IDEA4RC FHIR Implementation Guide
0.1.0 - CI Build 150

IDEA4RC FHIR Implementation Guide, published by IDEA4RC Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/idea4rc/ and changes regularly. See the Directory of published versions

Resource Profile: ProcedureRadiotherapyI4rc - Detailed Descriptions

Draft as of 2025-07-25

Definitions for the Procedure-radiotheraphy-eu-i4rc 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.extension
Definition

An Extension


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.

ShortExtensionAdditional content defined by implementations
Comments

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

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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. Procedure.extension:adaptive
    Slice Nameadaptive
    Definition

    Complex extension indicating whether the treatment is adaptive, based on code 2000100045 from IDEA4RC.

    ShortAdaptive
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Adaptive) (Complex Extension)
    Is Modifierfalse
    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.extension:sameHospital
    Slice NamesameHospital
    Definition

    This extension is included in the guide for covering the request of tracking if information has been captured at the same hospital that recorded the data.

    ShortSame Hospital
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Same Hospital) (Extension Type: boolean)
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Procedure.extension:procedureCategoryR5
    Slice NameprocedureCategoryR5
    Definition

    Optional Extension Element - found in all resources.

    ShortOptional Extensions Element
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Extension Definition for Procedure.category for Version 5.0) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta)
    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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. Procedure.extension:modalityAndTechnique
    Slice NamemodalityAndTechnique
    Definition

    Extension capturing modality and technique of a given radiotherapy procedure. The allowed combinations of modality and technique are constrained by invariants, one per modality.

    ShortRadiotherapy Modality And Technique Extension
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
    Is Modifierfalse
    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())
    14. Procedure.extension:modalityAndTechnique.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional content defined by implementations
    Comments

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

    Control10..*
    TypeExtension
    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.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. Procedure.extension:modalityAndTechnique.extension:modality
      Slice Namemodality
      Definition

      Extension capturing a modality of external beam or brachytherapy radiation procedures.

      ShortModality of external beam or brachytherapy radiation procedures
      Control1..1
      TypeExtension(Radiotherapy Modality Extension) (Extension Type: CodeableConcept)
      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())
      18. Procedure.extension:modalityAndTechnique.extension:modality.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional content defined by implementations
      Comments

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

      Control0..0*
      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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 20. Procedure.extension:modalityAndTechnique.extension:modality.url
        Definition

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

        Shortidentifies the meaning of the extension
        Comments

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

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-modality
        22. Procedure.extension:modalityAndTechnique.extension:modality.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        BindingThe codes SHOULD be taken from For codes, see Radiotherapy Modality Value Set
        (preferred to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs)
        TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Procedure.extension:modalityAndTechnique.extension:technique
        Slice Nametechnique
        Definition

        Extension capturing a technique of external beam or brachytherapy radiation procedures.

        ShortTechnique of external beam or brachytherapy radiation procedures
        Control0..*
        TypeExtension(Radiotherapy Technique Extension) (Extension Type: CodeableConcept)
        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())
        26. Procedure.extension:modalityAndTechnique.extension:technique.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional content defined by implementations
        Comments

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

        Control0..0*
        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.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 28. Procedure.extension:modalityAndTechnique.extension:technique.url
          Definition

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-technique
          30. Procedure.extension:modalityAndTechnique.extension:technique.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control10..1
          BindingThe codes SHOULD be taken from For codes, see Radiotherapy Technique Value Set
          (preferred to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs)
          TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. Procedure.extension:modalityAndTechnique.url
          Definition

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

          Shortidentifies the meaning of the extension
          Comments

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

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-modality-and-technique
          34. Procedure.extension:modalityAndTechnique.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control0..01
          TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
          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()))
          36. Procedure.extension:doseToVolume
          Slice NamedoseToVolume
          Definition

          Dose delivered to a given radiotherapy volume.

          ShortRadiotherapy Dose Delivered To Volume Extension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
          Is Modifierfalse
          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.extension:terminationReason
          Slice NameterminationReason
          Definition

          A code explaining the unplanned or premature termination, or normal completion, of a plan of treatment, course of medication, or research study. This extension is deprecated since it is redundant with the statusReason field.

          ShortTreatment Termination Reason Extension (deprecated)
          Control0..*
          This element is affected by the following invariants: ele-1
          TypeExtension(Treatment Termination Reason Extension (deprecated)) (Extension Type: CodeableConcept)
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          40. Procedure.extension:procedureIntent
          Slice NameprocedureIntent
          Definition

          The purpose of a treatment, medication, or procedure.

