HL7 Europe Patient Summary
0.0.1-ci - ci-build 150

HL7 Europe Patient Summary, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.0.1-ci built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/eps/ and changes regularly. See the Directory of published versions

Resource Profile: ProcedureEuEps - Detailed Descriptions

Draft as of 2025-06-20

Definitions for the procedure-eu-eps resource profile.

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

0. Procedure
Definition

An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

ShortAn action that is being or was performed on a patient
Control0..*
Is Modifierfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Procedure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Procedure.text
Definition

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

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 information is added later.

Control10..1
TypeNarrative
Is Modifierfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Procedure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Procedure.status
Definition

A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.

Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
Comments

The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

Control1..1
BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

A code specifying the state of the procedure.

Typecode
Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Procedure.code
Definition

Identification of the procedure or recording of "absence of relevant procedures" or of "procedures unknown".


The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

ShortIdentification of the procedure
Control10..1
BindingThe codes SHOULD be taken from For example codes, see Procedures - IPShttp://hl7.org/fhir/ValueSet/procedure-code
(preferred to http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips)

SNOMED CT procedure code set or a code for absent/unknown procedure


A code to identify a specific procedure .

TypeCodeableConcept(Codeable Concept (IPS))
Is Modifierfalse
Must Supporttrue
Obligations
    ObligationsActor
    SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
    SHALL:handleConsumer (IPS)from Procedure (IPS)
    SHOULD:displayConsumer (IPS)from Procedure (IPS)
    Summarytrue
    Requirements

    0..1 to account for primarily narrative only resources.

    Alternate Namestype
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Procedure.subject
    Definition

    The person on which the procedure was performed.


    The person, animal or group on which the procedure was performed.

    ShortWho the procedure was performed on
    Control1..1
    TypeReference(Patient (EPS), Patient, Group)
    Is Modifierfalse
    Must Supporttrue
    Obligations
      ObligationsActor
      SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
      SHALL:handleConsumer (IPS)from Procedure (IPS)
      SHOULD:displayConsumer (IPS)from Procedure (IPS)
      Summarytrue
      Alternate Namespatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. Procedure.subject.reference
      Definition

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

      ShortLiteral reference, Relative, internal or absolute URL
      Comments

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

      Control10..1
      This element is affected by the following invariants: ref-1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Obligations
        ObligationsActor
        SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
        SHALL:handleConsumer (IPS)from Procedure (IPS)
        SHOULD:displayConsumer (IPS)from Procedure (IPS)
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. Procedure.performed[x]
        Definition

        Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

        ShortWhen the procedure was performed
        Comments

        Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

        Control10..1
        TypeChoice of: dateTime, Period, string, Age, Range
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Obligations
          ObligationsActor
          SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
          SHALL:handleConsumer (IPS)from Procedure (IPS)
          SHOULD:displayConsumer (IPS)from Procedure (IPS)
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
          • type @ $this
          • 18. Procedure.performed[x].extension:data-absent-reason
            Slice Namedata-absent-reason
            Definition

            Provides a reason why the performed is missing.

            Shortperformed[x] absence reason
            Control0..1
            TypeExtension(Data Absent Reason) (Extension Type: code)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            20. Procedure.performed[x]:performedDateTime
            Slice NameperformedDateTime
            Definition

            Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

            ShortWhen the procedure was performed
            Comments

            Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

            Control0..1
            TypedateTime, string, Period, Range, Age
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Obligations
              ObligationsActor
              SHOULD:populate-if-knownProducer (IPS)from Procedure (IPS)
              SHALL:handleConsumer (IPS)from Procedure (IPS)
              SHOULD:displayConsumer (IPS)from Procedure (IPS)
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. Procedure.reasonCode
              Definition

              The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.

              ShortWhy the procedure was performed (code)Coded reason procedure performed
              Comments

              Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

              Control0..*
              BindingFor example codes, see ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reason
              (example to http://hl7.org/fhir/ValueSet/procedure-reason)

              A code that identifies the reason a procedure is required.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. Procedure.reasonReference
              Definition

              The justification of why the procedure was performed.

              ShortThe justification that the procedure was performed
              Comments

              It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

              Control0..*
              TypeReference(Condition (EPS), Observation, Procedure (EPS), DiagnosticReport, DocumentReference, Condition, Procedure)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Procedure.bodySite
              Definition

              Anatomical location which is the focus of the problem.


              Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

              ShortTarget body sites
              Comments

              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

              Control0..*
              BindingThe codes SHOULD be taken from For example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site
              (preferred to http://hl7.org/fhir/ValueSet/body-site)
              TypeCodeableConcept(Codeable Concept (IPS))
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. Procedure.outcome
              Definition

              The outcome of the procedure - did it resolve the reasons for the procedure being performed?

              ShortOutcome of the procedureThe result of procedure
              Comments

              If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

              Control0..1
              BindingFor example codes, see ProcedureOutcomeCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-outcome
              (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

              An outcome of a procedure - whether it was resolved or otherwise.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. Procedure.complication
              Definition

              Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.

              ShortComplications that occurred during the procedure (code)Complication following the procedure
              Comments

              If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

              Control0..*
              BindingFor example codes, see Condition/Problem/DiagnosisCodeshttp://hl7.org/fhir/ValueSet/condition-code
              (example to http://hl7.org/fhir/ValueSet/condition-code)

              Codes describing complications that resulted from a procedure.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. Procedure.complicationDetail
              Definition

              Any complications that occurred during the procedure, or in the immediate post-performance period.

              ShortComplications that occurred during the procedure (details)A condition that is a result of the procedure
              Control0..*
              TypeReference(Condition)
              Is Modifierfalse
              Summaryfalse
              Requirements

              This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. Procedure.focalDevice
              Definition

              A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

              ShortDevice implanted, removed or otherwise manipulatedManipulated, implanted, or removed device
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. Procedure.focalDevice.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

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

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              38. Procedure.focalDevice.manipulated
              Definition

              The device that was manipulated (changed) during the procedure.

              ShortDevice that was changed
              Control1..1
              TypeReference(Device (EPS), Device)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

              0. Procedure
              2. Procedure.text
              Control1..?
              4. Procedure.code
              BindingThe codes SHOULD be taken from Procedures - IPS
              (preferred to http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips)

              SNOMED CT procedure code set or a code for absent/unknown procedure

              6. Procedure.subject
              TypeReference(Patient (EPS))
              8. Procedure.performed[x]
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              10. Procedure.performed[x].extension:data-absent-reason
              Slice Namedata-absent-reason
              Definition

              Provides a reason why the performed is missing.

              Shortperformed[x] absence reason
              Control0..1
              TypeExtension(Data Absent Reason) (Extension Type: code)
              12. Procedure.performer
              14. Procedure.performer.actor
              TypeReference(PractitionerRole (EU core), Practitioner (EU core), Device - Performer or Observer (IPS), Patient (EPS), RelatedPerson, Organization (EU core))
              16. Procedure.performer.onBehalfOf
              TypeReference(Organization (EU core))
              18. Procedure.reasonCode
              ShortWhy the procedure was performed (code)
              20. Procedure.reasonReference
              TypeReference(Condition (EPS), Observation, Procedure (EPS), DiagnosticReport, DocumentReference)
              22. Procedure.bodySite
              Definition

              Anatomical location which is the focus of the problem.

              BindingThe codes SHOULD be taken from SNOMEDCTBodyStructures
              (preferred to http://hl7.org/fhir/ValueSet/body-site)
              24. Procedure.outcome
              ShortOutcome of the procedure
              26. Procedure.complication
              ShortComplications that occurred during the procedure (code)
              28. Procedure.complicationDetail
              ShortComplications that occurred during the procedure (details)
              30. Procedure.focalDevice
              ShortDevice implanted, removed or otherwise manipulated
              32. Procedure.focalDevice.manipulated
              TypeReference(Device (EPS))

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

              0. Procedure
              Definition

              An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

              ShortAn action that is being or was performed on a patient
              Control0..*
              Is Modifierfalse
              Summaryfalse
              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
              dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
              dom-6: A resource should have narrative for robust management (text.`div`.exists())
              2. Procedure.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
              Is Modifierfalse
              Summarytrue
              4. Procedure.meta
              Definition

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

              ShortMetadata about the resource
              Control0..1
              TypeMeta
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              6. Procedure.implicitRules
              Definition

              A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

              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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

              Control0..1
              Typeuri
              Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              8. Procedure.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
              BindingThe codes SHOULD be taken from CommonLanguages
              (preferred to http://hl7.org/fhir/ValueSet/languages)

              A human language.

              Additional BindingsPurpose
              AllLanguagesMax Binding
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              10. Procedure.text
              Definition

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

              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 information is added later.

