Lithuanian Laboratory Implementation Guide
0.0.1 - ci-build Lithuania vėliava

Lithuanian Laboratory Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-lab/ and changes regularly. See the Directory of published versions

Resursų profilis: ServiceRequest: Pathology Report (Lt)

Oficialus URL: https://hl7.lt/fhir/lab/StructureDefinition/pathology-report-lt-lab Versija: 0.0.1
Mašiniškai apdorojamas pavadinimas: PathologyReportLtLab

Autorių teisės/Teisinė informacija: Used by permission of HL7 LT, all rights reserved Creative Commons License

This profile defines how to represent an pathology report.

Usages:

You can also check for usages in the FHIR IG Statistics

Profilio turinio formaliosios peržiūros

Profilių, skirtumų rinkinių, momentinių kopijų aprašas ir jų reprezentacijos.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport C 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
Constraints: dgr-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code Status of the Report
Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
... Slices for category Σ 0..* CodeableConceptIPS(2.0.0) Report Category
Slice: Unordered, Open by pattern:$this
Binding: DiagnosticServiceSectionCodes (example): HL7 V2 table 0074

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:studyType Σ 0..* CodeableConcept The way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab (required)
.... category:specialty Σ 0..* CodeableConcept The clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab (required)
... code SΣ 1..1 CodeableConceptIPS(2.0.0) Type of (Laboratory) Report
Binding: PathologyProcedureLtLab (0.0.1) (required)
... subject SΣ 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter Σ 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] SΣ 0..1 Clinically relevant time/time-period for report.
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued SΣ 0..1 instant DateTime this version was made
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result SC 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
Binding: SNOMEDCTClinicalFindings (example): SNOMED CT Clinical Findings
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 SΣ 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
..... coding:icdo3 SΣ 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DiagnosticReport.status Base required Diagnostic Report Status 📍5.0.0 FHIR Std.
DiagnosticReport.category Base example Diagnostic Service Section Codes 📍5.0.0 FHIR Std.
DiagnosticReport.category:studyType Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab Not State Unknown
DiagnosticReport.category:specialty Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab Not State Unknown
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dgr-1 error DiagnosticReport When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference))
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 DiagnosticReport.implicitRules, DiagnosticReport.modifierExtension, DiagnosticReport.identifier, DiagnosticReport.status, DiagnosticReport.category, DiagnosticReport.category:studyType, DiagnosticReport.category:specialty, DiagnosticReport.code, DiagnosticReport.subject, DiagnosticReport.encounter, DiagnosticReport.effective[x], DiagnosticReport.issued, DiagnosticReport.performer, DiagnosticReport.resultsInterpreter, DiagnosticReport.specimen, DiagnosticReport.result, DiagnosticReport.conclusion, DiagnosticReport.conclusionCode, DiagnosticReport.conclusionCode.coding, DiagnosticReport.conclusionCode.coding:icd10, DiagnosticReport.conclusionCode.coding:icd10.system, DiagnosticReport.conclusionCode.coding:icdo3, DiagnosticReport.conclusionCode.coding:icdo3.system, DiagnosticReport.presentedForm All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error DiagnosticReport.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
... identifier S 1..* Identifier Report identifier
... status S 1..1 code Status of the Report
... category 0..* CodeableConceptIPS(2.0.0) Report Category
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
... subject S 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] S 0..1 dateTime, Period Clinically relevant time/time-period for report.
... issued S 0..1 instant DateTime this version was made
... performer S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result S 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
.... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 S 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
..... coding:icdo3 S 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport C 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
Constraints: dgr-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier SΣ 1..* Identifier Report identifier
... basedOn 0..* Reference(ServiceRequest: Laboratory Order (Eu Lab)(0.2.0-ci)) What was requested
... status ?!SΣ 1..1 code Status of the Report
Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
... Slices for category Σ 0..* CodeableConceptIPS(2.0.0) Report Category
Slice: Unordered, Open by pattern:$this
Binding: DiagnosticServiceSectionCodes (example): HL7 V2 table 0074