          ShortProcedure Intent Extension
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Procedure Intent Extension) (Extension Type: CodeableConcept)
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          42. Procedure.extension:settings
          Slice Namesettings
          Definition

          The setting in which the radiotherapy procedure was performed.

          ShortRadiotherapy Setting
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Radiotherapy Setting) (Extension Type: CodeableConcept)
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          44. Procedure.extension:totalHighDoseDelivered
          Slice NametotalHighDoseDelivered
          Definition

          Total High Dose delivered to a given radiotherapy volume.

          ShortTotal High Dose Delivered
          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Total High Dose Delivered) (Complex Extension)
          Is Modifierfalse
          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())
          46. 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())
          48. 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 radiotherapy / boostExternal 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()))
          50. Procedure.status
          Definition

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

          ShortProcedure statuspreparation | 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()))
          52. Procedure.category
          Definition

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

          ShortClassification of the procedure
          Control10..1
          BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-category
          (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
          Pattern Value{
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "108290001",
              "display" : "Radiotherapy"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Procedure.code
          Definition

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

          ShortADD VOC BINDINGIdentification of the procedure
          Control10..1
          BindingFor example codes, see ProcedureCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-code
          (example to http://hl7.org/fhir/ValueSet/procedure-code)

          A code to identify a specific procedure .

          TypeCodeableConcept
          Is Modifierfalse
          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()))
          56. Procedure.subject
          Definition

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

          ShortWho the procedure was performed on
          Control1..1
          TypeReference(Patient: IDEA4RC, Patient, Group)
          Is Modifierfalse
          Summarytrue
          Alternate Namespatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. 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
          TypePeriod, dateTime, string, Range, Age
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          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
          • 60. Procedure.performed[x]:performedPeriod
            Slice NameperformedPeriod
            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
            TypePeriod, dateTime, string, Range, Age
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            62. 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.

            ShortCoded 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..*
            BindingThe codes SHALL be taken from For example codes, see Re-irradiation reasonhttp://hl7.org/fhir/ValueSet/procedure-reason
            (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/re-irradiation-reason-eu-i4rc)
            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            64. 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.

            Control10..*
            TypeReference(Condition: Primary Cancer, Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            66. Procedure.bodySite
            Definition

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

            Shortrequired for Brachytherapy and External beamTarget 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 SHALL be taken from For example codes, see Radiotherapy Siteshttp://hl7.org/fhir/ValueSet/body-site
            (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-eu-i4rc)
            TypeCodeableConcept
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            68. Procedure.bodySite.extension:locationQualifier
            Slice NamelocationQualifier
            Definition

            Qualifier to refine an body location. These include qualifiers for relative location, directionality, number, and plane, and exclude qualifiers for laterality.

            ShortBody Location Qualifier
            Control0..*
            TypeExtension(Body Location Qualifier) (Extension Type: CodeableConcept)
            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())
            70. Procedure.bodySite.extension:locationQualifier.extension
            Definition

            An Extension


            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.

            ShortExtensionAdditional content defined by implementations
            Comments

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

            Control0..0*
            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.bodySite.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 72. Procedure.bodySite.extension:locationQualifier.url
              Definition

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

              Shortidentifies the meaning of the extension
              Comments

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

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-body-location-qualifier
              74. Procedure.bodySite.extension:locationQualifier.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control10..1
              BindingThe codes SHALL be taken from For codes, see Surgery Location Qualifier
              (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/surgery-location-qualifier-eu-i4rc)
              TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              76. Procedure.bodySite.extension:lateralityQualifier
              Slice NamelateralityQualifier
              Definition

              Qualifier to specify laterality.

              ShortLaterality Qualifier
              Control0..1
              TypeExtension(Laterality Qualifier) (Extension Type: CodeableConcept)
              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())
              78. Procedure.bodySite.extension:lateralityQualifier.extension
              Definition

              An Extension


              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.

