Advance Care Planning (PZP)
1.0.0-rc2 - trial-use

Advance Care Planning (PZP), published by IKNL. This guide is not an authorized publication; it is the continuous build for version 1.0.0-rc2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IKNL/PZP-FHIR-R4/ and changes regularly. See the Directory of published versions

## Resource Profile: ACPTreatmentDirective - Detailed Descriptions

Draft as of 2026-06-02

Definitions for the ACP-TreatmentDirective resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

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

0. Consent
Definition | A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.
Short | TreatmentDirectiveA healthcare consumer's choices to permit or deny recipients or roles to perform actions for specific purposes and periods of time
Comments | A straightforward and accurate mapping of zib TreatmentDirective2 to FHIR is not possible. The main consideration is to choose between the Consent and CarePlan resource. Unfortunately, the Consent resource does not have full support for treatment directives yet as its main focus is to model Patient's privacy consents. Regardless, it seems to be the best match to represent the intention of the zib, as both the resource and the zib cover a mutual agreement about treatments and not per se the resulting actions or policy for treatments, which would better be handled using the CarePlan resource. Future migration to a later version of FHIR or the zib will result in the reevaluation of the mapping. Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | BehandelAanwijzing, nl-core-TreatmentDirective2
Invariants | dom-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()`) ppc-1: Either a Policy or PolicyRule (`policy.exists() or policyRule.exists()`) ppc-2: IF Scope=privacy, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()`) ppc-3: IF Scope=research, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='research').exists().not()`) ppc-4: IF Scope=adr, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()`) ppc-5: IF Scope=treatment, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()`) zib-TreatmentDirective2-1: `extension.additionalAdvanceDirective` may only be used for AdvanceDirective references in addition to first reference in `.source[x]`. (`extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.AdvanceDirective').empty() or source.exists()`) zib-TreatmentDirective2-2: If the specificationOther extension is used, `.provision.type` MUST be absent and vice versa (`(extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.SpecificitionOther').exists() and provision.type.exists()).not()`) dom-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()) ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists()) ppc-2: IF Scope=privacy, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()) ppc-3: IF Scope=research, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='research').exists().not()) ppc-4: IF Scope=adr, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()) ppc-5: IF Scope=treatment, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not())
2. Consent.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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-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()))
4. Consent.extension:comment
Slice Name | comment
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(ext Comment) (Extension Type: string)
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`) 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())
6. Consent.extension:comment.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-Comment`
8. Consent.extension:additionalAdvanceDirective
Slice Name | additionalAdvanceDirective
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..* This element is affected by the following invariants: ele-1, zib-TreatmentDirective2-1
Type | Extension(ext TreatmentDirective2.AdvanceDirective) (Extension Type: Reference(zib AdvanceDirective))
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`) 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())
10. Consent.extension:additionalAdvanceDirective.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.AdvanceDirective`
12. Consent.extension:additionalAdvanceDirective.value[x]
Definition | A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter. Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | AdvanceDirectiveValue of extension
Comments | `Consent.source:sourceReference` is the primary target for referencing zib AdvanceDirective (zib concept NL-CM:2.2.8). However, the cardinality of `Consent.source[x]` is restricted to `0..1`. If more than one AdvanceDirective needs to be referenced, the additional references can be communicated using this extension. If this extension is used, `Consent.source:sourceReference` SHALL be populated and it SHALL not contain the same reference as this extension.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Reference(nl core AdvanceDirective), 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] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | false
Alternate Names | Wilsverklaring
Invariants | ele-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. Consent.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
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 Names | extensions, user content
Invariants | 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()`) 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())
Slicing | This element introduces a set of slices on `Consent.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. Consent.modifierExtension:specificationOther
Slice Name | specificationOther
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..1 This element is affected by the following invariants: ele-1, zib-TreatmentDirective2-2
Type | Extension(ext TreatmentDirective2.SpecificationOther) (Extension Type: string)
Is Modifier | true because This extension extends the options of _deny_ and _permit_ of `Consent.provision.type` with the opportunity to provide free text. The `Consent.provision` cannot be safely interpreted if the free text in this extension is omitted, hence the reason for labeling this extension as a modifier.