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:studyType Σ 0..* CodeableConcept The way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab (required)
.... category:specialty Σ 0..* CodeableConcept The clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab (required)
... code SΣ 1..1 CodeableConceptIPS(2.0.0) Type of (Laboratory) Report
Binding: PathologyProcedureLtLab (0.0.1) (required)
... subject SΣ 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter Σ 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] SΣ 0..1 Clinically relevant time/time-period for report.
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued SΣ 0..1 instant DateTime this version was made
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result SC 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... note 0..* Annotation Comments about the diagnostic report
... supportingInfo 0..* BackboneElement Additional information supporting the diagnostic report
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Supporting information role code
Binding: Hl7VSVSObservationType (3.0.0) (example): The code value for the role of the supporting information in the diagnostic report.
.... reference 1..1 Reference(Procedure | Observation | DiagnosticReport | Citation) Supporting information reference
... media Σ 0..* BackboneElement Additional data (like images, diagrams or documents) associated with this report
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... comment 0..1 string Comment about the image or data (e.g. explanation)
.... link Σ 1..1 Reference(DocumentReference) Reference to the image or data
... composition C 0..1 Reference(Composition) Reference to a Composition resource for the DiagnosticReport structure
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
Binding: SNOMEDCTClinicalFindings (example): SNOMED CT Clinical Findings
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 SΣ 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 0..1 code Symbol in syntax defined by the system
...... display ΣC 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... coding:icdo3 SΣ 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 0..1 code Symbol in syntax defined by the system
...... display ΣC 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DiagnosticReport.language Base required All Languages 📍5.0.0 FHIR Std.
DiagnosticReport.status Base required Diagnostic Report Status 📍5.0.0 FHIR Std.
DiagnosticReport.category Base example Diagnostic Service Section Codes 📍5.0.0 FHIR Std.
DiagnosticReport.category:studyType Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab Not State Unknown
DiagnosticReport.category:specialty Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab Not State Unknown
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.supportingInfo.​type Base example hl7VS-VS-observationType 📍3.0.0 THO v7.1
DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dgr-1 error DiagnosticReport When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference))
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 DiagnosticReport.meta, DiagnosticReport.implicitRules, DiagnosticReport.language, DiagnosticReport.text, DiagnosticReport.extension, DiagnosticReport.modifierExtension, DiagnosticReport.identifier, DiagnosticReport.basedOn, DiagnosticReport.status, DiagnosticReport.category, DiagnosticReport.category:studyType, DiagnosticReport.category:specialty, DiagnosticReport.code, DiagnosticReport.subject, DiagnosticReport.encounter, DiagnosticReport.effective[x], DiagnosticReport.issued, DiagnosticReport.performer, DiagnosticReport.resultsInterpreter, DiagnosticReport.specimen, DiagnosticReport.result, DiagnosticReport.note, DiagnosticReport.supportingInfo, DiagnosticReport.supportingInfo.extension, DiagnosticReport.supportingInfo.modifierExtension, DiagnosticReport.supportingInfo.type, DiagnosticReport.supportingInfo.reference, DiagnosticReport.media, DiagnosticReport.media.extension, DiagnosticReport.media.modifierExtension, DiagnosticReport.media.comment, DiagnosticReport.media.link, DiagnosticReport.composition, DiagnosticReport.conclusion, DiagnosticReport.conclusionCode, DiagnosticReport.conclusionCode.extension, DiagnosticReport.conclusionCode.coding, DiagnosticReport.conclusionCode.coding:icd10, DiagnosticReport.conclusionCode.coding:icd10.extension, DiagnosticReport.conclusionCode.coding:icd10.system, DiagnosticReport.conclusionCode.coding:icd10.version, DiagnosticReport.conclusionCode.coding:icd10.code, DiagnosticReport.conclusionCode.coding:icd10.display, DiagnosticReport.conclusionCode.coding:icd10.userSelected, DiagnosticReport.conclusionCode.coding:icdo3, DiagnosticReport.conclusionCode.coding:icdo3.extension, DiagnosticReport.conclusionCode.coding:icdo3.system, DiagnosticReport.conclusionCode.coding:icdo3.version, DiagnosticReport.conclusionCode.coding:icdo3.code, DiagnosticReport.conclusionCode.coding:icdo3.display, DiagnosticReport.conclusionCode.coding:icdo3.userSelected, DiagnosticReport.conclusionCode.text, DiagnosticReport.presentedForm All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error DiagnosticReport.extension, DiagnosticReport.modifierExtension, DiagnosticReport.supportingInfo.extension, DiagnosticReport.supportingInfo.modifierExtension, DiagnosticReport.media.extension, DiagnosticReport.media.modifierExtension, DiagnosticReport.conclusionCode.extension, DiagnosticReport.conclusionCode.coding:icd10.extension, DiagnosticReport.conclusionCode.coding:icdo3.extension Must have either extensions or value[x], not both extension.exists() != value.exists()

