RIVO-Noord Zorgviewer Implementation Guide
1.8.0 - 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 1.8.0 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: TreatmentDirective - Detailed Descriptions

Active as of 2024-11-19

Definitions for the TreatmentDirective resource profile.

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

0. Consent
2. Consent.extension:verification
Slice Nameverification
Control0..1
Must Supporttrue
4. Consent.extension:verification.extension:VerifiedWith
Slice NameVerifiedWith
Control0..1
Must Supporttrue
6. Consent.extension:verification.extension:VerifiedWith.valueCodeableConcept:valueCodeableConcept
Slice NamevalueCodeableConcept
Must Supporttrue
8. Consent.extension:treatment
Slice Nametreatment
Control0..1
Must Supporttrue
10. Consent.extension:treatment.valueCodeableConcept:valueCodeableConcept
Slice NamevalueCodeableConcept
BindingUnless not suitable, these codes SHALL be taken from ACP behandelingen waardelijst
(extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/ACPTreatmentCodelist)

The medical treatment to which the treatment instruction applies.

Must Supporttrue
12. Consent.modifierExtension:treatmentPermitted
Slice NametreatmentPermitted
Must Supporttrue
14. Consent.period
Must Supporttrue
16. Consent.period.start
Must Supporttrue
18. Consent.except
20. Consent.except.extension:restrictions
Slice Namerestrictions
Control0..1
Must Supporttrue

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

0. Consent
Definition

A record of a healthcare consumer’s policy 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.

ShortTreatmentDirectiveA healthcare consumer's policy choices to permits or denies recipients or roles to perform actions for specific purposes and periods of time
Comments

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.

Control0..*
Alternate NamesBehandelAanwijzing
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())
ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
hcim-treatmentdirective-1: extension.additionalSources may only be used for AdvanceDirective references in addition to first reference in .source[x] (extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/consent-additionalSources').empty() or source.exists())
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())
ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
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.

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. Consent.extension:verification
Slice Nameverification
Definition

Container of the Verification concept. This container contains all data elements of the Verification concept.

ShortVerification
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(HCIM TreatmentDirective Verification) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Alternate NamesVerificatie
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. Consent.extension:verification.extension
Definition

An Extension


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.

ShortExtensionAdditional 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.

Control10..*
TypeExtension
Alternate Namesextensions, user content
SlicingThis 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
  • 8. Consent.extension:verification.extension:Verified
    Slice NameVerified
    Definition

    An Extension

    ShortVerifiedAdditional Content defined by implementations
    Control10..1*
    TypeExtension
    Alternate NamesGeverifieerd
    10. Consent.extension:verification.extension:Verified.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 ValueVerified
    12. Consent.extension:verification.extension:Verified.value[x]
    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
    Control0..1
    Typeboolean, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
    • type @ $this
    • 14. Consent.extension:verification.extension:Verified.value[x]:valueBoolean
      Slice NamevalueBoolean
      Definition

      Indication of the fact that the treatment instruction has been verified with the patient, the patient’s family and/or the patient's authorized representative.


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

      ShortVerifiedValue of extension
      Control0..1
      Typeboolean, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Alternate NamesGeverifieerd
      16. Consent.extension:verification.extension:VerifiedWith
      Slice NameVerifiedWith
      Definition

      An Extension

      ShortExtensionAdditional Content defined by implementations
      Control0..1*
      TypeExtension
      Must Supporttrue
      18. Consent.extension:verification.extension:VerifiedWith.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 ValueVerifiedWith
      20. Consent.extension:verification.extension:VerifiedWith.value[x]
      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
      Control0..1
      TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
      • type @ $this
      • 22. Consent.extension:verification.extension:VerifiedWith.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        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
        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from For codes, see GeverifieerdBijCodelijst
        (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000)

        The person with whom the treatment instruction was discussed and verified.

        TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Must Supporttrue
        24. Consent.extension:verification.extension:VerificationDate
        Slice NameVerificationDate
        Definition

        An Extension

        ShortVerificationDateAdditional Content defined by implementations
        Control0..1*
        TypeExtension
        Alternate NamesVerificatieDatum
        26. Consent.extension:verification.extension:VerificationDate.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 ValueVerificationDate
        28. Consent.extension:verification.extension:VerificationDate.value[x]
        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
        Control0..1
        TypedateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
        • type @ $this
        • 30. Consent.extension:verification.extension:VerificationDate.value[x]:valueDateTime
          Slice NamevalueDateTime
          Definition

          Date on which the verification with the patient, the patient’s family and/or the patient's authorized representative took place.


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

          ShortVerificationDateValue of extension
          Control0..1
          TypedateTime, date, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal, CodeableConcept
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Alternate NamesVerificatieDatum
          32. Consent.extension:verification.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Verification
          34. Consent.extension:verification.value[x]
          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
          Control0..01
          TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          36. Consent.extension:comment
          Slice Namecomment
          Definition

          Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).