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`) 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())
18. Consent.modifierExtension:specificationOther.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.SpecificationOther`
20. Consent.modifierExtension:specificationOther.value[x]
Definition | Specification of the treatment decision when the decision is 'Other'. Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).
Short | SpecificationOtherValue of extension
Comments | In addition to the default zib/nl-core guidance, this extension is used to communicate further details about agreements concerning ICD.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-2
Type | string, 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, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Alternate Names | SpecificatieAnders
Invariants | ele-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()))
22. Consent.status
Definition | Indicates the current state of this consent.
Short | draft | proposed | active | rejected | inactive | entered-in-error
Comments | This element is implicitly mapped to the zib concepts NL-CM:2.2.5 (MostRecentReviewDate) and NL-CM:2.2.6 (DateExpired). Unless the status is explicitly recorded, the following guidance applies: When MostRecentReviewDate is in the past and DateExpired is absent or in the future, `.status` will usually be set to active. When DateExpired is in the past, `.status` will usually be set to inactive. When MostRecentReviewDate is absent or in the future, which is not possible following the zib, `.status` will usually be set to draft. This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the Consent as not currently valid.
Control | 1..1
Binding | The codes SHALL be taken from ConsentState http://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1 (required to `http://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1` ) Indicates the state of the consent.
Type | code
Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.
Invariants | ele-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()))
24. Consent.scope
Definition | A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.
Short | Which of the four areas this resource covers (extensible)
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from ConsentScopeCodes http://hl7.org/fhir/ValueSet/consent-scope|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/consent-scope|4.0.1` ) The four anticipated uses for the Consent Resource.
Type | CodeableConcept
Is Modifier | true because Allows changes to codes based on scope selection
Summary | true
Pattern Value | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentscope", "code" : "treatment" }] }`
Invariants | ele-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()))
26. Consent.category
Definition | A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
Short | Classification of the consent statement - for indexing/retrieval
Control | 1..*
Binding | Unless not suitable, these codes SHALL be taken from ConsentCategoryCodes http://hl7.org/fhir/ValueSet/consent-category|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/consent-category|4.0.1` ) A classification of the type of consents found in a consent statement.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-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()))
Slicing | This element introduces a set of slices on `Consent.category`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ $this
28. Consent.category:treatmentDirectiveCode
Slice Name | treatmentDirectiveCode
Definition | A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
Short | Classification of the consent statement - for indexing/retrieval
Control | 1..1*
Binding | Unless not suitable, these codes SHALL be taken from ConsentCategoryCodes http://hl7.org/fhir/ValueSet/consent-category|4.0.1 (extensible to `http://hl7.org/fhir/ValueSet/consent-category|4.0.1` ) A classification of the type of consents found in a consent statement.
Type | CodeableConcept
Is Modifier | false
Summary | true
Pattern Value | `{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "129125009" }] }`
Invariants | ele-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()))
30. Consent.patient
Definition | The patient/healthcare consumer to whom this consent applies.
Short | Who the consent applies to
Comments | Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.
Control | 0..1
Type | Reference(ACP Patient, Patient)
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Invariants | ele-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()))
32. Consent.dateTime
Definition | The date on which the treatment directive has been agreed with the patient and / or his representative (s). This can be the first time that the treatment directive have been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same. When this Consent was issued / created / indexed.
Short | MostRecentReviewDateWhen this Consent was created or indexed
Comments | This is not the time of the original consent, but the time that this statement was made or derived.