Summary

Mandatory: 1 element(4 nested mandatory elements)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DiagnosticReport.conclusionCode.coding (Closed)

Pagrindinių elementų peržiūra

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport C 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
Constraints: dgr-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Contained, inline Resources
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... status ?!SΣ 1..1 code Status of the Report
Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
... Slices for category Σ 0..* CodeableConceptIPS(2.0.0) Report Category
Slice: Unordered, Open by pattern:$this
Binding: DiagnosticServiceSectionCodes (example): HL7 V2 table 0074

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:studyType Σ 0..* CodeableConcept The way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab (required)
.... category:specialty Σ 0..* CodeableConcept The clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab (required)
... code SΣ 1..1 CodeableConceptIPS(2.0.0) Type of (Laboratory) Report
Binding: PathologyProcedureLtLab (0.0.1) (required)
... subject SΣ 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter Σ 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] SΣ 0..1 Clinically relevant time/time-period for report.
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued SΣ 0..1 instant DateTime this version was made
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result SC 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
Binding: SNOMEDCTClinicalFindings (example): SNOMED CT Clinical Findings
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 SΣ 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
..... coding:icdo3 SΣ 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DiagnosticReport.status Base required Diagnostic Report Status 📍5.0.0 FHIR Std.
DiagnosticReport.category Base example Diagnostic Service Section Codes 📍5.0.0 FHIR Std.
DiagnosticReport.category:studyType Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab Not State Unknown
DiagnosticReport.category:specialty Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab Not State Unknown
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dgr-1 error DiagnosticReport When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference))
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 DiagnosticReport.implicitRules, DiagnosticReport.modifierExtension, DiagnosticReport.identifier, DiagnosticReport.status, DiagnosticReport.category, DiagnosticReport.category:studyType, DiagnosticReport.category:specialty, DiagnosticReport.code, DiagnosticReport.subject, DiagnosticReport.encounter, DiagnosticReport.effective[x], DiagnosticReport.issued, DiagnosticReport.performer, DiagnosticReport.resultsInterpreter, DiagnosticReport.specimen, DiagnosticReport.result, DiagnosticReport.conclusion, DiagnosticReport.conclusionCode, DiagnosticReport.conclusionCode.coding, DiagnosticReport.conclusionCode.coding:icd10, DiagnosticReport.conclusionCode.coding:icd10.system, DiagnosticReport.conclusionCode.coding:icdo3, DiagnosticReport.conclusionCode.coding:icdo3.system, DiagnosticReport.presentedForm All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error DiagnosticReport.modifierExtension Must have either extensions or value[x], not both extension.exists() != value.exists()

Skirtumų rinkinių peržiūra

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
... identifier S 1..* Identifier Report identifier
... status S 1..1 code Status of the Report
... category 0..* CodeableConceptIPS(2.0.0) Report Category
Required Pattern: At least the following
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
... subject S 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] S 0..1 dateTime, Period Clinically relevant time/time-period for report.
... issued S 0..1 instant DateTime this version was made
... performer S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter S 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result S 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
.... Slices for coding 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 S 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
..... coding:icdo3 S 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... system 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG

Momentinės kopijos peržiūraView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. DiagnosticReport C 0..* DiagnosticReportLabEu(0.2.0-ci) Pathology Report
Constraints: dgr-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: AllLanguages (required): IETF language tag for a human language
Additional BindingsPurpose
CommonLanguages Starter
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored
Constraints: ext-1
... identifier SΣ 1..* Identifier Report identifier
... basedOn 0..* Reference(ServiceRequest: Laboratory Order (Eu Lab)(0.2.0-ci)) What was requested
... status ?!SΣ 1..1 code Status of the Report
Binding: DiagnosticReportStatus (required): The status of the diagnostic report.
... Slices for category Σ 0..* CodeableConceptIPS(2.0.0) Report Category
Slice: Unordered, Open by pattern:$this
Binding: DiagnosticServiceSectionCodes (example): HL7 V2 table 0074

