RIVO-Noord Zorgviewer Implementation Guide
1.7.0 - CI build Netherlands flag

RIVO-Noord Zorgviewer Implementation Guide, published by RIVO-NN HL7NL. This guide is not an authorized publication; it is the continuous build for version 1.7.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/RIVO-Noord/zorgviewer-ig/ and changes regularly. See the Directory of published versions

Resource Profile: Alert - Detailed Descriptions

Active as of 2024-11-06

Definitions for the Flag resource profile.

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

0. Flag
2. Flag.extension:ConcernReference
Slice NameConcernReference
Control0..
This element is affected by the following invariants: ele-1
TypeExtension(Flag details) (Extension Type: Reference(Resource))
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
4. Flag.category
6. Flag.category.coding
8. Flag.category.coding.display
Must Supporttrue
10. Flag.category.text
Must Supporttrue
12. Flag.code
14. Flag.code.coding
16. Flag.code.coding.display
Must Supporttrue
18. Flag.code.text
Must Supporttrue
20. Flag.period
22. Flag.period.start
Must Supporttrue

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

0. Flag
Definition

Prospective warnings of potential issues when providing care to the patient.

ShortAlertKey information to flag to healthcare providers
Control0..*
Alternate NamesBarriers to Care, Alert, Warning
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
2. Flag.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.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. Flag.extension:ConcernReference
Slice NameConcernReference
Definition

Points to the Observation, AllergyIntolerance or other record that provides additional supporting information about this flag.

ShortResource with details for flag
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Flag details) (Extension Type: Reference(Resource))
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Flag.extension:ConcernReference.url
Definition

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

Shortidentifies the meaning of the extension
Comments

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

Control1..1
Typeuri
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
Fixed Valuehttp://hl7.org/fhir/StructureDefinition/flag-detail
8. Flag.extension:ConcernReference.valueReference:valueReference
Slice NamevalueReference
Definition

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

ShortValue of extension
Comments

Within the context of zib-Alert the concern reference is only supposed to refer to zib-Problem. The reference is unconstrained to allow other use cases.

Control0..1
TypeReference(Resource), date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
10. Flag.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. Usually modifier elements provide negation or qualification. In order 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.

ShortExtensions that cannot be ignored
Comments

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

Control0..*
TypeExtension
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Alternate Namesextensions, user content
12. Flag.status
Definition

Supports basic workflow.

Shortactive | inactive | entered-in-error
Comments

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

Control1..1
BindingThe codes SHALL be taken from FlagStatushttp://hl7.org/fhir/ValueSet/flag-status
(required to http://hl7.org/fhir/ValueSet/flag-status)

Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error.

Typecode
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
14. Flag.category
Definition

Indicates the type of alert, meaning a rough description of the cause or origin of the warning.


Allows an flag to be divided into different categories like clinical, administrative etc. Intended to be used as a means of filtering which flags are displayed to particular user or in a given context.

ShortAlertTypeClinical, administrative, etc.
Control0..1
BindingUnless not suitable, these codes SHALL be taken from For example codes, see AlertTypeCodelijsthttp://hl7.org/fhir/ValueSet/flag-category
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.8.3.1--20171231000000)

Indicates the type of alert, meaning a rough description of the cause or origin of the warning.


A general category for flags for filtering/display purposes.

TypeCodeableConcept
Summarytrue
Alternate NamesAlertType
Example<br/><b>Example of AlertType</b>:{ "coding" : [{ "system" : "http://loinc.org", "code" : "75323-6", "display" : "condition", "userSelected" : false }] }
16. Flag.category.coding
Definition

A reference to a code defined by a terminology system.

ShortCode defined by a terminology system
Comments

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

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

18. Flag.category.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

ShortRepresentation defined by the system
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

20. Flag.category.text
Definition

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

ShortPlain text representation of the concept
Comments

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

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

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

22. Flag.code
Definition

A warning, other than a condition or problem. For example, a patient can be given an ‘Aggressive patient' alert. The warning can be entered in code (there are codes for frequently used alerts), but seeing the dynamic nature of the warnings cf. SARS and Ebola, these alerts will often be entered as free text.


The coded value or textual component of the flag to display to the user.

ShortAlertNameCoded or textual message to display to user
Comments

According to HCIM Alert this element does not need to be filled if a reference to HCIM Problem exists. In that case, instead of leaving this element empty, the NullFlavor with .coding.code equal to 'OTH' SHOULD be used.


If non coded, use CodeableConcept.text. This element should always be included in the narrative.