              Control1..1
              TypeNarrative
              Is Modifierfalse
              Summaryfalse
              Alternate Namesnarrative, html, xhtml, display
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              12. Procedure.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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

              Control0..*
              TypeResource
              Is Modifierfalse
              Summaryfalse
              Alternate Namesinline resources, anonymous resources, contained resources
              14. Procedure.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              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
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              16. Procedure.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              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 Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
              Summaryfalse
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              18. Procedure.identifier
              Definition

              Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.

              ShortExternal Identifiers for this procedure
              Comments

              This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.

              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control0..*
              TypeIdentifier
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              20. Procedure.instantiatesCanonical
              Definition

              The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.

              ShortInstantiates FHIR protocol or definition
              Control0..*
              Typecanonical(PlanDefinition, ActivityDefinition, Measure, OperationDefinition, Questionnaire)
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              22. Procedure.instantiatesUri
              Definition

              The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.

              ShortInstantiates external protocol or definition
              Comments

              This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

              Control0..*
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              24. Procedure.basedOn
              Definition

              A reference to a resource that contains details of the request for this procedure.

              ShortA request for this procedure
              Control0..*
              TypeReference(CarePlan, ServiceRequest)
              Is Modifierfalse
              Summarytrue
              Alternate Namesfulfills
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Procedure.partOf
              Definition

              A larger event of which this particular procedure is a component or step.

              ShortPart of referenced event
              Comments

              The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).

              Control0..*
              TypeReference(Procedure, Observation, MedicationAdministration)
              Is Modifierfalse
              Summarytrue
              Alternate Namescontainer
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. Procedure.status
              Definition

              A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.

              Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
              Comments

              The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

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

              Control1..1
              BindingThe codes SHALL be taken from EventStatus
              (required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

              A code specifying the state of the procedure.

              Typecode
              Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. Procedure.statusReason
              Definition

              Captures the reason for the current state of the procedure.

              ShortReason for current status
              Comments

              This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

              Control0..1
              BindingFor example codes, see ProcedureNotPerformedReason(SNOMED-CT)
              (example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

              A code that identifies the reason a procedure was not performed.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Alternate NamesSuspended Reason, Cancelled Reason
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. Procedure.category
              Definition

              A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").

              ShortClassification of the procedure
              Control0..1
              BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)
              (example to http://hl7.org/fhir/ValueSet/procedure-category)

              A code that classifies a procedure for searching, sorting and display purposes.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. Procedure.code
              Definition

              Identification of the procedure or recording of "absence of relevant procedures" or of "procedures unknown".

              ShortIdentification of the procedure
              Control1..1
              BindingThe codes SHOULD be taken from Procedures - IPS
              (preferred to http://hl7.org/fhir/uv/ips/ValueSet/procedures-uv-ips)

              SNOMED CT procedure code set or a code for absent/unknown procedure

              TypeCodeableConcept(Codeable Concept (IPS))
              Is Modifierfalse
              Must Supporttrue
              Obligations
                ObligationsActor
                SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
                SHALL:handleConsumer (IPS)from Procedure (IPS)
                SHOULD:displayConsumer (IPS)from Procedure (IPS)
                Summarytrue
                Requirements

                0..1 to account for primarily narrative only resources.

                Alternate Namestype
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. Procedure.subject
                Definition

                The person on which the procedure was performed.

                ShortWho the procedure was performed on
                Control1..1
                TypeReference(Patient (EPS))
                Is Modifierfalse
                Must Supporttrue
                Obligations
                  ObligationsActor
                  SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
                  SHALL:handleConsumer (IPS)from Procedure (IPS)
                  SHOULD:displayConsumer (IPS)from Procedure (IPS)
                  Summarytrue
                  Alternate Namespatient
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  38. Procedure.subject.id
                  Definition

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

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  40. Procedure.subject.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  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
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on Procedure.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 42. Procedure.subject.reference
                    Definition

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

                    ShortLiteral reference, Relative, internal or absolute URL
                    Comments

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

                    Control1..1
                    This element is affected by the following invariants: ref-1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
                      SHALL:handleConsumer (IPS)from Procedure (IPS)
                      SHOULD:displayConsumer (IPS)from Procedure (IPS)
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      44. Procedure.subject.type
                      Definition

                      The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                      The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                      ShortType the reference refers to (e.g. "Patient")
                      Comments

                      This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                      Control0..1
                      BindingUnless not suitable, these codes SHALL be taken from ResourceType
                      (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                      Aa resource (or, for logical models, the URI of the logical model).