          ShortComment
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Comment) (Extension Type: string)
          Alternate NamesToelichting
          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())
          38. Consent.extension:treatment
          Slice Nametreatment
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(HCIM TreatmentDirective Treatment) (Extension Type: CodeableConcept)
          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())
          40. Consent.extension:treatment.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Treatment
          42. Consent.extension:treatment.value[x]
          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
          Control0..1
          TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          SlicingThis element introduces a set of slices on Consent.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 44. Consent.extension:treatment.value[x]:valueCodeableConcept
            Slice NamevalueCodeableConcept
            Definition

            The medical treatment to which the treatment instruction applies.


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

            ShortTreatmentValue of extension
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from For codes, see ACP behandelingen waardelijst
            (extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/ACPTreatmentCodelist)

            The medical treatment to which the treatment instruction applies.

            TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Must Supporttrue
            Alternate NamesBehandeling
            46. Consent.extension:additionalSources
            Slice NameadditionalSources
            Definition

            Optional Extension Element - found in all resources.

            ShortOptional Extensions Element
            Comments

            The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using this extension.

            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(Consent additionalSource) (Extension Type: Choice of: Attachment, Identifier, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse))
            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())
            48. Consent.extension:additionalSources.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://nictiz.nl/fhir/StructureDefinition/consent-additionalSources
            50. Consent.modifierExtension
            Definition

            An Extension


            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.

            ShortExtensionExtensions 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.

            Control10..*
            TypeExtension
            Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
            Alternate Namesextensions, user content
            SlicingThis element introduces a set of slices on Consent.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 52. Consent.modifierExtension:treatmentPermitted
              Slice NametreatmentPermitted
              Definition

              An Extension

              ShortExtension
              Control1..1
              This element is affected by the following invariants: ele-1
              TypeExtension(HCIM TreatmentDirective TreatmentPermitted) (Extension Type: CodeableConcept)
              Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
              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())
              54. Consent.modifierExtension:treatmentPermitted.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-TreatmentPermitted
              56. Consent.modifierExtension:treatmentPermitted.value[x]
              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
              Control0..1
              TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              SlicingThis element introduces a set of slices on Consent.modifierExtension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 58. Consent.modifierExtension:treatmentPermitted.value[x]:valueCodeableConcept
                Slice NamevalueCodeableConcept
                Definition

                Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.


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

                ShortTreatmentPermittedValue of extension
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from For codes, see BehandelingToegestaanCodelijst
                (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000)

                Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                TypeCodeableConcept, date, dateTime, Meta, code, string, Address, Attachment, integer, oid, Count, instant, ContactPoint, HumanName, Money, Identifier, Coding, markdown, SampledData, Ratio, id, positiveInt, Age, Distance, Reference, Period, Quantity, Duration, Range, uri, Annotation, boolean, base64Binary, Signature, unsignedInt, time, Timing, decimal
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Alternate NamesBehandelingToegestaan
                60. Consent.status
                Definition

                Indicates the current state of this consent.

                Shortdraft | proposed | active | rejected | inactive | entered-in-error
                Comments

                The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is "active" unless stated otherwise.


                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.

                Control1..1
                BindingThe codes SHALL be taken from ConsentStatehttp://hl7.org/fhir/ValueSet/consent-state-codes
                (required to http://hl7.org/fhir/ValueSet/consent-state-codes)

                Indicates the state of the consent

                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
                Requirements

                The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

                62. Consent.category
                Definition

                A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

                ShortClassification of the consent statement - for indexing/retrieval
                Control10..*
                BindingFor example codes, see Consent Category Codeshttp://hl7.org/fhir/ValueSet/consent-category
                (example to http://hl7.org/fhir/ValueSet/consent-category)

                A classification of the type of consents found in a consent statement

                TypeCodeableConcept
                Summarytrue
                64. Consent.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.

                Control10..*
                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.

                SlicingThis element introduces a set of slices on Consent.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ code
                • 66. Consent.category.coding:treatmentDirective
                  Slice NametreatmentDirective
                  Definition

                  Category SNOMED code used for indexing/retrieval of the HCIM TreatmentDirective.


                  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.

                  Control10..1*
                  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.

                  68. Consent.category.coding:treatmentDirective.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.

                  Control10..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.

                  Fixed Valuehttp://snomed.info/sct
                  70. Consent.category.coding:treatmentDirective.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
                  Control10..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.

                  Fixed Value11291000146105
                  72. Consent.patient
                  Definition

                  The patient/healthcare consumer to whom this consent applies.

                  ShortWho 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.

                  Control1..1
                  TypeReference(nl-core-patient, Patient)
                  Summarytrue
                  74. Consent.period
                  Definition

                  Relevant time or time-period when this Consent is applicable.

                  ShortPeriod that this consent applies
                  Comments

                  This can be a subset of the period of the original statement.

