing Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): inadequate-housing
        Intimate Partner Violence Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): intimate-partner-violence
        Material Hardship Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): material-hardship
        Medical Cost Burden Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): medical-cost-burden
        Health Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): personal-health-literacy
        Social Connection Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): social-connection
        Stress Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): stress
        Transportation Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): transportation-insecurity
        Utility Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): utility-insecurity
        Veteran Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): veteran-status
        US Core Procedure CodesRequiredProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): sdoh-category-unspecified
        20. Procedure.performed[x]
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Requirements

        NOTE: dateTime should be Must Support, but currenlty tooling does not support this.

        22. Procedure.reasonCode
        Comments

        Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

        Information represented by Procedure.reasonCode may overlap significantly with information represented by Procedure.reasonReference. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar information could be provided by either Procedure.reasonCode or Procedure.reasonReference, it is recommended that Procedure.reasonReference be used to provide a reason for why a procedure was performed.

        24. Procedure.reasonReference
        Comments

        Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

        Additionally, see Comments for reasonCode.

        SlicingThis element introduces a set of slices on Procedure.reasonReference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • profile @ resolve()
          • 26. Procedure.reasonReference:SupportedReasonReference
          Slice NameSupportedReasonReference
          Comments

          Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

          Control0..*
          TypeReference(SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Observation Assessment)
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Requirements

          When a procedure is justified by one or more SDOH conditions or observations, Procedure.reasonReference should reference instances that comply with the SDOHCC Condition profile, or one of the SDOHCC Observation profiles. However, references to other instance types are also possible.

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

          0. Procedure
          Definition

          For procedures that address SDOH conditions, SDOH observations, or SDOH goals.


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

          ShortAn action that addresses an SDOH condition, observation, or goal.An action that is being or was performed on a patient
          Comments

          Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

          Control0..*
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. Procedure.implicitRules
          Definition

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

          ShortA set of rules under which this content was created
          Comments

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

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

          An Extension


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

          ShortExtensionAdditional content defined by implementations
          Comments

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

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

            Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to provide food vouchers pertainsToGoal of achieving food security.

            ShortPertains to SDOH goal
            Comments

            This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

            Control0..*
            TypeExtension(ServiceRequest Pertains To Goal) (Extension Type: Reference(Goal))
            Is Modifierfalse
            Must Supporttrue
            Requirements

            Indicates that the procedure is related to the referenced SDOHCC Goal.

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

            An Extension


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

            ShortExtensionAdditional content defined by implementations
            Comments

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

            Control0..0*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
              • 10. Procedure.extension:pertainsToGoal.url
              Definition

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

              Shortidentifies the meaning of the extension
              Comments

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

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
              12. Procedure.extension:pertainsToGoal.value[x]
              Definition

              Value of extension must reference a Goal resource.


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

              ShortValue of extension
              Control10..1
              This element is affected by the following invariants: ext-1
              TypeReference(SDOHCC Goal), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Indicates that the procedure is related to the referenced SDOHCC Goal.

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

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

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

              ShortExtensions that cannot be ignored
              Comments

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

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

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

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

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

              ShortA request for this procedure
              Control0..*
              TypeReference(CarePlan, ServiceRequest)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Alternate Namesfulfills
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • profile @ resolve()
                • 18. Procedure.basedOn:SupportedBasedOn
                Slice NameSupportedBasedOn
                Definition

                A reference to an SDOHCC service request that contains details of the request for this procedure.


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

                ShortAn SDOH service request for this procedureA request for this procedure
                Control0..*
                TypeReference(SDOHCC ServiceRequest, CarePlan, ServiceRequest)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                When a procedure is based on an SDOH ServiceRequest, Procedure.basedOn should reference instances that comply with the SDOHCC ServiceRequest profile. However, references to other instance types are also possible.

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

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

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

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

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

                Control1..1
                BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status|4.0.1
                (required to http://hl7.org/fhir/ValueSet/event-status)
                Typecode
                Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                22. Procedure.category
                Definition

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


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

                ShortClassification of the procedure
                Control0..1
                BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-category
                (example to http://hl7.org/fhir/ValueSet/procedure-category)

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

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

                A reference to a code defined by a terminology system.

                ShortCode defined by a terminology system
                Comments

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

                Control0..*
                TypeCoding
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

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

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Procedure.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ $this
                  • 26. Procedure.category.coding:SDOH
                  Slice NameSDOH
                  Definition

                  An SDOH category assigned to the procedure.


                  A reference to a code defined by a terminology system.