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | MeestRecenteBespreekdatum
Invariants | ele-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()))
34. Consent.source[x]
Definition | The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
Short | Source from which this consent is taken
Comments | The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Choice of: Attachment, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Invariants | ele-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()))
Slicing | This element introduces a set of slices on `Consent.source[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
36. Consent.source[x]:sourceReference
Slice Name | sourceReference
Definition | A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter. The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
Short | AdvanceDirectiveSource from which this consent is taken
Comments | The cardinality of this `Consent.source[x]` element is restricted to `0..1`, which is narrower than the AdvanceDirective concept (NL-CM:2.2.8) specified in the HCIM TreatmentDirective2. If additional AdvanceDirective references are needed, the additionalAdvanceDirective extension can be used in addition to this element. If the additionalAdvanceDirective extension is used, this element SHALL be populated and it SHALL not contain a reference that is also present in the extension. The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Reference(ACP AdvanceDirective, Consent, DocumentReference, Contract, QuestionnaireResponse), Attachment
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | Wilsverklaring
Invariants | ele-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()))

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

0. Consent
2. Consent.extension:comment
Slice Name | comment
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
4. Consent.extension:additionalAdvanceDirective
Slice Name | additionalAdvanceDirective
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
6. Consent.extension:additionalAdvanceDirective.value[x]
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
8. Consent.modifierExtension:specificationOther
Slice Name | specificationOther
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
10. Consent.modifierExtension:specificationOther.value[x]
Comments | In addition to the default zib/nl-core guidance, this extension is used to communicate further details about agreements concerning ICD.
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
12. Consent.patient
Type | Reference(ACP Patient)
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
14. Consent.dateTime
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
16. Consent.source[x]:sourceReference
Slice Name | sourceReference
Type | Reference(ACP AdvanceDirective)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
18. Consent.provision
20. Consent.provision.extension:reasonForEnding
Slice Name | reasonForEnding
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
22. Consent.provision.type
Comments | Additional terminology mapping guidance, in addition to the default zib/nl-core guidance: BehandelBesluit (dataset id 603) values: Wel uitvoeren -> permit Niet uitvoeren -> deny Anders or Onbekend -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element. Afspraak uitzetten ICD (dataset id 638) values: Wel uitvoeren -> permit No value is mapped to deny Nee, nog geen besluit genomen or Niet besproken -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element.
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
24. Consent.provision.period
26. Consent.provision.period.end
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
28. Consent.provision.actor:agreementParty
Slice Name | agreementParty
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
30. Consent.provision.actor:agreementParty.reference
Type | Reference(ACP Patient, ACP HealthProfessional PractitionerRole, ACP ContactPerson)
32. Consent.provision.code
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
34. Consent.provision.code.text
Comments | `.code.type` has a required binding. Therefore, only codes in the bound ValueSet are permitted. For concepts not present in the ValueSet, such as SNOMED CT code 400231000146108 (Uitzetten van cardioverter-defibrillator in laatste levensfase), use the `.text` field as per FHIR guidance.
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter

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

0. Consent
Definition | A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.
Short | TreatmentDirective
Comments | A straightforward and accurate mapping of zib TreatmentDirective2 to FHIR is not possible. The main consideration is to choose between the Consent and CarePlan resource. Unfortunately, the Consent resource does not have full support for treatment directives yet as its main focus is to model Patient's privacy consents. Regardless, it seems to be the best match to represent the intention of the zib, as both the resource and the zib cover a mutual agreement about treatments and not per se the resulting actions or policy for treatments, which would better be handled using the CarePlan resource. Future migration to a later version of FHIR or the zib will result in the reevaluation of the mapping.
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | BehandelAanwijzing, nl-core-TreatmentDirective2
Invariants | dom-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()`) ppc-1: Either a Policy or PolicyRule (`policy.exists() or policyRule.exists()`) ppc-2: IF Scope=privacy, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not()`) ppc-3: IF Scope=research, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='research').exists().not()`) ppc-4: IF Scope=adr, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='adr').exists().not()`) ppc-5: IF Scope=treatment, there must be a patient (`patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not()`) zib-TreatmentDirective2-1: `extension.additionalAdvanceDirective` may only be used for AdvanceDirective references in addition to first reference in `.source[x]`. (`extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.AdvanceDirective').empty() or source.exists()`) zib-TreatmentDirective2-2: If the specificationOther extension is used, `.provision.type` MUST be absent and vice versa (`(extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.SpecificitionOther').exists() and provision.type.exists()).not()`)
2. Consent.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical 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.