                  Control0..1
                  TypePeriod
                  Must Supporttrue
                  Summarytrue
                  Meaning if Missingall date ranges included
                  76. Consent.period.start
                  Definition

                  Date on which the treatment instruction went into effect. A ‘vague’ date, such as only the year, is permitted.


                  The start of the period. The boundary is inclusive.

                  ShortStartDateStarting 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 NamesBeginDatum
                  78. Consent.except
                  Definition

                  An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

                  ShortAdditional rule - addition or removal of permissions
                  Comments

                  If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR.

                  Control0..*
                  TypeBackboneElement
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  ele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                  80. Consent.except.extension:restrictions
                  Slice Namerestrictions
                  Definition

                  Optional Extension Element - found in all resources.

                  ShortOptional Extensions Element
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(HCIM TreatmentDirective Restrictions) (Extension Type: string)
                  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())
                  82. Consent.except.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 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
                  Summarytrue
                  Alternate Namesextensions, user content, modifiers
                  84. Consent.except.type
                  Definition

                  Action to take - permit or deny - when the exception conditions are met.

                  Shortdeny | permit
                  Comments

                  If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of this element SHALL be "deny"

                  Control1..1
                  BindingThe codes SHALL be taken from ConsentExceptTypehttp://hl7.org/fhir/ValueSet/consent-except-type
                  (required to http://hl7.org/fhir/ValueSet/consent-except-type)

                  How an exception statement is applied, such as adding additional consent or removing consent

                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue

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

                  0. Consent
                  Definition

                  A record of a healthcare consumer’s policy 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.

                  ShortTreatmentDirective
                  Comments

                  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.

                  Control0..*
                  Alternate NamesBehandelAanwijzing
                  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())
                  ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
                  hcim-treatmentdirective-1: extension.additionalSources may only be used for AdvanceDirective references in addition to first reference in .source[x] (extension.where(url = 'http://nictiz.nl/fhir/StructureDefinition/consent-additionalSources').empty() or source.exists())
                  2. Consent.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. Consent.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. 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.

                  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. Consent.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
                  All LanguagesMax Binding
                  Typecode
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  10. Consent.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. 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.

                  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. Consent.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  SlicingThis 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:verification
                    Slice Nameverification
                    Definition

                    Container of the Verification concept. This container contains all data elements of the Verification concept.

                    ShortVerification
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(HCIM TreatmentDirective Verification) (Complex Extension)
                    Is Modifierfalse
                    Must Supporttrue
                    Alternate NamesVerificatie
                    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. Consent.extension: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.

                    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. Consent.extension:verification.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control1..*
                    TypeExtension
                    SlicingThis 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:verification.extension:Verified
                      Slice NameVerified
                      Definition

                      An Extension

                      ShortVerified
                      Control1..1
                      TypeExtension
                      Alternate NamesGeverifieerd
                      24. Consent.extension:verification.extension:Verified.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.
                      26. Consent.extension:verification.extension:Verified.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 Consent.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 28. Consent.extension:verification.extension:Verified.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 ValueVerified
                        30. Consent.extension:verification.extension:Verified.value[x]
                        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
                        Control0..1
                        Typeboolean
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 32. Consent.extension:verification.extension:Verified.value[x]:valueBoolean
                          Slice NamevalueBoolean
                          Definition

                          Indication of the fact that the treatment instruction has been verified with the patient, the patient’s family and/or the patient's authorized representative.

                          ShortVerified
                          Control0..1
                          Typeboolean
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Alternate NamesGeverifieerd
                          34. Consent.extension:verification.extension:VerifiedWith
                          Slice NameVerifiedWith
                          Definition

                          An Extension

                          ShortExtension
                          Control0..1
                          TypeExtension
                          Must Supporttrue
                          36. Consent.extension:verification.extension:VerifiedWith.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.
                          38. Consent.extension:verification.extension:VerifiedWith.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 Consent.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 40. Consent.extension:verification.extension:VerifiedWith.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 ValueVerifiedWith
                            42. Consent.extension:verification.extension:VerifiedWith.value[x]
                            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
                            Control0..1
                            TypeCodeableConcept
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                            • type @ $this
                            • 44. Consent.extension:verification.extension:VerifiedWith.value[x]:valueCodeableConcept
                              Slice NamevalueCodeableConcept
                              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
                              Control0..1
                              BindingUnless not suitable, these codes SHALL be taken from GeverifieerdBijCodelijst
                              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000)

                              The person with whom the treatment instruction was discussed and verified.