                  Shorte.g., food-insecurity | transportation-insecurityCode defined by a terminology system
                  Comments

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

                  Control0..1*
                  BindingThe codes SHALL be taken from For codes, see SDOHCC ValueSet SDOH Category
                  (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

                  Codes for high-level SDOH categories.

                  TypeCoding
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  Allows for alternative encodings within a code system, and translations to other code systems.
                  Codes from this value set can be used to assign an SDOH category (e.g., food-insecurity, transportation-insecurity, etc.) to a procedure. It is recommended that SDOH category codes be used to facilitate searching for SDOH procedures that address SDOH conditions, observations, service requests, or goals.


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

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

                  The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded.


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

                  ShortProcedure codes from SNOMED CT, CPT, HCPCS II, ICD-10PC, or CDTIdentification of the procedure
                  Control10..1
                  BindingThe codes SHALL be taken from For example codes, see US Core Procedure Codeshttp://hl7.org/fhir/ValueSet/procedure-code
                  (required to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

                  Codes describing the type of Procedure


                  A code to identify a specific procedure .

                  Additional BindingsPurposeUsage
                  Digital Access Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-access
                  Digital Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-literacy
                  Less Than High School Education Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): educational-attainment
                  Elder Abuse Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): elder-abuse
                  Unemployment Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): employment-status
                  Financial Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): financial-insecurity
                  Food Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): food-insecurity
                  Health Insurance Coverage Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): health-insurance-coverage-status
                  Homelessness Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): homelessness
                  Housing Instability Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): housing-instability
                  Inadequate Housing Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): inadequate-housing
                  Intimate Partner Violence Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): intimate-partner-violence
                  Material Hardship Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): material-hardship
                  Medical Cost Burden Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): medical-cost-burden
                  Health Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): personal-health-literacy
                  Social Connection Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): social-connection
                  Stress Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): stress
                  Transportation Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): transportation-insecurity
                  Utility Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): utility-insecurity
                  Veteran Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): veteran-status
                  US Core Procedure CodesRequiredProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): sdoh-category-unspecified
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

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

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

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

                  ShortWho the procedure was performed on
                  Control1..1
                  TypeReference(US Core Patient Profile, Patient, Group)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Alternate Namespatient
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  32. Procedure.performed[x]
                  Definition

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

                  ShortWhen the procedure was performed
                  Comments

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

                  Control10..1
                  TypeChoice of: dateTime, Period, string, Range, Age
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Must Support TypesNo must-support rules about the choice of types/profiles
                  Summarytrue
                  Requirements

                  NOTE: dateTime should be Must Support, but currenlty tooling does not support this.

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

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

                  ShortCoded reason procedure performed
                  Comments

                  Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                  Information represented by Procedure.reasonCode may overlap significantly with information represented by Procedure.reasonReference. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar information could be provided by either Procedure.reasonCode or Procedure.reasonReference, it is recommended that Procedure.reasonReference be used to provide a reason for why a procedure was performed.


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

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

                  A code that identifies the reason a procedure is required.

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

                  The justification of why the procedure was performed.

                  ShortThe justification that the procedure was performed
                  Comments

                  Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                  Additionally, see Comments for reasonCode.


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

                  Control0..*
                  TypeReference(Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Procedure.reasonReference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • profile @ resolve()
                    • 38. Procedure.reasonReference:SupportedReasonReference
                    Slice NameSupportedReasonReference
                    Definition

                    The justification of why the procedure was performed.

                    ShortThe justification that the procedure was performed
                    Comments

                    Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.


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

                    Control0..*
                    TypeReference(SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Observation Assessment, Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
                    Is Modifierfalse
                    Must Supporttrue
                    Must Support TypesNo must-support rules about the choice of types/profiles
                    Summarytrue
                    Requirements

                    When a procedure is justified by one or more SDOH conditions or observations, Procedure.reasonReference should reference instances that comply with the SDOHCC Condition profile, or one of the SDOHCC Observation profiles. However, references to other instance types are also possible.

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

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

                    0. Procedure
                    Definition

                    For procedures that address SDOH conditions, SDOH observations, or SDOH goals.

                    ShortAn action that addresses an SDOH condition, observation, or goal.
                    Comments

                    Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

                    Control0..*
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                    dom-6: A resource should have narrative for robust management (text.`div`.exists())
                    2. Procedure.id
                    Definition

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

                    ShortLogical id of this artifact
                    Comments

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

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

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

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

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

                    ShortA set of rules under which this content was created
                    Comments

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

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

                    The base language in which the resource is written.

                    ShortLanguage of the resource content
                    Comments

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

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

                    A human language.