Control | 0..1
Type | id
Is Modifier | false
Summary | true
4. Consent.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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. Consent.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.
Short | A 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.
Control | 0..1
Type | uri
Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. Consent.language
Definition | The base language in which the resource is written.
Short | Language 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).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages|4.0.1` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. Consent.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.
Short | Text 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.
Control | 0..1
Type | Narrative
Is Modifier | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. Consent.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.
Short | Contained, 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.
Control | 0..*
Type | Resource
Is Modifier | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. Consent.extension
Definition | 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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. Consent.extension:comment
Slice Name | comment
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(ext Comment) (Extension Type: string)
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`)
18. Consent.extension:comment.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
20. Consent.extension:comment.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
22. Consent.extension:comment.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-Comment`
24. Consent.extension:comment.value[x]
Definition | The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc.
Short | Comment
Control | 0..1
Type | string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Alternate Names | Toelichting
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. Consent.extension:additionalAdvanceDirective
Slice Name | additionalAdvanceDirective
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..* This element is affected by the following invariants: ele-1, zib-TreatmentDirective2-1
Type | Extension(ext TreatmentDirective2.AdvanceDirective) (Extension Type: Reference(zib AdvanceDirective))
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`)
28. Consent.extension:additionalAdvanceDirective.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
30. Consent.extension:additionalAdvanceDirective.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
32. Consent.extension:additionalAdvanceDirective.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.AdvanceDirective`
34. Consent.extension:additionalAdvanceDirective.value[x]
Definition | A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.
Short | AdvanceDirective
Comments | `Consent.source:sourceReference` is the primary target for referencing zib AdvanceDirective (zib concept NL-CM:2.2.8). However, the cardinality of `Consent.source[x]` is restricted to `0..1`. If more than one AdvanceDirective needs to be referenced, the additional references can be communicated using this extension. If this extension is used, `Consent.source:sourceReference` SHALL be populated and it SHALL not contain the same reference as this extension.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Reference(nl core AdvanceDirective)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | false
Alternate Names | Wilsverklaring
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. Consent.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
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 Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.modifierExtension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
38. Consent.modifierExtension:specificationOther
Slice Name | specificationOther
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..1 This element is affected by the following invariants: ele-1, zib-TreatmentDirective2-2
Type | Extension(ext TreatmentDirective2.SpecificationOther) (Extension Type: string)
Is Modifier | true because This extension extends the options of _deny_ and _permit_ of `Consent.provision.type` with the opportunity to provide free text. The `Consent.provision` cannot be safely interpreted if the free text in this extension is omitted, hence the reason for labeling this extension as a modifier.
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`)
40. Consent.modifierExtension:specificationOther.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
42. Consent.modifierExtension:specificationOther.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.modifierExtension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
44. Consent.modifierExtension:specificationOther.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://nictiz.nl/fhir/StructureDefinition/ext-TreatmentDirective2.SpecificationOther`
46. Consent.modifierExtension:specificationOther.value[x]
Definition | Specification of the treatment decision when the decision is 'Other'.
Short | SpecificationOther
Comments | In addition to the default zib/nl-core guidance, this extension is used to communicate further details about agreements concerning ICD.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-2
Type | string
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Alternate Names | SpecificatieAnders
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. Consent.identifier
Definition | Unique identifier for this copy of the Consent Statement.
Short | Identifier for this record (external references)
Comments | This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
Is Modifier | false
Summary | true
Example | General: { "system" : "urn:ietf:rfc:3986", "value" : "Local eCMS identifier" }
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. Consent.status
Definition | Indicates the current state of this consent.