                              TypeCodeableConcept
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Must Supporttrue
                              46. Consent.extension:verification.extension:VerificationDate
                              Slice NameVerificationDate
                              Definition

                              An Extension

                              ShortVerificationDate
                              Control0..1
                              TypeExtension
                              Alternate NamesVerificatieDatum
                              48. Consent.extension:verification.extension:VerificationDate.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.
                              50. Consent.extension:verification.extension:VerificationDate.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 Consent.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 52. Consent.extension:verification.extension:VerificationDate.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 ValueVerificationDate
                                54. Consent.extension:verification.extension:VerificationDate.value[x]
                                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
                                Control0..1
                                TypedateTime
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                SlicingThis element introduces a set of slices on Consent.extension.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 56. Consent.extension:verification.extension:VerificationDate.value[x]:valueDateTime
                                  Slice NamevalueDateTime
                                  Definition

                                  Date on which the verification with the patient, the patient’s family and/or the patient's authorized representative took place.

                                  ShortVerificationDate
                                  Control0..1
                                  TypedateTime
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Alternate NamesVerificatieDatum
                                  58. Consent.extension:verification.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Verification
                                  60. Consent.extension:verification.value[x]
                                  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
                                  Control0..0
                                  TypeChoice of: base64Binary, boolean, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, Meta
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  62. Consent.extension:comment
                                  Slice Namecomment
                                  Definition

                                  Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).

                                  ShortComment
                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(Comment) (Extension Type: string)
                                  Alternate NamesToelichting
                                  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())
                                  64. Consent.extension:treatment
                                  Slice Nametreatment
                                  Definition

                                  Optional Extension Element - found in all resources.

                                  ShortOptional Extensions Element
                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(HCIM TreatmentDirective Treatment) (Extension Type: CodeableConcept)
                                  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())
                                  66. Consent.extension:treatment.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.
                                  68. Consent.extension:treatment.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 Consent.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 70. Consent.extension:treatment.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Treatment
                                    72. Consent.extension:treatment.value[x]
                                    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
                                    Control0..1
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    SlicingThis element introduces a set of slices on Consent.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                    • type @ $this
                                    • 74. Consent.extension:treatment.value[x]:valueCodeableConcept
                                      Slice NamevalueCodeableConcept
                                      Definition

                                      The medical treatment to which the treatment instruction applies.

                                      ShortTreatment
                                      Control0..1
                                      BindingUnless not suitable, these codes SHALL be taken from ACP behandelingen waardelijst
                                      (extensible to http://hl7.nl/fhir/zorgviewer/ValueSet/ACPTreatmentCodelist)

                                      The medical treatment to which the treatment instruction applies.

                                      TypeCodeableConcept
                                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                      Must Supporttrue
                                      Alternate NamesBehandeling
                                      76. Consent.extension:additionalSources
                                      Slice NameadditionalSources
                                      Definition

                                      Optional Extension Element - found in all resources.

                                      ShortOptional Extensions Element
                                      Comments

                                      The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using this extension.

                                      Control0..*
                                      This element is affected by the following invariants: ele-1
                                      TypeExtension(Consent additionalSource) (Extension Type: Choice of: Attachment, Identifier, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse))
                                      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())
                                      78. Consent.extension:additionalSources.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.
                                      80. Consent.extension:additionalSources.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 Consent.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 82. Consent.extension:additionalSources.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://nictiz.nl/fhir/StructureDefinition/consent-additionalSources
                                        84. Consent.extension:additionalSources.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.

                                        ShortAdvanceDirective
                                        Control0..1
                                        TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        86. Consent.modifierExtension
                                        Definition

                                        An Extension

                                        ShortExtension
                                        Control1..*
                                        TypeExtension
                                        Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                        SlicingThis element introduces a set of slices on Consent.modifierExtension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 88. Consent.modifierExtension:treatmentPermitted
                                          Slice NametreatmentPermitted
                                          Definition

                                          An Extension

                                          ShortExtension
                                          Control1..1
                                          This element is affected by the following invariants: ele-1
                                          TypeExtension(HCIM TreatmentDirective TreatmentPermitted) (Extension Type: CodeableConcept)
                                          Is Modifiertrue because No Modifier Reason provideed in previous versions of FHIR
                                          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())
                                          90. Consent.modifierExtension:treatmentPermitted.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.
                                          92. Consent.modifierExtension:treatmentPermitted.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 Consent.modifierExtension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 94. Consent.modifierExtension:treatmentPermitted.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://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-TreatmentPermitted
                                            96. Consent.modifierExtension:treatmentPermitted.value[x]
                                            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
                                            Control0..1
                                            TypeCodeableConcept
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            SlicingThis element introduces a set of slices on Consent.modifierExtension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                            • type @ $this
                                            • 98. Consent.modifierExtension:treatmentPermitted.value[x]:valueCodeableConcept
                                              Slice NamevalueCodeableConcept
                                              Definition

                                              Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                              ShortTreatmentPermitted
                                              Control0..1
                                              BindingUnless not suitable, these codes SHALL be taken from BehandelingToegestaanCodelijst
                                              (extensible to http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000)

                                              Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.

                                              TypeCodeableConcept
                                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                              Alternate NamesBehandelingToegestaan
                                              100. Consent.identifier
                                              Definition

                                              Unique identifier for this copy of the Consent Statement.