Required Pattern: At least the following
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... system 1..1 uri Identity of the terminology system
Fixed Value: http://loinc.org
..... version 0..1 string Version of the system - if relevant
..... code 1..1 code Symbol in syntax defined by the system
Fixed Value: 11526-1
..... display 1..1 string Representation defined by the system
Fixed Value: Pathology study
..... userSelected 0..1 boolean If this coding was chosen directly by the user
.... text 0..1 string Plain text representation of the concept
.... category:studyType Σ 0..* CodeableConcept The way of grouping of the test results into clinically meaningful domains (e.g. hematology study, microbiology study, etc.)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab (required)
.... category:specialty Σ 0..* CodeableConcept The clinical domain of the laboratory performing the observation (e.g. microbiology, toxicology, chemistry)
Binding: http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab (required)
... code SΣ 1..1 CodeableConceptIPS(2.0.0) Type of (Laboratory) Report
Binding: PathologyProcedureLtLab (0.0.1) (required)
... subject SΣ 1..1 Reference(PatientLt(0.3.0)) Who and/or what this report is about
... encounter Σ 0..1 Reference(EncounterLt(0.3.0)) The healthcare event which this Laboratory Report is about (when test ordered).
... effective[x] SΣ 0..1 Clinically relevant time/time-period for report.
.... effectiveDateTime dateTime
.... effectivePeriod Period
... issued SΣ 0..1 instant DateTime this version was made
... performer SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Responsible Diagnostic Service.
... resultsInterpreter SΣ 0..* Reference(Practitioner | PractitionerRole | Organization | CareTeam) Primary result interpreter
... specimen S 0..* Reference(Specimen: Laboratory (Eu Lab)(0.2.0-ci)) Specimens this report is based on.
... result SC 0..* Reference(Observation Results: laboratory (Eu Lab)(0.2.0-ci)) results
... note 0..* Annotation Comments about the diagnostic report
... supportingInfo 0..* BackboneElement Additional information supporting the diagnostic report
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... type 1..1 CodeableConcept Supporting information role code
Binding: Hl7VSVSObservationType (3.0.0) (example): The code value for the role of the supporting information in the diagnostic report.
.... reference 1..1 Reference(Procedure | Observation | DiagnosticReport | Citation) Supporting information reference
... media Σ 0..* BackboneElement Additional data (like images, diagrams or documents) associated with this report
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Constraints: ext-1
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
Constraints: ext-1
.... comment 0..1 string Comment about the image or data (e.g. explanation)
.... link Σ 1..1 Reference(DocumentReference) Reference to the image or data
... composition C 0..1 Reference(Composition) Reference to a Composition resource for the DiagnosticReport structure
... conclusion S 0..1 markdown Clinical conclusion (interpretation) of test results
... conclusionCode S 0..* CodeableConcept Codes for the clinical conclusion of test results
Binding: SNOMEDCTClinicalFindings (example): SNOMED CT Clinical Findings
.... id 0..1 id Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
.... Slices for coding Σ 1..* Coding Code defined by a terminology system
Slice: Unordered, Closed by value:system
..... coding:icd10 SΣ 1..1 Coding Code defined by a terminology system
Binding: ICD10Codes (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://hl7.org/fhir/sid/icd-10
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 0..1 code Symbol in syntax defined by the system
...... display ΣC 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... coding:icdo3 SΣ 0..1 Coding Code defined by a terminology system
Binding: ICD_O_3 (1.0.0) (required)
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Constraints: ext-1
...... system Σ 1..1 uri Identity of the terminology system
Required Pattern: http://terminology.hl7.org/CodeSystem/icd-o-3
...... version Σ 0..1 string Version of the system - if relevant
...... code ΣC 0..1 code Symbol in syntax defined by the system
...... display ΣC 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... presentedForm S 0..* Attachment Entire report as issued (pdf recommended)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
DiagnosticReport.language Base required All Languages 📍5.0.0 FHIR Std.
DiagnosticReport.status Base required Diagnostic Report Status 📍5.0.0 FHIR Std.
DiagnosticReport.category Base example Diagnostic Service Section Codes 📍5.0.0 FHIR Std.
DiagnosticReport.category:studyType Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-studyType-eu-lab Not State Unknown
DiagnosticReport.category:specialty Base required http://hl7.eu/fhir/laboratory/ValueSet/lab-specialty-eu-lab Not State Unknown
DiagnosticReport.code Base required Pathology Procedure 📍0.0.1 This IG
DiagnosticReport.supportingInfo.​type Base example hl7VS-VS-observationType 📍3.0.0 THO v7.1
DiagnosticReport.conclusionCode Base example SNOMED CT Clinical Findings 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icd10 Base required ICD-10 Codes 📍5.0.0 FHIR Std.
DiagnosticReport.conclusionCode.​coding:icdo3 Base required ICD-O-3 Morphology 📍1.0.0 This IG