Short | draft | proposed | active | rejected | inactive | entered-in-error
Comments | This element is implicitly mapped to the zib concepts NL-CM:2.2.5 (MostRecentReviewDate) and NL-CM:2.2.6 (DateExpired). Unless the status is explicitly recorded, the following guidance applies: When MostRecentReviewDate is in the past and DateExpired is absent or in the future, `.status` will usually be set to active. When DateExpired is in the past, `.status` will usually be set to inactive. When MostRecentReviewDate is absent or in the future, which is not possible following the zib, `.status` will usually be set to draft.
Control | 1..1
Binding | The codes SHALL be taken from ConsentState (required to `http://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1` ) Indicates the state of the consent.
Type | code
Is Modifier | true 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 Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. Consent.scope
Definition | A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.
Short | Which of the four areas this resource covers (extensible)
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from ConsentScopeCodes (extensible to `http://hl7.org/fhir/ValueSet/consent-scope|4.0.1` ) The four anticipated uses for the Consent Resource.
Type | CodeableConcept
Is Modifier | true because Allows changes to codes based on scope selection
Summary | true
Pattern Value | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/consentscope", "code" : "treatment" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. Consent.category
Definition | A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
Short | Classification of the consent statement - for indexing/retrieval
Control | 1..*
Binding | Unless not suitable, these codes SHALL be taken from ConsentCategoryCodes (extensible to `http://hl7.org/fhir/ValueSet/consent-category|4.0.1` ) A classification of the type of consents found in a consent statement.
Type | CodeableConcept
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `Consent.category`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ $this
56. Consent.category:treatmentDirectiveCode
Slice Name | treatmentDirectiveCode
Definition | A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.
Short | Classification of the consent statement - for indexing/retrieval
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from ConsentCategoryCodes (extensible to `http://hl7.org/fhir/ValueSet/consent-category|4.0.1` ) A classification of the type of consents found in a consent statement.
Type | CodeableConcept
Is Modifier | false
Summary | true
Pattern Value | `{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "129125009" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. Consent.patient
Definition | The patient/healthcare consumer to whom this consent applies.
Short | Who the consent applies to
Comments | Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.
Control | 0..1
Type | Reference(ACP Patient)
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
60. Consent.dateTime
Definition | The date on which the treatment directive has been agreed with the patient and / or his representative (s). This can be the first time that the treatment directive have been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same.
Short | MostRecentReviewDate
Comments | This is not the time of the original consent, but the time that this statement was made or derived.
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | MeestRecenteBespreekdatum
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
62. Consent.performer
Definition | Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.
Short | Who is agreeing to the policy and rules
Comments | Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.
Control | 0..*
Type | Reference(Organization, Patient, Practitioner, RelatedPerson, PractitionerRole)
Is Modifier | false
Summary | true
Alternate Names | consentor
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. Consent.organization
Definition | The organization that manages the consent, and the framework within which it is executed.
Short | Custodian of the consent
Control | 0..*
Type | Reference(Organization)
Is Modifier | false
Summary | true
Alternate Names | custodian
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. Consent.source[x]
Definition | The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.
Short | Source from which this consent is taken
Comments | The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Choice of: Attachment, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `Consent.source[x]`. The slices areUnordered and Closed, and can be differentiated using the following discriminators: type @ $this
68. Consent.source[x]:sourceReference
Slice Name | sourceReference
Definition | A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.
Short | AdvanceDirective
Comments | The cardinality of this `Consent.source[x]` element is restricted to `0..1`, which is narrower than the AdvanceDirective concept (NL-CM:2.2.8) specified in the HCIM TreatmentDirective2. If additional AdvanceDirective references are needed, the additionalAdvanceDirective extension can be used in addition to this element. If the additionalAdvanceDirective extension is used, this element SHALL be populated and it SHALL not contain a reference that is also present in the extension.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-1
Type | Reference(ACP AdvanceDirective)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | Wilsverklaring
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. Consent.policy
Definition | The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
Short | Policies covered by this consent
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. Consent.policy.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
74. Consent.policy.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
76. Consent.policy.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
78. Consent.policy.authority
Definition | Entity or Organization having regulatory jurisdiction or accountability for enforcing policies pertaining to Consent Directives.