              ShortExtensionAdditional content defined by implementations
              Comments

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

              Control0..0*
              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.bodySite.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 80. Procedure.bodySite.extension:lateralityQualifier.url
                Definition

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

                Shortidentifies the meaning of the extension
                Comments

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

                Control1..1
                Typeuri
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-laterality-qualifier
                82. Procedure.bodySite.extension:lateralityQualifier.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                ShortValue of extension
                Control10..1
                BindingThe codes SHALL be taken from For codes, see Radiotherapy Site Laterality Qualifier
                (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-laterality-qualifier-eu-i4rc)
                TypeCodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. Procedure.outcome
                Definition

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

                ShortThe result of procedure
                Comments

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

                Control0..1
                BindingThe codes SHALL be taken from For example codes, see Treatment Responsehttp://hl7.org/fhir/ValueSet/procedure-outcome
                (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/treatment-response-eu-i4rc)
                TypeCodeableConcept
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. Procedure.note
                Definition

                Any other notes and comments about the procedure.

                ShortAdditional information about the RadiotherapyAdditional 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()))

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

                0. Procedure
                2. Procedure.extension
                SlicingThis element introduces a set of slices on Procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 4. Procedure.extension:adaptive
                  Slice Nameadaptive
                  Control0..1
                  TypeExtension(Adaptive) (Complex Extension)
                  6. Procedure.extension:sameHospital
                  Slice NamesameHospital
                  Control0..1
                  TypeExtension(Same Hospital) (Extension Type: boolean)
                  8. Procedure.extension:procedureCategoryR5
                  Slice NameprocedureCategoryR5
                  Control0..*
                  TypeExtension(Extension Definition for Procedure.category for Version 5.0) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta)
                  10. Procedure.extension:modalityAndTechnique
                  Slice NamemodalityAndTechnique
                  Control0..*
                  TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
                  12. Procedure.extension:modalityAndTechnique.extension:modality
                  Slice Namemodality
                  ShortModality of external beam or brachytherapy radiation procedures
                  14. Procedure.extension:modalityAndTechnique.extension:technique
                  Slice Nametechnique
                  ShortTechnique of external beam or brachytherapy radiation procedures
                  16. Procedure.extension:doseToVolume
                  Slice NamedoseToVolume
                  Control0..1
                  TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
                  18. Procedure.extension:terminationReason
                  Slice NameterminationReason
                  Control0..*
                  TypeExtension(Treatment Termination Reason Extension (deprecated)) (Extension Type: CodeableConcept)
                  20. Procedure.extension:procedureIntent
                  Slice NameprocedureIntent
                  Control0..1
                  TypeExtension(Procedure Intent Extension) (Extension Type: CodeableConcept)
                  22. Procedure.extension:settings
                  Slice Namesettings
                  Control0..1
                  TypeExtension(Radiotherapy Setting) (Extension Type: CodeableConcept)
                  24. Procedure.extension:totalHighDoseDelivered
                  Slice NametotalHighDoseDelivered
                  Control0..1
                  TypeExtension(Total High Dose Delivered) (Complex Extension)
                  26. Procedure.identifier
                  ShortExternal Identifiers for this radiotherapy / boost
                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  28. Procedure.status
                  ShortProcedure status
                  30. Procedure.category
                  Control1..?
                  Pattern Value{
                    "coding" : [{
                      "system" : "http://snomed.info/sct",
                      "code" : "108290001",
                      "display" : "Radiotherapy"
                    }]
                  }
                  32. Procedure.code
                  ShortADD VOC BINDING
                  Control1..?
                  34. Procedure.subject
                  TypeReference(Patient: IDEA4RC)
                  36. Procedure.performed[x]
                  Control1..?
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  SlicingThis element introduces a set of slices on Procedure.performed[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 38. Procedure.performed[x]:performedPeriod
                    Slice NameperformedPeriod
                    Control1..1
                    TypePeriod
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    40. Procedure.reasonCode
                    BindingThe codes SHALL be taken from Re-irradiation reason
                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/re-irradiation-reason-eu-i4rc)
                    42. Procedure.reasonReference
                    Control1..?
                    TypeReference(Condition: Primary Cancer)
                    44. Procedure.bodySite
                    Shortrequired for Brachytherapy and External beam
                    BindingThe codes SHALL be taken from Radiotherapy Sites
                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-eu-i4rc)
                    46. Procedure.bodySite.extension:locationQualifier
                    Slice NamelocationQualifier
                    Control0..*
                    TypeExtension(Body Location Qualifier) (Extension Type: CodeableConcept)
                    48. Procedure.bodySite.extension:locationQualifier.value[x]
                    BindingThe codes SHALL be taken from Surgery Location Qualifier
                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/surgery-location-qualifier-eu-i4rc)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    50. Procedure.bodySite.extension:lateralityQualifier
                    Slice NamelateralityQualifier
                    Control0..1
                    TypeExtension(Laterality Qualifier) (Extension Type: CodeableConcept)
                    52. Procedure.bodySite.extension:lateralityQualifier.value[x]
                    BindingThe codes SHALL be taken from Radiotherapy Site Laterality Qualifier
                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-laterality-qualifier-eu-i4rc)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    54. Procedure.outcome
                    BindingThe codes SHALL be taken from Treatment Response
                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/treatment-response-eu-i4rc)
                    56. Procedure.note
                    ShortAdditional information about the Radiotherapy

                    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.