                                              ShortIdentifier for this record (external references)
                                              Comments

                                              This identifier is 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.

                                              NoteThis is a business identifier, not a resource identifier (see discussion)
                                              Control0..1
                                              TypeIdentifier
                                              Summarytrue
                                              Example<br/><b>General</b>:{ "system" : "urn:ietf:rfc:3986", "value" : "Local eCMS identifier" }
                                              102. Consent.status
                                              Definition

                                              Indicates the current state of this consent.

                                              Shortdraft | proposed | active | rejected | inactive | entered-in-error
                                              Comments

                                              The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is "active" unless stated otherwise.

                                              Control1..1
                                              BindingThe codes SHALL be taken from ConsentState
                                              (required to http://hl7.org/fhir/ValueSet/consent-state-codes)

                                              Indicates the state of the consent

                                              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
                                              Requirements

                                              The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

                                              104. Consent.category
                                              Definition

                                              A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

                                              ShortClassification of the consent statement - for indexing/retrieval
                                              Control1..*
                                              BindingFor example codes, see Consent Category Codes
                                              (example to http://hl7.org/fhir/ValueSet/consent-category)

                                              A classification of the type of consents found in a consent statement

                                              TypeCodeableConcept
                                              Summarytrue
                                              106. Consent.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.
                                              108. Consent.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 Consent.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 110. Consent.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.

                                                Control1..*
                                                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.

                                                SlicingThis element introduces a set of slices on Consent.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ code
                                                • 112. Consent.category.coding:treatmentDirective
                                                  Slice NametreatmentDirective
                                                  Definition

                                                  Category SNOMED code used for indexing/retrieval of the HCIM TreatmentDirective.

                                                  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.

                                                  Control1..1
                                                  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.

                                                  114. Consent.category.coding:treatmentDirective.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.
                                                  116. Consent.category.coding:treatmentDirective.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 Consent.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                  • value @ url
                                                  • 118. Consent.category.coding:treatmentDirective.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.

                                                    Control1..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.

                                                    Fixed Valuehttp://snomed.info/sct
                                                    120. Consent.category.coding:treatmentDirective.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
                                                    122. Consent.category.coding:treatmentDirective.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
                                                    Control1..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.

                                                    Fixed Value11291000146105
                                                    124. Consent.category.coding:treatmentDirective.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
                                                    Summarytrue
                                                    Requirements

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

                                                    126. Consent.category.coding:treatmentDirective.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.

                                                    128. Consent.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
                                                    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.

                                                    130. Consent.patient
                                                    Definition

                                                    The patient/healthcare consumer to whom this consent applies.

                                                    ShortWho 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.

                                                    Control1..1
                                                    TypeReference(nl-core-patient)
                                                    Summarytrue
                                                    132. Consent.period
                                                    Definition

                                                    Relevant time or time-period when this Consent is applicable.

                                                    ShortPeriod that this consent applies
                                                    Comments

                                                    This can be a subset of the period of the original statement.

                                                    Control0..1
                                                    TypePeriod
                                                    Must Supporttrue
                                                    Summarytrue
                                                    Meaning if Missingall date ranges included
                                                    134. Consent.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.
                                                    136. Consent.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 Consent.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                    • value @ url
                                                    • 138. Consent.period.start
                                                      Definition

                                                      Date on which the treatment instruction went into effect. A ‘vague’ date, such as only the year, is permitted.

                                                      ShortStartDate
                                                      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 NamesBeginDatum
                                                      140. Consent.period.end
                                                      Definition

                                                      Date on which the treatment instruction ends. A ‘vague’ date, such as only the year, is permitted.

                                                      ShortEndDate
                                                      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
                                                      Alternate NamesEindDatum
                                                      Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
                                                      142. Consent.dateTime
                                                      Definition

                                                      When this Consent was issued / created / indexed.

                                                      ShortWhen 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.

                                                      Control0..1
                                                      TypedateTime
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summarytrue
                                                      144. Consent.consentingParty
                                                      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.

                                                      ShortWho is agreeing to the policy and exceptions
                                                      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.

                                                      Control0..*
                                                      TypeReference(nl-core-relatedperson, nl-core-organization, nl-core-patient, nl-core-practitioner)
                                                      Summarytrue
                                                      Alternate Namesconsentor
                                                      146. Consent.consentingParty.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.
                                                      148. Consent.consentingParty.extension
                                                      Definition

                                                      An Extension

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

                                                        Optional Extension Element - found in all resources.

                                                        ShortOptional Extensions Element
                                                        Control0..1
                                                        TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                        152. Consent.consentingParty.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
                                                        154. Consent.consentingParty.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
                                                        156. Consent.consentingParty.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
                                                        158. Consent.actor
                                                        Definition

                                                        Who or what is controlled by this consent. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                        ShortWho|what controlled by this consent (or group, by role)
                                                        Control0..*
                                                        TypeBackboneElement
                                                        Summarytrue
                                                        Meaning if MissingThere is no specific actor associated with the consent
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                        160. Consent.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.