                      Typeuri
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      46. Procedure.subject.identifier
                      Definition

                      An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents 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.

                      Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                      NoteThis is a business identifier, not a resource identifier (see discussion)
                      Control0..1
                      TypeIdentifier
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      48. Procedure.subject.display
                      Definition

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

                      ShortText alternative for the resource
                      Comments

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

                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      50. Procedure.encounter
                      Definition

                      The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.

                      ShortEncounter created as part of
                      Comments

                      This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                      Control0..1
                      TypeReference(Encounter)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      52. Procedure.performed[x]
                      Definition

                      Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                      ShortWhen the procedure was performed
                      Comments

                      Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

                      Control1..1
                      TypeChoice of: dateTime, Period, string, Age, Range
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Must Support TypesNo must-support rules about the choice of types/profiles
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownProducer (IPS)from Procedure (IPS)
                        SHALL:handleConsumer (IPS)from Procedure (IPS)
                        SHOULD:displayConsumer (IPS)from Procedure (IPS)
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                        • type @ $this
                        • 54. Procedure.performed[x].id
                          Definition

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

                          ShortUnique id for inter-element referencing
                          Control0..1
                          Typestring
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          56. Procedure.performed[x].extension
                          Definition

                          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                          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
                          Is Modifierfalse
                          Summaryfalse
                          Alternate Namesextensions, user content
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          SlicingThis element introduces a set of slices on Procedure.performed[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 58. Procedure.performed[x].extension:data-absent-reason
                            Slice Namedata-absent-reason
                            Definition

                            Provides a reason why the performed is missing.

                            Shortperformed[x] absence reason
                            Control0..1
                            TypeExtension(Data Absent Reason) (Extension Type: code)
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            60. Procedure.performed[x]:performedDateTime
                            Slice NameperformedDateTime
                            Definition

                            Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.

                            ShortWhen the procedure was performed
                            Comments

                            Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

                            Control0..1
                            TypedateTime
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Must Supporttrue
                            Obligations
                              ObligationsActor
                              SHOULD:populate-if-knownProducer (IPS)from Procedure (IPS)
                              SHALL:handleConsumer (IPS)from Procedure (IPS)
                              SHOULD:displayConsumer (IPS)from Procedure (IPS)
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              62. Procedure.recorder
                              Definition

                              Individual who recorded the record and takes responsibility for its content.

                              ShortWho recorded the procedure
                              Control0..1
                              TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              64. Procedure.asserter
                              Definition

                              Individual who is making the procedure statement.

                              ShortPerson who asserts this procedure
                              Control0..1
                              TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              66. Procedure.performer
                              Definition

                              Limited to "real" people rather than equipment.

                              ShortThe people who performed the procedure
                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              68. Procedure.performer.id
                              Definition

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

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              70. Procedure.performer.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              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
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              72. Procedure.performer.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

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

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              74. Procedure.performer.function
                              Definition

                              Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.

                              ShortType of performance
                              Control0..1
                              BindingFor example codes, see ProcedurePerformerRoleCodes
                              (example to http://hl7.org/fhir/ValueSet/performer-role)

                              A code that identifies the role of a performer of the procedure.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Allows disambiguation of the types of involvement of different performers.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              76. Procedure.performer.actor
                              Definition

                              The practitioner who was involved in the procedure.

                              ShortThe reference to the practitioner
                              Control1..1
                              TypeReference(PractitionerRole (EU core), Practitioner (EU core), Device - Performer or Observer (IPS), Patient (EPS), RelatedPerson, Organization (EU core))
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              A reference to Device supports use cases, such as pacemakers.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              78. Procedure.performer.onBehalfOf
                              Definition

                              The organization the device or practitioner was acting on behalf of.

                              ShortOrganization the device or practitioner was acting for
                              Control0..1
                              TypeReference(Organization (EU core))
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              80. Procedure.location
                              Definition

                              The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.

                              ShortWhere the procedure happened
                              Control0..1
                              TypeReference(Location)
                              Is Modifierfalse
                              Summarytrue
                              Requirements

                              Ties a procedure to where the records are likely kept.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              82. Procedure.reasonCode
                              Definition

                              The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.