                    Control0..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

                    An Extension

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

                      Complex extension indicating whether the treatment is adaptive, based on code 2000100045 from IDEA4RC.

                      ShortAdaptive
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Adaptive) (Complex Extension)
                      Is Modifierfalse
                      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.extension:sameHospital
                      Slice NamesameHospital
                      Definition

                      This extension is included in the guide for covering the request of tracking if information has been captured at the same hospital that recorded the data.

                      ShortSame Hospital
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Same Hospital) (Extension Type: boolean)
                      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.extension:procedureCategoryR5
                      Slice NameprocedureCategoryR5
                      Definition

                      Optional Extension Element - found in all resources.

                      ShortOptional Extensions Element
                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Extension Definition for Procedure.category for Version 5.0) (Extension Type: Choice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta)
                      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())
                      22. Procedure.extension:modalityAndTechnique
                      Slice NamemodalityAndTechnique
                      Definition

                      Extension capturing modality and technique of a given radiotherapy procedure. The allowed combinations of modality and technique are constrained by invariants, one per modality.

                      ShortRadiotherapy Modality And Technique Extension
                      Control0..*
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Radiotherapy Modality And Technique Extension) (Complex Extension)
                      Is Modifierfalse
                      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())
                      24. Procedure.extension:modalityAndTechnique.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
                      26. Procedure.extension:modalityAndTechnique.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control1..*
                      TypeExtension
                      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())
                      SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 28. Procedure.extension:modalityAndTechnique.extension:modality
                        Slice Namemodality
                        Definition

                        Extension capturing a modality of external beam or brachytherapy radiation procedures.

                        ShortModality of external beam or brachytherapy radiation procedures
                        Control1..1
                        TypeExtension(Radiotherapy Modality Extension) (Extension Type: CodeableConcept)
                        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())
                        30. Procedure.extension:modalityAndTechnique.extension:modality.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
                        32. Procedure.extension:modalityAndTechnique.extension:modality.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control0..0
                        TypeExtension
                        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())
                        SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 34. Procedure.extension:modalityAndTechnique.extension:modality.url
                          Definition

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

                          Shortidentifies the meaning of the extension
                          Comments

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

                          Control1..1
                          Typeuri
                          Is Modifierfalse
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-modality
                          36. Procedure.extension:modalityAndTechnique.extension:modality.value[x]
                          Definition

                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                          ShortValue of extension
                          Control1..1
                          BindingThe codes SHOULD be taken from Radiotherapy Modality Value Set
                          (preferred to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs)
                          TypeCodeableConcept
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          38. Procedure.extension:modalityAndTechnique.extension:technique
                          Slice Nametechnique
                          Definition

                          Extension capturing a technique of external beam or brachytherapy radiation procedures.

                          ShortTechnique of external beam or brachytherapy radiation procedures
                          Control0..*
                          TypeExtension(Radiotherapy Technique Extension) (Extension Type: CodeableConcept)
                          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())
                          40. Procedure.extension:modalityAndTechnique.extension:technique.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
                          42. Procedure.extension:modalityAndTechnique.extension:technique.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..0
                          TypeExtension
                          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())
                          SlicingThis element introduces a set of slices on Procedure.extension.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 44. Procedure.extension:modalityAndTechnique.extension:technique.url
                            Definition

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

                            Shortidentifies the meaning of the extension
                            Comments

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

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-technique
                            46. Procedure.extension:modalityAndTechnique.extension:technique.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control1..1
                            BindingThe codes SHOULD be taken from Radiotherapy Technique Value Set
                            (preferred to http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs)
                            TypeCodeableConcept
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            48. Procedure.extension:modalityAndTechnique.url
                            Definition

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

                            Shortidentifies the meaning of the extension
                            Comments

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

                            Control1..1
                            Typeuri
                            Is Modifierfalse
                            XML FormatIn the XML format, this property is represented as an attribute.
                            Summaryfalse
                            Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-radiotherapy-modality-and-technique
                            50. Procedure.extension:modalityAndTechnique.value[x]
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            ShortValue of extension
                            Control0..0
                            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta
                            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()))
                            52. Procedure.extension:doseToVolume
                            Slice NamedoseToVolume
                            Definition

                            Dose delivered to a given radiotherapy volume.