Short | Enforcement source for policy
Control | 0..1 This element is affected by the following invariants: ppc-1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. Consent.policy.uri
Definition | The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.
Short | Specific policy covered by this consent
Comments | Either `.policy` or `.policyRule` should exist following core constraint ppc-1. If no explicit value is recorded, a fallback is to populate `.policy.uri` with https://wetten.overheid.nl/ if the treatment directive is recorded following Dutch law and regulations.
Control | 0..1 This element is affected by the following invariants: ppc-1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
82. Consent.policyRule
Definition | A reference to the specific base computable regulation or policy.
Short | Regulation that this consents to
Comments | If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.
Control | 0..1 This element is affected by the following invariants: ppc-1
Binding | Unless not suitable, these codes SHALL be taken from ConsentPolicyRuleCodes (extensible to `http://hl7.org/fhir/ValueSet/consent-policy|4.0.1` ) Regulatory policy examples.
Type | CodeableConcept
Is Modifier | false
Summary | true
Requirements | Might be a unique identifier of a policy set in XACML, or other rules engine.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
84. Consent.verification
Definition | Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.
Short | Consent Verified by patient or family
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
86. Consent.verification.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
88. Consent.verification.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
90. Consent.verification.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
92. Consent.verification.verified
Definition | Has the instruction been verified.
Short | Has been verified
Control | 1..1
Type | boolean
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
94. Consent.verification.verifiedWith
Definition | Who verified the instruction (Patient, Relative or other Authorized Person).
Short | Person who verified
Control | 0..1
Type | Reference(Patient, RelatedPerson)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. Consent.verification.verificationDate
Definition | Date verification was collected.
Short | When consent verified
Control | 0..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
98. Consent.provision
Definition | An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.
Short | Constraints to the base Consent.policyRule
Control | 0..1
Type | BackboneElement
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
100. Consent.provision.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
102. Consent.provision.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.provision.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
104. Consent.provision.extension:reasonForEnding
Slice Name | reasonForEnding
Definition | Optional Extension Element - found in all resources.
Short | Optional Extensions Element
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(ext TreatmentDirective2.ReasonForEnding) (Extension Type: string)
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Invariants | 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()`)
106. Consent.provision.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
108. Consent.provision.type
Definition | The joint decision taken with regard to the desirability of performing the indicated treatment. If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment. Implementers SHALL support the specificationOther modifier extension for this.
Short | TreatmentDecision
Comments | Additional terminology mapping guidance, in addition to the default zib/nl-core guidance: BehandelBesluit (dataset id 603) values: Wel uitvoeren -> permit Niet uitvoeren -> deny Anders or Onbekend -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element. Afspraak uitzetten ICD (dataset id 638) values: Wel uitvoeren -> permit No value is mapped to deny Nee, nog geen besluit genomen or Niet besproken -> do not set a value. Instead, communicate this via the `modifierExtension[specificationOther].valueString` element.
Control | 0..1 This element is affected by the following invariants: zib-TreatmentDirective2-2
Binding | The codes SHALL be taken from ConsentProvisionType (required to `http://hl7.org/fhir/ValueSet/consent-provision-type|4.0.1` ) Use ConceptMap TreatmentDecisionCodelist-to-ConsentProvisionType to translate terminology from the functional model to profile terminology in ValueSet ConsentProvisionType.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | BehandelBesluit
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
110. Consent.provision.period
Definition | The timeframe in this rule is valid.
Short | Timeframe for this rule
Control | 0..1
Type | Period
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
112. Consent.provision.period.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
114. Consent.provision.period.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.provision.period.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
116. Consent.provision.period.start
Definition | The start of the period. The boundary is inclusive.