Constraints

Id Grade Path(s) Description Expression
dgr-1 error DiagnosticReport When a Composition is referenced in `Diagnostic.composition`, all Observation resources referenced in `Composition.entry` must also be referenced in `Diagnostic.entry` or in the references Observations in `Observation.hasMember` composition.exists() implies (composition.resolve().section.entry.reference.where(resolve() is Observation) in (result.reference|result.reference.resolve().hasMember.reference))
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().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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 DiagnosticReport.meta, DiagnosticReport.implicitRules, DiagnosticReport.language, DiagnosticReport.text, DiagnosticReport.extension, DiagnosticReport.modifierExtension, DiagnosticReport.identifier, DiagnosticReport.basedOn, DiagnosticReport.status, DiagnosticReport.category, DiagnosticReport.category:studyType, DiagnosticReport.category:specialty, DiagnosticReport.code, DiagnosticReport.subject, DiagnosticReport.encounter, DiagnosticReport.effective[x], DiagnosticReport.issued, DiagnosticReport.performer, DiagnosticReport.resultsInterpreter, DiagnosticReport.specimen, DiagnosticReport.result, DiagnosticReport.note, DiagnosticReport.supportingInfo, DiagnosticReport.supportingInfo.extension, DiagnosticReport.supportingInfo.modifierExtension, DiagnosticReport.supportingInfo.type, DiagnosticReport.supportingInfo.reference, DiagnosticReport.media, DiagnosticReport.media.extension, DiagnosticReport.media.modifierExtension, DiagnosticReport.media.comment, DiagnosticReport.media.link, DiagnosticReport.composition, DiagnosticReport.conclusion, DiagnosticReport.conclusionCode, DiagnosticReport.conclusionCode.extension, DiagnosticReport.conclusionCode.coding, DiagnosticReport.conclusionCode.coding:icd10, DiagnosticReport.conclusionCode.coding:icd10.extension, DiagnosticReport.conclusionCode.coding:icd10.system, DiagnosticReport.conclusionCode.coding:icd10.version, DiagnosticReport.conclusionCode.coding:icd10.code, DiagnosticReport.conclusionCode.coding:icd10.display, DiagnosticReport.conclusionCode.coding:icd10.userSelected, DiagnosticReport.conclusionCode.coding:icdo3, DiagnosticReport.conclusionCode.coding:icdo3.extension, DiagnosticReport.conclusionCode.coding:icdo3.system, DiagnosticReport.conclusionCode.coding:icdo3.version, DiagnosticReport.conclusionCode.coding:icdo3.code, DiagnosticReport.conclusionCode.coding:icdo3.display, DiagnosticReport.conclusionCode.coding:icdo3.userSelected, DiagnosticReport.conclusionCode.text, DiagnosticReport.presentedForm All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error DiagnosticReport.extension, DiagnosticReport.modifierExtension, DiagnosticReport.supportingInfo.extension, DiagnosticReport.supportingInfo.modifierExtension, DiagnosticReport.media.extension, DiagnosticReport.media.modifierExtension, DiagnosticReport.conclusionCode.extension, DiagnosticReport.conclusionCode.coding:icd10.extension, DiagnosticReport.conclusionCode.coding:icdo3.extension Must have either extensions or value[x], not both extension.exists() != value.exists()

Summary

Mandatory: 1 element(4 nested mandatory elements)
Must-Support: 15 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of DiagnosticReport.conclusionCode.coding (Closed)

 

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