Resumen Clínico del Paciente de Chile
0.4.0 - STU2
Resumen Clínico del Paciente de Chile
0.4.0 - STU2
Resumen Clínico del Paciente de Chile, published by HL7 Chile. This guide is not an authorized publication; it is the continuous build for version 0.4.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7Chile/IPS-CL/ and changes regularly. See the Directory of published versions
| Official URL: https://hl7chile.cl/fhir/ig/clips/StructureDefinition/DiagnosticReport-cl-ips | Version: 0.4.0 | |||
| Standards status: Draft | Maturity Level: 1 | Computable Name: DiagnosticReportClIps | ||
Reporte resultado de un o varios estudios para diagnosticar una enfermedad. Este perfil es el simil al DiagnosticReport(IPS).
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  DiagnosticReport |
0..* | DiagnosticReport | A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
| status |
?!SΣ | 1..1 | code | registered | partial | preliminary | final + Binding: DiagnosticReportStatus (required): The status of the diagnostic report. ele-1: All FHIR elements must have a @value or children Required Pattern: final |
 category |
SΣ | 1..1 | CodeableConceptIPS | Concepto - referencia a una terminología o sólo texto Binding: DiagnosticServiceSectionCodes (example): Codes for diagnostic service sections. ele-1: All FHIR elements must have a @value or children |
| code |
SΣ | 1..1 | CodeableConceptIPS | Concepto - referencia a una terminología o sólo texto Binding: LOINCDiagnosticReportCodes (preferred): Codes that describe Diagnostic Reports. ele-1: All FHIR elements must have a @value or children |
  subject |
SΣ | 1..1 | Reference(Paciente | Group) | El sujeto del informe, generalmente, pero no siempre, es el paciente ele-1: All FHIR elements must have a @value or children |
  reference |
SΣC | 1..1 | string | Referencia literal, interna o url absoluta ele-1: All FHIR elements must have a @value or children |
 effective[x] |
SΣ | 1..1 | Tiempo o periodo de tiempo clínicamente relevante para el informe ele-1: All FHIR elements must have a @value or children | |
 effective[x]All Types |
Content/Rules for all Types | |||
  Slices for extension |
Content/Rules for all slices | |||
  data-absent-reason |
S | 0..1 | (Complex) | Motivo por el cual no se encuentra el dato URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both |
  extension |
0..0 | |||
| url |
1..1 | uri | "http://hl7.org/fhir/StructureDefinition/data-absent-reason" | |
 value[x] |
1..1 | code | Value of extension Binding: DataAbsentReason (required): Es usado para especificar porque el elemento esperado por algún motivo el dato no se encuentra ele-1: All FHIR elements must have a @value or children | |
| effectiveDateTime |
dateTime | |||
| effectivePeriod |
Period | |||
| performer |
SΣ | 0..* | Reference(Prestador Individual | Función o Rol de Prestador Individual | Organización | CareTeam) | Servicio de Diagnóstico Responsable ele-1: All FHIR elements must have a @value or children |
| resultsInterpreter |
SΣ | 0..* | Reference(Prestador Individual | Función o Rol de Prestador Individual | Organización | CareTeam) | Interprete primario del resultado ele-1: All FHIR elements must have a @value or children |
| specimen |
S | 0..* | Reference(Muestra) | Muestras en las que se basa este informe ele-1: All FHIR elements must have a @value or children |
| Slices for result |
S | 0..* | Reference(CL Observación) | Observaciones Slice: Unordered, Open by profile:resolve() ele-1: All FHIR elements must have a @value or children |
 result:observacion-resultados |
S | 0..* | Reference(Observación Resultado: Laboratorio/Patología | Observación Resultado: Imagenológico) | Observations ele-1: All FHIR elements must have a @value or children |
| imagingStudy |
0..* | Reference(Estudio de Imagenología) | Referencia a los detalles completos de las imágenes asociadas con el informe diagnóstico ele-1: All FHIR elements must have a @value or children | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet / Code | URI |
| DiagnosticReport.status | required | Pattern: finalhttp://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1from the FHIR Standard | |
| DiagnosticReport.category | example | DiagnosticServiceSectionCodeshttp://hl7.org/fhir/ValueSet/diagnostic-service-sectionsfrom the FHIR Standard | |
| DiagnosticReport.code | preferred | LOINCDiagnosticReportCodes (a valid code from LOINC)http://hl7.org/fhir/ValueSet/report-codesfrom the FHIR Standard | |
| DiagnosticReport.effective[x].extension:data-absent-reason.value[x] | required | DataAbsentReasonhttp://hl7.org/fhir/ValueSet/data-absent-reasonfrom the FHIR Standard |
| Id | Grade | Path(s) | Details | Requirements |
| dom-2 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
| dom-3 | error | DiagnosticReport | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
| dom-4 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
| dom-5 | error | DiagnosticReport | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
| dom-6 | best practice | DiagnosticReport | A resource should have narrative for robust management : text.`div`.exists() | |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
Other representations of profile: CSV, Excel, Schematron