Control1..1
BindingUnless not suitable, these codes SHALL be taken from For example codes, see AlertNaamCodelijsthttp://hl7.org/fhir/ValueSet/flag-code
(extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.8.3.2--20171231000000)
TypeCodeableConcept
Summarytrue
Alternate NamesAlertNaam
Example<br/><b>Example of AlertName</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "432415000", "display" : "Methicillin resistant staphylococcus aureus carrier" }] }
24. Flag.code.coding
Definition

A reference to a code defined by a terminology system.

ShortCode defined by a terminology system
Comments

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

Control0..*
TypeCoding
Summarytrue
Requirements

Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

26. Flag.code.coding.display
Definition

A representation of the meaning of the code in the system, following the rules of the system.

ShortRepresentation defined by the system
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

28. Flag.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.

ShortPlain text representation of the concept
Comments

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

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

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

30. Flag.subject
Definition

The patient, location, group , organization , or practitioner, etc. this is about record this flag is associated with.

ShortWho/What is flag about?
Control1..1
TypeReference(nl-core-patient, nl-core-location, Group, nl-core-organization, nl-core-practitioner, PlanDefinition, HCIM PharmaceuticalProduct, HCIM Procedure, Patient, Location, Organization, Practitioner, Medication, Procedure)
Summarytrue
32. Flag.subject.extension:practitionerRole
Slice NamepractitionerRole
Definition

Optional Extension Element - found in all resources.

ShortOptional Extensions Element
Control0..1
TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
34. Flag.period
Definition

The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecified.

ShortTime period when flag is active
Control0..1
TypePeriod
Summarytrue
36. Flag.period.start
Definition

The date and time at which the described condition was entered as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).


The start of the period. The boundary is inclusive.

ShortStartDateTimeStarting time with inclusive boundary
Comments

If the low element is missing, the meaning is that the low boundary is not known.

Control0..1
This element is affected by the following invariants: per-1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Alternate NamesBeginDatumTijd
Example<br/><b>Example of StartDateTime</b>:2017-02-07

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

0. Flag
Definition

Prospective warnings of potential issues when providing care to the patient.

ShortAlert
Control0..*
Alternate NamesBarriers to Care, Alert, Warning
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative (contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource (contained.where(('#'+id in %resource.descendants().reference).not()).empty())
2. Flag.id
Definition

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

ShortLogical id of this artifact
Comments

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

Control0..1
Typeid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
4. Flag.meta
Definition

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

ShortMetadata about the resource
Control0..1
TypeMeta
Summarytrue
6. Flag.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.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

Control0..1
Typeuri
Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
8. Flag.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

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

Control0..1
BindingUnless not suitable, these codes SHALL be taken from Common Languages
(extensible to http://hl7.org/fhir/ValueSet/languages)

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
10. Flag.text
Definition

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

ShortText summary of the resource, for human interpretation
Comments

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

Control0..1
This element is affected by the following invariants: dom-1
TypeNarrative
Alternate Namesnarrative, html, xhtml, display
12. Flag.contained
Definition

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

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

Control0..*
TypeResource
Alternate Namesinline resources, anonymous resources, contained resources
14. Flag.extension
Definition

An Extension

ShortExtension
Control0..*
TypeExtension
SlicingThis element introduces a set of slices on Flag.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. Flag.extension:ConcernReference
    Slice NameConcernReference
    Definition

    Points to the Observation, AllergyIntolerance or other record that provides additional supporting information about this flag.

    ShortResource with details for flag
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Flag details) (Extension Type: Reference(Resource))
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    18. Flag.extension:ConcernReference.id
    Definition

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

    Shortxml:id (or equivalent in JSON)
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    20. Flag.extension:ConcernReference.extension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element. In order 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.

    ShortAdditional Content defined by implementations
    Comments

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

    Control0..*
    TypeExtension
    Alternate Namesextensions, user content
    SlicingThis element introduces a set of slices on Flag.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 22. Flag.extension:ConcernReference.url
      Definition

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

      Shortidentifies the meaning of the extension
      Comments

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

      Control1..1
      Typeuri
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/flag-detail
      24. Flag.extension:ConcernReference.valueReference:valueReference
      Slice NamevalueReference
      Definition

      Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

      ShortValue of extension
      Comments

      Within the context of zib-Alert the concern reference is only supposed to refer to zib-Problem. The reference is unconstrained to allow other use cases.

      Control0..1
      TypeReference(Resource)
      26. Flag.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. Usually modifier elements provide negation or qualification. In order 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.

      ShortExtensions that cannot be ignored
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
      Alternate Namesextensions, user content
      28. Flag.identifier
      Definition

      Identifier assigned to the flag for external use (outside the FHIR environment).

      ShortBusiness identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Summarytrue
      30. Flag.status
      Definition

      Supports basic workflow.

      Shortactive | inactive | entered-in-error
      Comments

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

      Control1..1
      BindingThe codes SHALL be taken from FlagStatus
      (required to http://hl7.org/fhir/ValueSet/flag-status)

      Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or entered in error.