Short | Starting time with inclusive boundary
Comments | If the low element is missing, the meaning is that the low boundary is not known.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. Consent.provision.period.end
Definition | The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care provider and the patient or his representative(s).Any future termination can only be entered as a condition. Often this will be linked to 1 or more events.
Short | DateExpired
Comments | The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
Control | 0..1 This element is affected by the following invariants: per-1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | DatumBeeindigd
Meaning if Missing | If the end of the period is missing, it means that the period is ongoing
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. Consent.provision.actor
Definition | Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').
Short | Who|what controlled by this rule (or group, by role)
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | false
Meaning if Missing | There is no specific actor associated with the exception
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
Slicing | This element introduces a set of slices on `Consent.provision.actor`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ role
122. Consent.provision.actor.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
124. Consent.provision.actor.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
126. Consent.provision.actor.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
128. Consent.provision.actor.role
Definition | How the individual is involved in the resources content that is described in the exception.
Short | How the actor is involved
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from SecurityRoleType (extensible to `http://hl7.org/fhir/ValueSet/security-role-type|4.0.1` ) How an actor is involved in the consent considerations.
Type | CodeableConcept
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
130. Consent.provision.actor.reference
Definition | The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').
Short | Resource for the actor (or group, by role)
Control | 1..1
Type | Reference(Device, Group, CareTeam, Organization, Patient, Practitioner, RelatedPerson, PractitionerRole)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
132. Consent.provision.actor:agreementParty
Slice Name | agreementParty
Definition | Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').
Short | AgreementParty
Control | 0..*
Type | BackboneElement
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | false
Alternate Names | AfspraakPartij
Meaning if Missing | There is no specific actor associated with the exception
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
134. Consent.provision.actor:agreementParty.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
136. Consent.provision.actor:agreementParty.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
138. Consent.provision.actor:agreementParty.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
140. Consent.provision.actor:agreementParty.role
Definition | How the individual is involved in the resources content that is described in the exception.
Short | How the actor is involved
Control | 1..1
Binding | Unless not suitable, these codes SHALL be taken from SecurityRoleType (extensible to `http://hl7.org/fhir/ValueSet/security-role-type|4.0.1` ) How an actor is involved in the consent considerations.
Type | CodeableConcept
Is Modifier | false
Summary | false
Pattern Value | `{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "code" : "CONSENTER" }] }`
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
142. Consent.provision.actor:agreementParty.reference
Definition | Patient as the person with whom the agreement was made. Person who represents the patient in health care matters and with whom the agreement has been made (too). HealthProfessional who has made the agreement regarding the treatment directive.
Short | Patient / Representative / HealthProfessional
Comments | Each occurrence of the zib HealthProfessional is normally represented by two FHIR resources: a PractitionerRole resource (instance of nl-core-HealthProfessional-PractitionerRole) and a Practitioner resource (instance of nl-core-HealthProfessional-Practitioner). The Practitioner resource is referenced from the PractitionerRole instance. For this reason, sending systems should fill the reference to the PractitionerRole instance here, and not the Practitioner resource. Receiving systems can then retrieve the reference to the Practitioner resource from that PractitionerRole instance. In rare circumstances, there is only a Practitioner instance, in which case it is that instance which will be referenced here. However, since this should be the exception, the nl-core-HealthProfessional-Practitioner profile is not explicitly mentioned as a target profile.
Control | 1..1
Type | Reference(ACP Patient, ACP HealthProfessional PractitionerRole, ACP ContactPerson)
Is Modifier | false
Summary | false
Alternate Names | Patient, Vertegenwoordiger, Zorgverlener
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
144. Consent.provision.action
Definition | Actions controlled by this Rule.
Short | Actions controlled by this rule
Comments | Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.
Control | 0..*
Binding | For example codes, see ConsentActionCodes (example to `http://hl7.org/fhir/ValueSet/consent-action|4.0.1` ) Detailed codes for the consent action.
Type | CodeableConcept
Is Modifier | false
Summary | true
Meaning if Missing | all actions
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
146. Consent.provision.securityLabel
Definition | A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.