                                                        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.
                                                        162. Consent.actor.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
                                                        164. Consent.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 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
                                                        Summarytrue
                                                        Alternate Namesextensions, user content, modifiers
                                                        166. Consent.actor.role
                                                        Definition

                                                        How the individual is involved in the resources content that is described in the consent.

                                                        ShortHow the actor is involved
                                                        Control1..1
                                                        BindingUnless not suitable, these codes SHALL be taken from SecurityRoleType
                                                        (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

                                                        How an actor is involved in the consent considerations

                                                        TypeCodeableConcept
                                                        168. Consent.actor.reference
                                                        Definition

                                                        The resource that identifies the actor. To identify a actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                        ShortResource for the actor (or group, by role)
                                                        Control1..1
                                                        TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                                                        170. Consent.actor.reference.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.
                                                        172. Consent.actor.reference.extension
                                                        Definition

                                                        An Extension

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

                                                          Optional Extension Element - found in all resources.

                                                          ShortOptional Extensions Element
                                                          Control0..1
                                                          TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                          176. Consent.actor.reference.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
                                                          178. Consent.actor.reference.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
                                                          180. Consent.actor.reference.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
                                                          182. Consent.action
                                                          Definition

                                                          Actions controlled by this consent.

                                                          ShortActions controlled by this consent
                                                          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'.

                                                          Control0..*
                                                          BindingFor example codes, see Consent Action Codes
                                                          (example to http://hl7.org/fhir/ValueSet/consent-action)

                                                          Detailed codes for the consent action.

                                                          TypeCodeableConcept
                                                          Summarytrue
                                                          Meaning if Missingall actions
                                                          184. Consent.organization
                                                          Definition

                                                          The organization that manages the consent, and the framework within which it is executed.

                                                          ShortCustodian of the consent
                                                          Control0..*
                                                          TypeReference(nl-core-organization)
                                                          Summarytrue
                                                          Alternate Namescustodian
                                                          186. Consent.source[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.

                                                          ShortAdvanceDirective
                                                          Comments

                                                          The cardinality of the source element does not comply with the cardinality of the AdvanceDirective concept (NL-CM:2.1.14) specified in the HCIM TreatmentDirective. Additional AdvanceDirective references can be added using the additionalSources extension.

                                                          Control0..1
                                                          TypeChoice of: Attachment, Identifier, Reference(HCIM AdvanceDirective, DocumentReference, Contract, QuestionnaireResponse)
                                                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                          Summarytrue
                                                          Alternate NamesWilsverklaring
                                                          188. 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.

                                                          ShortPolicies covered by this consent
                                                          Control0..*
                                                          TypeBackboneElement
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                          190. 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.

                                                          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.
                                                          192. Consent.policy.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
                                                          194. 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 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
                                                          Summarytrue
                                                          Alternate Namesextensions, user content, modifiers
                                                          196. Consent.policy.authority
                                                          Definition

                                                          Entity or Organization having regulatory jurisdiction or accountability for  enforcing policies pertaining to Consent Directives.

                                                          ShortEnforcement source for policy
                                                          Control0..1
                                                          This element is affected by the following invariants: ppc-1
                                                          Typeuri
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          198. 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.

                                                          ShortSpecific 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.

                                                          Control0..1
                                                          This element is affected by the following invariants: ppc-1
                                                          Typeuri
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Example<br/><b>General Dutch Law</b>:http://wetten.overheid.nl/
                                                          200. Consent.policyRule
                                                          Definition

                                                          A referece to the specific computable policy.

                                                          ShortPolicy that this consents to
                                                          Comments

                                                          If the policy reference is not known, the resource cannot be processed. Where the reference is absent, there is no particular policy other than what is expressed directly in the consent resource.

                                                          Control0..1
                                                          This element is affected by the following invariants: ppc-1
                                                          Typeuri
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          Requirements

                                                          Might be a unique identifier of a policy set in XACML, or other rules engine.

                                                          202. Consent.securityLabel
                                                          Definition

                                                          A set of security labels that define which resources are controlled by this consent. If more than one label is specified, all resources must have all the specified labels.

                                                          ShortSecurity 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. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                          Control0..*
                                                          BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                          (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                                                          Security Labels from the Healthcare Privacy and Security Classification System.

                                                          TypeCoding
                                                          Summarytrue
                                                          204. Consent.purpose
                                                          Definition

                                                          The context of the activities a user is taking - why the user is accessing the data - that are controlled by this consent.

                                                          ShortContext of activities for which the agreement is made
                                                          Comments

                                                          This element is for discoverability / documentation, and does not modify or qualify the policy (e.g. the policy itself describes the purposes for which it applies).