      Typecode
      Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      32. Flag.category
      Definition

      Indicates the type of alert, meaning a rough description of the cause or origin of the warning.

      ShortAlertType
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from AlertTypeCodelijst
      (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.8.3.1--20171231000000)

      Indicates the type of alert, meaning a rough description of the cause or origin of the warning.

      TypeCodeableConcept
      Summarytrue
      Alternate NamesAlertType
      Example<br/><b>Example of AlertType</b>:{ "coding" : [{ "system" : "http://loinc.org", "code" : "75323-6", "display" : "condition", "userSelected" : false }] }
      34. Flag.category.id
      Definition

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

      Shortxml:id (or equivalent in JSON)
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      36. Flag.category.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. In order 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.

      ShortAdditional Content defined by implementations
      Comments

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

      Control0..*
      TypeExtension
      Alternate Namesextensions, user content
      SlicingThis element introduces a set of slices on Flag.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 38. Flag.category.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

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

        Control0..*
        TypeCoding
        Summarytrue
        Requirements

        Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

        40. Flag.category.coding.id
        Definition

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

        Shortxml:id (or equivalent in JSON)
        Control0..1
        Typestring
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        42. Flag.category.coding.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. In order 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.

        ShortAdditional Content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Alternate Namesextensions, user content
        SlicingThis element introduces a set of slices on Flag.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 44. Flag.category.coding.system
          Definition

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

          Need to be unambiguous about the source of the definition of the symbol.

          46. Flag.category.coding.version
          Definition

          The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

          ShortVersion of the system - if relevant
          Comments

          Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

          NoteThis is a business version Id, not a resource version Id (see discussion)
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          48. Flag.category.coding.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control0..1
          Typecode
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          50. Flag.category.coding.display
          Definition

          A representation of the meaning of the code in the system, following the rules of the system.

          ShortRepresentation defined by the system
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

          52. Flag.category.coding.userSelected
          Definition

          Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

          ShortIf this coding was chosen directly by the user
          Comments

          Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

          This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

          54. Flag.category.text
          Definition

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

          ShortPlain text representation of the concept
          Comments

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

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

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

          56. Flag.code
          Definition

          A warning, other than a condition or problem. For example, a patient can be given an ‘Aggressive patient' alert. The warning can be entered in code (there are codes for frequently used alerts), but seeing the dynamic nature of the warnings cf. SARS and Ebola, these alerts will often be entered as free text.

          ShortAlertName
          Comments

          According to HCIM Alert this element does not need to be filled if a reference to HCIM Problem exists. In that case, instead of leaving this element empty, the NullFlavor with .coding.code equal to 'OTH' SHOULD be used.

          Control1..1
          BindingUnless not suitable, these codes SHALL be taken from AlertNaamCodelijst
          (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.8.3.2--20171231000000)
          TypeCodeableConcept
          Summarytrue
          Alternate NamesAlertNaam
          Example<br/><b>Example of AlertName</b>:{ "coding" : [{ "system" : "http://snomed.info/sct", "code" : "432415000", "display" : "Methicillin resistant staphylococcus aureus carrier" }] }
          58. Flag.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.

          Shortxml:id (or equivalent in JSON)
          Control0..1
          Typestring
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          XML FormatIn the XML format, this property is represented as an attribute.
          60. Flag.code.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. In order 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.

          ShortAdditional Content defined by implementations
          Comments

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

          Control0..*
          TypeExtension
          Alternate Namesextensions, user content
          SlicingThis element introduces a set of slices on Flag.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 62. Flag.code.coding
            Definition

            A reference to a code defined by a terminology system.

            ShortCode defined by a terminology system
            Comments

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

            Control0..*
            TypeCoding
            Summarytrue
            Requirements

            Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.

            64. Flag.code.coding.id
            Definition

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

            Shortxml:id (or equivalent in JSON)
            Control0..1
            Typestring
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            66. Flag.code.coding.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. In order 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.

            ShortAdditional Content defined by implementations
            Comments

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

            Control0..*
            TypeExtension
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Flag.code.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 68. Flag.code.coding.system
              Definition

              The identification of the code system that defines the meaning of the symbol in the code.

              ShortIdentity of the terminology system
              Comments

              The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

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

              Need to be unambiguous about the source of the definition of the symbol.

              70. Flag.code.coding.version
              Definition

              The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

              ShortVersion of the system - if relevant
              Comments

              Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

              NoteThis is a business version Id, not a resource version Id (see discussion)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              72. Flag.code.coding.code
              Definition

              A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

              ShortSymbol in syntax defined by the system
              Control0..1
              Typecode
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Requirements

              Need to refer to a particular code in the system.