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

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

                    ShortText summary of the resource, for human interpretation
                    Comments

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

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

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

                    ShortContained, inline Resources
                    Comments

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

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

                    An Extension

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

                      Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to provide food vouchers pertainsToGoal of achieving food security.

                      ShortPertains to SDOH goal
                      Comments

                      This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

                      Control0..*
                      TypeExtension(ServiceRequest Pertains To Goal) (Extension Type: Reference(Goal))
                      Is Modifierfalse
                      Must Supporttrue
                      Requirements

                      Indicates that the procedure is related to the referenced SDOHCC Goal.

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

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

                      ShortUnique id for inter-element referencing
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      Typeid
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      20. Procedure.extension:pertainsToGoal.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..0
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                        • 22. Procedure.extension:pertainsToGoal.url
                        Definition

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

                        Shortidentifies the meaning of the extension
                        Comments

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

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

                        Value of extension must reference a Goal resource.

                        ShortValue of extension
                        Control1..1
                        This element is affected by the following invariants: ext-1
                        TypeReference(SDOHCC Goal)
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Must Supporttrue
                        Summaryfalse
                        Requirements

                        Indicates that the procedure is related to the referenced SDOHCC Goal.

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

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

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

                        ShortExtensions that cannot be ignored
                        Comments

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

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

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

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

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

                        ShortExternal Identifiers for this procedure
                        Comments

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

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

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

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

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

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

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

                        ShortInstantiates external protocol or definition
                        Comments

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

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

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

                        ShortA request for this procedure
                        Control0..*
                        TypeReference(CarePlan, ServiceRequest)
                        Is Modifierfalse
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Summarytrue
                        Alternate Namesfulfills
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • profile @ resolve()
                          • 36. Procedure.basedOn:SupportedBasedOn
                          Slice NameSupportedBasedOn
                          Definition

                          A reference to an SDOHCC service request that contains details of the request for this procedure.

                          ShortAn SDOH service request for this procedure
                          Control0..*
                          TypeReference(SDOHCC ServiceRequest)
                          Is Modifierfalse
                          Must Supporttrue
                          Summarytrue
                          Requirements

                          When a procedure is based on an SDOH ServiceRequest, Procedure.basedOn should reference instances that comply with the SDOHCC ServiceRequest profile. However, references to other instance types are also possible.

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

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

                          ShortPart of referenced event
                          Comments

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

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

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

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

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

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

                          Control1..1
                          BindingThe codes SHALL be taken from EventStatus
                          (required to http://hl7.org/fhir/ValueSet/event-status)
                          Typecode
                          Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          42. Procedure.statusReason
                          Definition

                          Captures the reason for the current state of the procedure.

                          ShortReason for current status
                          Comments

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

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

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

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

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

                          ShortClassification of the procedure
                          Control0..1
                          BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)
                          (example to http://hl7.org/fhir/ValueSet/procedure-category)

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

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

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

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

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

                          ShortAdditional content defined by implementations
                          Comments

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

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

                            A reference to a code defined by a terminology system.

                            ShortCode defined by a terminology system
                            Comments

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

                            Control0..*
                            TypeCoding
                            Is Modifierfalse
                            Must Supporttrue
                            Summarytrue
                            Requirements

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

                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            SlicingThis element introduces a set of slices on Procedure.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ $this
                              • 52. Procedure.category.coding:SDOH
                              Slice NameSDOH
                              Definition

                              An SDOH category assigned to the procedure.

                              Shorte.g., food-insecurity | transportation-insecurity
                              Comments

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

                              Control0..1
                              BindingThe codes SHALL be taken from SDOHCC ValueSet SDOH Category
                              (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

                              Codes for high-level SDOH categories.

                              TypeCoding
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

                              Allows for alternative encodings within a code system, and translations to other code systems.
                              Codes from this value set can be used to assign an SDOH category (e.g., food-insecurity, transportation-insecurity, etc.) to a procedure. It is recommended that SDOH category codes be used to facilitate searching for SDOH procedures that address SDOH conditions, observations, service requests, or goals.

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

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

                              ShortPlain text representation of the concept
                              Comments

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

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

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

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

                              The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded.