                                                          Control0..*
                                                          BindingUnless not suitable, these codes SHALL be taken from PurposeOfUse
                                                          (extensible to http://hl7.org/fhir/ValueSet/v3-PurposeOfUse)

                                                          What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels

                                                          TypeCoding
                                                          Summarytrue
                                                          206. Consent.dataPeriod
                                                          Definition

                                                          Clinical or Operational Relevant period of time that bounds the data controlled by this consent.

                                                          ShortTimeframe for data controlled by this consent
                                                          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.

                                                          Control0..1
                                                          TypePeriod
                                                          Summarytrue
                                                          208. Consent.data
                                                          Definition

                                                          The resources controlled by this consent, if specific resources are referenced.

                                                          ShortData controlled by this consent
                                                          Control0..*
                                                          TypeBackboneElement
                                                          Summarytrue
                                                          Meaning if Missingall data
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                          210. Consent.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.

                                                          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.
                                                          212. Consent.data.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
                                                          214. Consent.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 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
                                                          Summarytrue
                                                          Alternate Namesextensions, user content, modifiers
                                                          216. Consent.data.meaning
                                                          Definition

                                                          How the resource reference is interpreted when testing consent restrictions.

                                                          Shortinstance | related | dependents | authoredby
                                                          Control1..1
                                                          BindingThe codes SHALL be taken from ConsentDataMeaning
                                                          (required to http://hl7.org/fhir/ValueSet/consent-data-meaning)

                                                          How a resource reference is interpreted when testing consent restrictions

                                                          Typecode
                                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                          Summarytrue
                                                          218. Consent.data.reference
                                                          Definition

                                                          A reference to a specific resource that defines which resources are covered by this consent.

                                                          ShortThe actual data reference
                                                          Control1..1
                                                          TypeReference(Resource)
                                                          Summarytrue
                                                          220. Consent.except
                                                          Definition

                                                          An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

                                                          ShortAdditional rule - addition or removal of permissions
                                                          Comments

                                                          If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR.

                                                          Control0..*
                                                          TypeBackboneElement
                                                          Summarytrue
                                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                          222. Consent.except.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.
                                                          224. Consent.except.extension
                                                          Definition

                                                          An Extension

                                                          ShortExtension
                                                          Control0..*
                                                          TypeExtension
                                                          SlicingThis element introduces a set of slices on Consent.except.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                          • value @ url
                                                          • 226. Consent.except.extension:restrictions
                                                            Slice Namerestrictions
                                                            Definition

                                                            Optional Extension Element - found in all resources.

                                                            ShortOptional Extensions Element
                                                            Control0..1
                                                            This element is affected by the following invariants: ele-1
                                                            TypeExtension(HCIM TreatmentDirective Restrictions) (Extension Type: string)
                                                            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())
                                                            228. Consent.except.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 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
                                                            Summarytrue
                                                            Alternate Namesextensions, user content, modifiers
                                                            230. Consent.except.type
                                                            Definition

                                                            Action to take - permit or deny - when the exception conditions are met.

                                                            Shortdeny | permit
                                                            Comments

                                                            If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YESBUT/JAMAAR, then the value of this element SHALL be "deny"

                                                            Control1..1
                                                            BindingThe codes SHALL be taken from ConsentExceptType
                                                            (required to http://hl7.org/fhir/ValueSet/consent-except-type)

                                                            How an exception statement is applied, such as adding additional consent or removing consent

                                                            Typecode
                                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                            Summarytrue
                                                            232. Consent.except.period
                                                            Definition

                                                            The timeframe in this exception is valid.

                                                            ShortTimeframe for this exception
                                                            Control0..1
                                                            TypePeriod
                                                            Summarytrue
                                                            234. Consent.except.actor
                                                            Definition

                                                            Who or what is controlled by this Exception. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                            ShortWho|what controlled by this exception (or group, by role)
                                                            Control0..*
                                                            TypeBackboneElement
                                                            Summarytrue
                                                            Meaning if MissingThere is no specific actor associated with the exception
                                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                            236. Consent.except.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.

                                                            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.
                                                            238. Consent.except.actor.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
                                                            240. Consent.except.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 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
                                                            Summarytrue
                                                            Alternate Namesextensions, user content, modifiers
                                                            242. Consent.except.actor.role
                                                            Definition

                                                            How the individual is involved in the resources content that is described in the exception.

                                                            ShortHow the actor is involved
                                                            Control1..1
                                                            BindingUnless not suitable, these codes SHALL be taken from SecurityRoleType
                                                            (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

                                                            How an actor is involved in the consent considerations

                                                            TypeCodeableConcept
                                                            244. Consent.except.actor.reference
                                                            Definition

                                                            The resource that identifies the actor. To identify a actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

                                                            ShortResource for the actor (or group, by role)
                                                            Control1..1
                                                            TypeReference(Device, Group, CareTeam, nl-core-organization, nl-core-patient, nl-core-practitioner, nl-core-relatedperson)
                                                            246. Consent.except.actor.reference.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.
                                                            248. Consent.except.actor.reference.extension
                                                            Definition

                                                            An Extension

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

                                                              Optional Extension Element - found in all resources.