              74. Flag.code.coding.display
              Definition

              A representation of the meaning of the code in the system, following the rules of the system.

              ShortRepresentation defined by the system
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

              76. Flag.code.coding.userSelected
              Definition

              Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).

              ShortIf this coding was chosen directly by the user
              Comments

              Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

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

              This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

              78. Flag.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.

              ShortPlain text representation of the concept
              Comments

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

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

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

              80. Flag.subject
              Definition

              The patient, location, group , organization , or practitioner, etc. this is about record this flag is associated with.

              ShortWho/What is flag about?
              Control1..1
              TypeReference(nl-core-patient, nl-core-location, Group, nl-core-organization, nl-core-practitioner, PlanDefinition, HCIM PharmaceuticalProduct, HCIM Procedure)
              Summarytrue
              82. Flag.subject.id
              Definition

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

              Shortxml:id (or equivalent in JSON)
              Control0..1
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              84. Flag.subject.extension
              Definition

              An Extension

              ShortExtension
              Control0..*
              TypeExtension
              SlicingThis element introduces a set of slices on Flag.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 86. Flag.subject.extension:practitionerRole
                Slice NamepractitionerRole
                Definition

                Optional Extension Element - found in all resources.

                ShortOptional Extensions Element
                Control0..1
                TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                88. Flag.subject.reference
                Definition

                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                ShortLiteral reference, Relative, internal or absolute URL
                Comments

                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                Control0..1
                This element is affected by the following invariants: ref-1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                90. Flag.subject.identifier
                Definition

                An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                ShortLogical reference, when literal reference is not known
                Comments

                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                TypeIdentifier
                Summarytrue
                92. Flag.subject.display
                Definition

                Plain text narrative that identifies the resource in addition to the resource reference.

                ShortText alternative for the resource
                Comments

                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                94. Flag.period
                Definition

                The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecified.

                ShortTime period when flag is active
                Control0..1
                TypePeriod
                Summarytrue
                96. Flag.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.

                Shortxml:id (or equivalent in JSON)
                Control0..1
                Typestring
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                98. Flag.period.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. In order 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.

                ShortAdditional Content defined by implementations
                Comments

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

                Control0..*
                TypeExtension
                Alternate Namesextensions, user content
                SlicingThis element introduces a set of slices on Flag.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 100. Flag.period.start
                  Definition

                  The date and time at which the described condition was entered as a warning. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).

                  ShortStartDateTime
                  Comments

                  If the low element is missing, the meaning is that the low boundary is not known.

                  Control0..1
                  This element is affected by the following invariants: per-1
                  TypedateTime
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summarytrue
                  Alternate NamesBeginDatumTijd
                  Example<br/><b>Example of StartDateTime</b>:2017-02-07
                  102. Flag.period.end
                  Definition

                  The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                  ShortEnd time with inclusive boundary, if not ongoing
                  Comments

                  The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.

                  Control0..1
                  This element is affected by the following invariants: per-1
                  TypedateTime
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                  104. Flag.encounter
                  Definition

                  This alert is only relevant during the encounter.

                  ShortAlert relevant during encounter
                  Comments

                  If both Flag.encounter and Flag.period are valued, then Flag.period.start shall not be before Encounter.period.start and Flag.period.end shall not be after Encounter.period.end.

                  Control0..1
                  TypeReference(HCIM Encounter)
                  Summarytrue
                  106. Flag.author
                  Definition

                  The person, organization or device that created the flag.

                  ShortFlag creator
                  Control0..1
                  TypeReference(HCIM MedicalDevice Product, nl-core-patient, nl-core-practitioner, nl-core-organization)
                  Summarytrue
                  108. Flag.author.id
                  Definition

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

                  Shortxml:id (or equivalent in JSON)
                  Control0..1
                  Typestring
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  110. Flag.author.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  SlicingThis element introduces a set of slices on Flag.author.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 112. Flag.author.extension:practitionerRole
                    Slice NamepractitionerRole
                    Definition

                    Optional Extension Element - found in all resources.

                    ShortOptional Extensions Element
                    Control0..1
                    TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                    114. Flag.author.reference
                    Definition

                    A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                    ShortLiteral reference, Relative, internal or absolute URL
                    Comments

                    Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                    Control0..1
                    This element is affected by the following invariants: ref-1
                    Typestring
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summarytrue
                    116. Flag.author.identifier
                    Definition

                    An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                    ShortLogical reference, when literal reference is not known
                    Comments

                    When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                    When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                    Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                    NoteThis is a business identifier, not a resource identifier (see discussion)
                    Control0..1
                    TypeIdentifier
                    Summarytrue
                    118. Flag.author.display
                    Definition

                    Plain text narrative that identifies the resource in addition to the resource reference.

                    ShortText alternative for the resource
                    Comments

                    This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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