Short | Security Labels that define affected resources
Comments | If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from All Security Labels (extensible to `http://hl7.org/fhir/ValueSet/security-labels|4.0.1` ) Security Labels from the Healthcare Privacy and Security Classification System.
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
148. Consent.provision.purpose
Definition | The context of the activities a user is taking - why the user is accessing the data - that are controlled by this rule.
Short | Context of activities covered by this rule
Comments | When the purpose of use tag is on the data, access request purpose of use shall not conflict.
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from v3.PurposeOfUse (2014-03-26) (extensible to `http://terminology.hl7.org/ValueSet/v3-PurposeOfUse|2014-03-26` ) What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
150. Consent.provision.class
Definition | The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.
Short | e.g. Resource Type, Profile, CDA, etc.
Comments | Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.
Control | 0..*
Binding | Unless not suitable, these codes SHALL be taken from ConsentContentClass (extensible to `http://hl7.org/fhir/ValueSet/consent-content-class|4.0.1` ) The class (type) of information a consent rule covers.
Type | Coding
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
152. Consent.provision.code
Definition | The medical treatment to which the treatment instruction applies.
Short | Treatment
Comments | Typical use of this is a Document code with class = CDA.
Control | 0..1
Binding | The codes SHALL be taken from BehandelingCodelijst (2020-09-01T00:00:00) (required to `http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.2.1--20200901000000|2020-09-01T00:00:00` ) If this code is found in an instance, then the exception applies.
Type | CodeableConcept
Is Modifier | false
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
Alternate Names | Behandeling
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
154. Consent.provision.code.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
156. Consent.provision.code.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
Slicing | This element introduces a set of slices on `Consent.provision.code.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
158. Consent.provision.code.coding
Definition | A reference to a code defined by a terminology system.
Short | Code 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.
Control | 0..*
Type | Coding
Is Modifier | false
Summary | true
Requirements | Allows for alternative encodings within a code system, and translations to other code systems.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
160. Consent.provision.code.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.
Short | Plain text representation of the concept
Comments | `.code.type` has a required binding. Therefore, only codes in the bound ValueSet are permitted. For concepts not present in the ValueSet, such as SNOMED CT code 400231000146108 (Uitzetten van cardioverter-defibrillator in laatste levensfase), use the `.text` field as per FHIR guidance.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Obligations |
Obligations | Actor
SHALL:populate-if-known | ACP Actor Provider
SHALL:no-error | ACP Actor Consulter
Summary | true
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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
162. Consent.provision.dataPeriod
Definition | Clinical or Operational Relevant period of time that bounds the data controlled by this rule.
Short | Timeframe for data controlled by this rule
Comments | This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.
Control | 0..1
Type | Period
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
164. Consent.provision.data
Definition | The resources controlled by this rule if specific resources are referenced.
Short | Data controlled by this rule
Control | 0..*
Type | BackboneElement
Is Modifier | false
Summary | true
Meaning if Missing | all data
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
166. Consent.provision.data.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
168. Consent.provision.data.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.
Short | Additional 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | 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()`)
170. Consent.provision.data.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).
Short | Extensions 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
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 Names | extensions, user content, modifiers
Invariants | 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()`)
172. Consent.provision.data.meaning
Definition | How the resource reference is interpreted when testing consent restrictions.
Short | instance | related | dependents | authoredby
Control | 1..1
Binding | The codes SHALL be taken from ConsentDataMeaning (required to `http://hl7.org/fhir/ValueSet/consent-data-meaning|4.0.1` ) How a resource reference is interpreted when testing consent restrictions.
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
174. Consent.provision.data.reference
Definition | A reference to a specific resource that defines which resources are covered by this consent.
Short | The actual data reference
Control | 1..1
Type | Reference(Resource)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
176. Consent.provision.provision
Definition | Rules which provide exceptions to the base rule or subrules.
Short | Nested Exception Rules
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/Consent#Consent.provision
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)