                                                              ShortOptional Extensions Element
                                                              Control0..1
                                                              TypeExtension(PractitionerRole Reference) (Extension Type: Reference)
                                                              252. Consent.except.actor.reference.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
                                                              254. Consent.except.actor.reference.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
                                                              256. Consent.except.actor.reference.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
                                                              258. Consent.except.action
                                                              Definition

                                                              Actions controlled by this Exception.

                                                              ShortActions controlled by this exception
                                                              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'.

                                                              Control0..*
                                                              BindingFor example codes, see Consent Action Codes
                                                              (example to http://hl7.org/fhir/ValueSet/consent-action)

                                                              Detailed codes for the consent action.

                                                              TypeCodeableConcept
                                                              Summarytrue
                                                              Meaning if Missingall actions
                                                              260. Consent.except.securityLabel
                                                              Definition

                                                              A set of security labels that define which resources are controlled by this exception. If more than one label is specified, all resources must have all the specified labels.

                                                              ShortSecurity 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. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                              Control0..*
                                                              BindingUnless not suitable, these codes SHALL be taken from All Security Labels
                                                              (extensible to http://hl7.org/fhir/ValueSet/security-labels)

                                                              Security Labels from the Healthcare Privacy and Security Classification System.

                                                              TypeCoding
                                                              Summarytrue
                                                              262. Consent.except.purpose
                                                              Definition

                                                              The context of the activities a user is taking - why the user is accessing the data - that are controlled by this exception.

                                                              ShortContext of activities covered by this exception
                                                              Comments

                                                              E.g. if the purpose is 'research', then the operational context must be research, in order for the consent to apply. Not all of the security labels make sense for use in this element (may define a narrower value set?).

                                                              Control0..*
                                                              BindingUnless not suitable, these codes SHALL be taken from PurposeOfUse
                                                              (extensible to http://hl7.org/fhir/ValueSet/v3-PurposeOfUse)

                                                              What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels

                                                              TypeCoding
                                                              Summarytrue
                                                              264. Consent.except.class
                                                              Definition

                                                              The class of information covered by this exception. 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.

                                                              Shorte.g. Resource Type, Profile, or 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.

                                                              Control0..*
                                                              BindingUnless not suitable, these codes SHALL be taken from Consent Content Class
                                                              (extensible to http://hl7.org/fhir/ValueSet/consent-content-class)

                                                              The class (type) of information a consent rule covers

                                                              TypeCoding
                                                              Summarytrue
                                                              266. Consent.except.code
                                                              Definition

                                                              If this code is found in an instance, then the exception applies.

                                                              Shorte.g. LOINC or SNOMED CT code, etc in the content
                                                              Comments

                                                              Typical use of this is a Document code with class = CDA.

                                                              Control0..*
                                                              BindingFor example codes, see Consent Content Codes
                                                              (example to http://hl7.org/fhir/ValueSet/consent-content-code)

                                                              If this code is found in an instance, then the exception applies

                                                              TypeCoding
                                                              Summarytrue
                                                              268. Consent.except.dataPeriod
                                                              Definition

                                                              Clinical or Operational Relevant period of time that bounds the data controlled by this exception.

                                                              ShortTimeframe for data controlled by this exception
                                                              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.

                                                              Control0..1
                                                              TypePeriod
                                                              Summarytrue
                                                              270. Consent.except.data
                                                              Definition

                                                              The resources controlled by this exception, if specific resources are referenced.

                                                              ShortData controlled by this exception
                                                              Control0..*
                                                              TypeBackboneElement
                                                              Summarytrue
                                                              Meaning if Missingall data
                                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() | (children().count() > id.count()))
                                                              272. Consent.except.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.

                                                              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.
                                                              274. Consent.except.data.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
                                                              276. Consent.except.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 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
                                                              Summarytrue
                                                              Alternate Namesextensions, user content, modifiers
                                                              278. Consent.except.data.meaning
                                                              Definition

                                                              How the resource reference is interpreted when testing consent restrictions.

                                                              Shortinstance | related | dependents | authoredby
                                                              Control1..1
                                                              BindingThe codes SHALL be taken from ConsentDataMeaning
                                                              (required to http://hl7.org/fhir/ValueSet/consent-data-meaning)

                                                              How a resource reference is interpreted when testing consent restrictions

                                                              Typecode
                                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                              Summarytrue
                                                              280. Consent.except.data.reference
                                                              Definition

                                                              A reference to a specific resource that defines which resources are covered by this consent.

                                                              ShortThe actual data reference
                                                              Control1..1
                                                              TypeReference(Resource)
                                                              Summarytrue