                              ShortWhy the procedure was performed (code)
                              Comments

                              Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                              Control0..*
                              BindingFor example codes, see ProcedureReasonCodes
                              (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                              A code that identifies the reason a procedure is required.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              84. Procedure.reasonReference
                              Definition

                              The justification of why the procedure was performed.

                              ShortThe justification that the procedure was performed
                              Comments

                              It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                              Control0..*
                              TypeReference(Condition (EPS), Observation, Procedure (EPS), DiagnosticReport, DocumentReference)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              86. Procedure.bodySite
                              Definition

                              Anatomical location which is the focus of the problem.

                              ShortTarget body sites
                              Comments

                              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

                              Control0..*
                              BindingThe codes SHOULD be taken from SNOMEDCTBodyStructures
                              (preferred to http://hl7.org/fhir/ValueSet/body-site)
                              TypeCodeableConcept(Codeable Concept (IPS))
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              88. Procedure.outcome
                              Definition

                              The outcome of the procedure - did it resolve the reasons for the procedure being performed?

                              ShortOutcome of the procedure
                              Comments

                              If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

                              Control0..1
                              BindingFor example codes, see ProcedureOutcomeCodes(SNOMEDCT)
                              (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

                              An outcome of a procedure - whether it was resolved or otherwise.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              90. Procedure.report
                              Definition

                              This could be a histology result, pathology report, surgical report, etc.

                              ShortAny report resulting from the procedure
                              Comments

                              There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

                              Control0..*
                              TypeReference(DiagnosticReport, DocumentReference, Composition)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              92. Procedure.complication
                              Definition

                              Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.

                              ShortComplications that occurred during the procedure (code)
                              Comments

                              If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

                              Control0..*
                              BindingFor example codes, see Condition/Problem/DiagnosisCodes
                              (example to http://hl7.org/fhir/ValueSet/condition-code)

                              Codes describing complications that resulted from a procedure.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              94. Procedure.complicationDetail
                              Definition

                              Any complications that occurred during the procedure, or in the immediate post-performance period.

                              ShortComplications that occurred during the procedure (details)
                              Control0..*
                              TypeReference(Condition)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              96. Procedure.followUp
                              Definition

                              If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.

                              ShortInstructions for follow up
                              Control0..*
                              BindingFor example codes, see ProcedureFollowUpCodes(SNOMEDCT)
                              (example to http://hl7.org/fhir/ValueSet/procedure-followup)

                              Specific follow up required for a procedure e.g. removal of sutures.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              98. Procedure.note
                              Definition

                              Any other notes and comments about the procedure.

                              ShortAdditional information about the procedure
                              Control0..*
                              TypeAnnotation
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              100. Procedure.focalDevice
                              Definition

                              A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.

                              ShortDevice implanted, removed or otherwise manipulated
                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              102. Procedure.focalDevice.id
                              Definition

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

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              104. Procedure.focalDevice.extension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                              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
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              106. Procedure.focalDevice.modifierExtension
                              Definition

                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                              ShortExtensions that cannot be ignored even if unrecognized
                              Comments

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

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              Summarytrue
                              Requirements

                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                              Alternate Namesextensions, user content, modifiers
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              108. Procedure.focalDevice.action
                              Definition

                              The kind of change that happened to the device during the procedure.

                              ShortKind of change to device
                              Control0..1
                              BindingThe codes SHOULD be taken from ProcedureDeviceActionCodes
                              (preferred to http://hl7.org/fhir/ValueSet/device-action)

                              A kind of change that happened to the device during the procedure.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              110. Procedure.focalDevice.manipulated
                              Definition

                              The device that was manipulated (changed) during the procedure.

                              ShortDevice that was changed
                              Control1..1
                              TypeReference(Device (EPS))
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              112. Procedure.usedReference
                              Definition

                              Identifies medications, devices and any other substance used as part of the procedure.

                              ShortItems used during procedure
                              Comments

                              For devices actually implanted or removed, use Procedure.device.

                              Control0..*
                              TypeReference(Device, Medication, Substance)
                              Is Modifierfalse
                              Summaryfalse
                              Requirements

                              Used for tracking contamination, etc.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              114. Procedure.usedCode
                              Definition

                              Identifies coded items that were used as part of the procedure.

                              ShortCoded items used during the procedure
                              Comments

                              For devices actually implanted or removed, use Procedure.device.

                              Control0..*
                              BindingFor example codes, see FHIRDeviceTypes
                              (example to http://hl7.org/fhir/ValueSet/device-kind)

                              Codes describing items used during a procedure.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))