Imaging Diagnostic Report
0.0.1-current - ci-build

Imaging Diagnostic Report, published by IHE Radiology Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.0.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/RAD.IDR/ and changes regularly. See the Directory of published versions

## Resource Profile: Past diagnosis of patient in Imaging Diagnostic Report

Official URL: https://profiles.ihe.net/RAD/IDR/StructureDefinition/idr-patient-history-condition | Version: 0.0.1-current
Draft as of 2024-06-25 | Computable Name: IDRPatientHistoryCondition

A past diagnosis of a patient in an Imaging Diagnostic Report.

Usage:

- Refer to this Resource Profile: IDR Patient History

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Differential Table
- Key Elements Table
- Snapshot Table
- Statistics/References
- All

This structure is derived from Condition

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition |  | 0..* | Condition | Detailed information about conditions, problems or diagnoses
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition | C | 0..* | Condition | Detailed information about conditions, problems or diagnoses con-2: If category is problems list item, the clinicalStatus should not be unknown con-3: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
clinicalStatus | ?!Σ C | 1..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved | unknown Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus | ?!Σ | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
subject | Σ | 1..1 | Reference(Patient | Group) | Who has the condition?
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Condition.clinicalStatus | required | ConditionClinicalStatusCodes `http://hl7.org/fhir/ValueSet/condition-clinical|5.0.0` from the FHIR Standard
Condition.verificationStatus | required | ConditionVerificationStatus `http://hl7.org/fhir/ValueSet/condition-ver-status|5.0.0` from the FHIR Standard

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition | C | 0..* | Condition | Detailed information about conditions, problems or diagnoses con-2: If category is problems list item, the clinicalStatus should not be unknown con-3: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.
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 Bindings | Purpose
CommonLanguages | Starter Set
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External Ids for this condition
clinicalStatus | ?!Σ C | 1..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved | unknown Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus | ?!Σ | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
category | C | 0..* | CodeableConcept | problem-list-item | encounter-diagnosis Binding: ConditionCategoryCodes (preferred): A category assigned to the condition.
severity |  | 0..1 | CodeableConcept | Subjective severity of condition Binding: ConditionDiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code | Σ | 0..1 | CodeableConcept | Identification of the condition, problem or diagnosis Binding: ConditionProblemDiagnosisCodes (example): Identification of the condition or diagnosis.
bodySite | Σ | 0..* | CodeableConcept | Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
subject | Σ | 1..1 | Reference(Patient | Group) | Who has the condition?
encounter | Σ | 0..1 | Reference(Encounter) | The Encounter during which this Condition was created
onset[x] | Σ | 0..1 |  | Estimated or actual date, date-time, or age
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
onsetString |  |  | string |
abatement[x] | C | 0..1 |  | When in resolution/remission
abatementDateTime |  |  | dateTime |
abatementAge |  |  | Age |
abatementPeriod |  |  | Period |
abatementRange |  |  | Range |
abatementString |  |  | string |
recordedDate | Σ | 0..1 | dateTime | Date condition was first recorded
participant | Σ | 0..* | BackboneElement | Who or what participated in the activities related to the condition and how they were involved
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | Type of involvement Binding: ParticipationRoleType (extensible)
actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam) | Who or what participated in the activities related to the condition
stage | C | 0..* | BackboneElement | Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
summary | C | 0..1 | CodeableConcept | Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment | C | 0..* | Reference(ClinicalImpression | DiagnosticReport | Observation) | Formal record of assessment
type |  | 0..1 | CodeableConcept | Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence | Σ | 0..* | CodeableReference(Resource) | Supporting evidence for the verification status Binding: SNOMEDCTClinicalFindings (example)
note |  | 0..* | Annotation | Additional information about the Condition
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Condition.language | required | AllLanguages `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` from the FHIR Standard
Condition.clinicalStatus | required | ConditionClinicalStatusCodes `http://hl7.org/fhir/ValueSet/condition-clinical|5.0.0` from the FHIR Standard
Condition.verificationStatus | required | ConditionVerificationStatus `http://hl7.org/fhir/ValueSet/condition-ver-status|5.0.0` from the FHIR Standard
Condition.category | preferred | ConditionCategoryCodes `http://hl7.org/fhir/ValueSet/condition-category` from the FHIR Standard
Condition.severity | preferred | ConditionDiagnosisSeverity `http://hl7.org/fhir/ValueSet/condition-severity` from the FHIR Standard
Condition.code | example | ConditionProblemDiagnosisCodes `http://hl7.org/fhir/ValueSet/condition-code` from the FHIR Standard
Condition.bodySite | example | SNOMEDCTBodyStructures `http://hl7.org/fhir/ValueSet/body-site` from the FHIR Standard
Condition.participant.function | extensible | ParticipationRoleType `http://hl7.org/fhir/ValueSet/participation-role-type` from the FHIR Standard
Condition.stage.summary | example | ConditionStage `http://hl7.org/fhir/ValueSet/condition-stage` from the FHIR Standard
Condition.stage.type | example | ConditionStageType `http://hl7.org/fhir/ValueSet/condition-stage-type` from the FHIR Standard
Condition.evidence | example | SNOMEDCTClinicalFindings `http://hl7.org/fhir/ValueSet/clinical-findings` from the FHIR Standard

This structure is derived from Condition

Summary

Must-Support: 1 element

Differential View

This structure is derived from Condition

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition |  | 0..* | Condition | Detailed information about conditions, problems or diagnoses
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
Documentation for this format