                              ShortProcedure codes from SNOMED CT, CPT, HCPCS II, ICD-10PC, or CDT
                              Control1..1
                              BindingThe codes SHALL be taken from US Core Procedure Codes
                              (required to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

                              Codes describing the type of Procedure

                              Additional BindingsPurposeUsage
                              Digital Access Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-access
                              Digital Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): digital-literacy
                              Less Than High School Education Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): educational-attainment
                              Elder Abuse Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): elder-abuse
                              Unemployment Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): employment-status
                              Financial Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): financial-insecurity
                              Food Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): food-insecurity
                              Health Insurance Coverage Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): health-insurance-coverage-status
                              Homelessness Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): homelessness
                              Housing Instability Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): housing-instability
                              Inadequate Housing Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): inadequate-housing
                              Intimate Partner Violence Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): intimate-partner-violence
                              Material Hardship Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): material-hardship
                              Medical Cost Burden Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): medical-cost-burden
                              Health Literacy Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): personal-health-literacy
                              Social Connection Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): social-connection
                              Stress Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): stress
                              Transportation Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): transportation-insecurity
                              Utility Insecurity Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): utility-insecurity
                              Veteran Status Procedures .ExtensibleProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): veteran-status
                              US Core Procedure CodesRequiredProcedure.category (Details: SDOHCC-Procedure code Procedure.category = ' Procedure.category ', stated as ' null '): sdoh-category-unspecified
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Requirements

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

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

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

                              ShortWho the procedure was performed on
                              Control1..1
                              TypeReference(US Core Patient Profile)
                              Is Modifierfalse
                              Must Supporttrue
                              Summarytrue
                              Alternate Namespatient
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              60. Procedure.encounter
                              Definition

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

                              ShortEncounter created as part of
                              Comments

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

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

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

                              ShortWhen the procedure was performed
                              Comments

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

                              Control1..1
                              TypeChoice of: dateTime, Period
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Must Support TypesNo must-support rules about the choice of types/profiles
                              Summarytrue
                              Requirements

                              NOTE: dateTime should be Must Support, but currenlty tooling does not support this.

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

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

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

                              Individual who is making the procedure statement.

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

                              Limited to "real" people rather than equipment.

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

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

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

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

                              ShortAdditional content defined by implementations
                              Comments

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

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

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

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

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

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

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

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

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

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

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

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

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows disambiguation of the types of involvement of different performers.

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

                              The practitioner who was involved in the procedure.

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

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

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

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

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

                              Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

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

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

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

                              Ties a procedure to where the records are likely kept.

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

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

                              ShortCoded reason procedure performed
                              Comments

                              Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                              Information represented by Procedure.reasonCode may overlap significantly with information represented by Procedure.reasonReference. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar information could be provided by either Procedure.reasonCode or Procedure.reasonReference, it is recommended that Procedure.reasonReference be used to provide a reason for why a procedure was performed.

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

                              A code that identifies the reason a procedure is required.

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

                              The justification of why the procedure was performed.

                              ShortThe justification that the procedure was performed
                              Comments

                              Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                              Additionally, see Comments for reasonCode.

                              Control0..*
                              TypeReference(Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              SlicingThis element introduces a set of slices on Procedure.reasonReference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • profile @ resolve()
                                • 88. Procedure.reasonReference:SupportedReasonReference
                                Slice NameSupportedReasonReference
                                Definition

                                The justification of why the procedure was performed.

                                ShortThe justification that the procedure was performed
                                Comments

                                Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                                Control0..*
                                TypeReference(SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Observation Assessment)
                                Is Modifierfalse
                                Must Supporttrue
                                Must Support TypesNo must-support rules about the choice of types/profiles
                                Summarytrue
                                Requirements

                                When a procedure is justified by one or more SDOH conditions or observations, Procedure.reasonReference should reference instances that comply with the SDOHCC Condition profile, or one of the SDOHCC Observation profiles. However, references to other instance types are also possible.

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

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

                                ShortTarget body sites
                                Comments

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

                                Control0..*
                                BindingFor example codes, see SNOMEDCTBodyStructures
                                (example to http://hl7.org/fhir/ValueSet/body-site)

                                Codes describing anatomical locations. May include laterality.

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

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

                                ShortThe result of procedure
                                Comments

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

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

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

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

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

                                ShortAny report resulting from the procedure
                                Comments

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

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

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

                                ShortComplication following the procedure
                                Comments

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

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

                                Codes describing complications that resulted from a procedure.

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

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

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

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

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

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

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

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

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

                                Any other notes and comments about the procedure.

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

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

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

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

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

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

                                ShortAdditional content defined by implementations
                                Comments

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

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

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

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

                                ShortExtensions that cannot be ignored even if unrecognized
                                Comments

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

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

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

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

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

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

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

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

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

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

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

                                ShortItems used during procedure
                                Comments

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

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

                                Used for tracking contamination, etc.

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

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

                                ShortCoded items used during the procedure
                                Comments

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

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

                                Codes describing items used during a procedure.

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