Key Elements View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition | C | 0..* | Condition | Detailed information about conditions, problems or diagnoses con-2: If category is problems list item, the clinicalStatus should not be unknown con-3: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
clinicalStatus | ?!Σ C | 1..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved | unknown Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus | ?!Σ | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
subject | Σ | 1..1 | Reference(Patient | Group) | Who has the condition?
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Condition.clinicalStatus | required | ConditionClinicalStatusCodes `http://hl7.org/fhir/ValueSet/condition-clinical|5.0.0` from the FHIR Standard
Condition.verificationStatus | required | ConditionVerificationStatus `http://hl7.org/fhir/ValueSet/condition-ver-status|5.0.0` from the FHIR Standard

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Condition | C | 0..* | Condition | Detailed information about conditions, problems or diagnoses con-2: If category is problems list item, the clinicalStatus should not be unknown con-3: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.
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 Bindings | Purpose
CommonLanguages | Starter Set
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation
contained |  | 0..* | Resource | Contained, inline Resources
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..* | Identifier | External Ids for this condition
clinicalStatus | ?!Σ C | 1..1 | CodeableConcept | active | recurrence | relapse | inactive | remission | resolved | unknown Binding: ConditionClinicalStatusCodes (required): The clinical status of the condition or diagnosis.
verificationStatus | ?!Σ | 0..1 | CodeableConcept | unconfirmed | provisional | differential | confirmed | refuted | entered-in-error Binding: ConditionVerificationStatus (required): The verification status to support or decline the clinical status of the condition or diagnosis.
category | C | 0..* | CodeableConcept | problem-list-item | encounter-diagnosis Binding: ConditionCategoryCodes (preferred): A category assigned to the condition.
severity |  | 0..1 | CodeableConcept | Subjective severity of condition Binding: ConditionDiagnosisSeverity (preferred): A subjective assessment of the severity of the condition as evaluated by the clinician.
code | Σ | 0..1 | CodeableConcept | Identification of the condition, problem or diagnosis Binding: ConditionProblemDiagnosisCodes (example): Identification of the condition or diagnosis.
bodySite | Σ | 0..* | CodeableConcept | Anatomical location, if relevant Binding: SNOMEDCTBodyStructures (example): SNOMED CT Body site concepts
subject | Σ | 1..1 | Reference(Patient | Group) | Who has the condition?
encounter | Σ | 0..1 | Reference(Encounter) | The Encounter during which this Condition was created
onset[x] | Σ | 0..1 |  | Estimated or actual date, date-time, or age
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
onsetString |  |  | string |
abatement[x] | C | 0..1 |  | When in resolution/remission
abatementDateTime |  |  | dateTime |
abatementAge |  |  | Age |
abatementPeriod |  |  | Period |
abatementRange |  |  | Range |
abatementString |  |  | string |
recordedDate | Σ | 0..1 | dateTime | Date condition was first recorded
participant | Σ | 0..* | BackboneElement | Who or what participated in the activities related to the condition and how they were involved
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
function | Σ | 0..1 | CodeableConcept | Type of involvement Binding: ParticipationRoleType (extensible)
actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson | Device | Organization | CareTeam) | Who or what participated in the activities related to the condition
stage | C | 0..* | BackboneElement | Stage/grade, usually assessed formally con-1: Stage SHALL have summary or assessment
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
summary | C | 0..1 | CodeableConcept | Simple summary (disease specific) Binding: ConditionStage (example): Codes describing condition stages (e.g. Cancer stages).
assessment | C | 0..* | Reference(ClinicalImpression | DiagnosticReport | Observation) | Formal record of assessment
type |  | 0..1 | CodeableConcept | Kind of staging Binding: ConditionStageType (example): Codes describing the kind of condition staging (e.g. clinical or pathological).
evidence | Σ | 0..* | CodeableReference(Resource) | Supporting evidence for the verification status Binding: SNOMEDCTClinicalFindings (example)
note |  | 0..* | Annotation | Additional information about the Condition
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet | URI
Condition.language | required | AllLanguages `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` from the FHIR Standard
Condition.clinicalStatus | required | ConditionClinicalStatusCodes `http://hl7.org/fhir/ValueSet/condition-clinical|5.0.0` from the FHIR Standard
Condition.verificationStatus | required | ConditionVerificationStatus `http://hl7.org/fhir/ValueSet/condition-ver-status|5.0.0` from the FHIR Standard
Condition.category | preferred | ConditionCategoryCodes `http://hl7.org/fhir/ValueSet/condition-category` from the FHIR Standard
Condition.severity | preferred | ConditionDiagnosisSeverity `http://hl7.org/fhir/ValueSet/condition-severity` from the FHIR Standard
Condition.code | example | ConditionProblemDiagnosisCodes `http://hl7.org/fhir/ValueSet/condition-code` from the FHIR Standard
Condition.bodySite | example | SNOMEDCTBodyStructures `http://hl7.org/fhir/ValueSet/body-site` from the FHIR Standard
Condition.participant.function | extensible | ParticipationRoleType `http://hl7.org/fhir/ValueSet/participation-role-type` from the FHIR Standard
Condition.stage.summary | example | ConditionStage `http://hl7.org/fhir/ValueSet/condition-stage` from the FHIR Standard
Condition.stage.type | example | ConditionStageType `http://hl7.org/fhir/ValueSet/condition-stage-type` from the FHIR Standard
Condition.evidence | example | SNOMEDCTClinicalFindings `http://hl7.org/fhir/ValueSet/clinical-findings` from the FHIR Standard

This structure is derived from Condition

Summary

Must-Support: 1 element

Other representations of profile: CSV, Excel, Schematron