                            ShortRadiotherapy Dose Delivered To Volume Extension
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Radiotherapy Dose Delivered To Volume Extension) (Complex Extension)
                            Is Modifierfalse
                            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())
                            54. Procedure.extension:terminationReason
                            Slice NameterminationReason
                            Definition

                            A code explaining the unplanned or premature termination, or normal completion, of a plan of treatment, course of medication, or research study. This extension is deprecated since it is redundant with the statusReason field.

                            ShortTreatment Termination Reason Extension (deprecated)
                            Control0..*
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Treatment Termination Reason Extension (deprecated)) (Extension Type: CodeableConcept)
                            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())
                            56. Procedure.extension:procedureIntent
                            Slice NameprocedureIntent
                            Definition

                            The purpose of a treatment, medication, or procedure.

                            ShortProcedure Intent Extension
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Procedure Intent Extension) (Extension Type: CodeableConcept)
                            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())
                            58. Procedure.extension:settings
                            Slice Namesettings
                            Definition

                            The setting in which the radiotherapy procedure was performed.

                            ShortRadiotherapy Setting
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Radiotherapy Setting) (Extension Type: CodeableConcept)
                            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.extension:totalHighDoseDelivered
                            Slice NametotalHighDoseDelivered
                            Definition

                            Total High Dose delivered to a given radiotherapy volume.

                            ShortTotal High Dose Delivered
                            Control0..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Total High Dose Delivered) (Complex Extension)
                            Is Modifierfalse
                            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())
                            62. 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())
                            64. 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 radiotherapy / boost
                            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()))
                            66. 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()))
                            68. 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()))
                            70. 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()))
                            72. 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()))
                            74. Procedure.status
                            Definition

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

                            ShortProcedure status
                            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()))
                            76. 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()))
                            78. Procedure.category
                            Definition

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

                            ShortClassification of the procedure
                            Control1..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
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://snomed.info/sct",
                                "code" : "108290001",
                                "display" : "Radiotherapy"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            80. Procedure.code
                            Definition

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

                            ShortADD VOC BINDING
                            Control1..1
                            BindingFor example codes, see ProcedureCodes(SNOMEDCT)
                            (example to http://hl7.org/fhir/ValueSet/procedure-code)

                            A code to identify a specific procedure .

                            TypeCodeableConcept
                            Is Modifierfalse
                            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()))
                            82. Procedure.subject
                            Definition

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

                            ShortWho the procedure was performed on
                            Control1..1
                            TypeReference(Patient: IDEA4RC)
                            Is Modifierfalse
                            Summarytrue
                            Alternate Namespatient
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            84. 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()))
                            86. 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
                            TypePeriod
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifierfalse
                            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
                            • 88. Procedure.performed[x]:performedPeriod
                              Slice NameperformedPeriod
                              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
                              TypePeriod
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              90. 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()))
                              92. 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()))
                              94. 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()))
                              96. 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
                              98. 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())
                              100. 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())
                              102. 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()))
                              104. Procedure.performer.actor
                              Definition

                              The practitioner who was involved in the procedure.

                              ShortThe reference to the practitioner
                              Control1..1
                              TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                              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()))
                              106. 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)
                              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()))
                              108. 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()))
                              110. 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.

                              ShortCoded 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..*
                              BindingThe codes SHALL be taken from Re-irradiation reason
                              (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/re-irradiation-reason-eu-i4rc)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              112. 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.

                              Control1..*
                              TypeReference(Condition: Primary Cancer)
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              114. Procedure.bodySite
                              Definition

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

                              Shortrequired for Brachytherapy and External beam
                              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 SHALL be taken from Radiotherapy Sites
                              (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-eu-i4rc)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              116. Procedure.bodySite.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
                              118. Procedure.bodySite.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.bodySite.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 120. Procedure.bodySite.extension:locationQualifier
                                Slice NamelocationQualifier
                                Definition

                                Qualifier to refine an body location. These include qualifiers for relative location, directionality, number, and plane, and exclude qualifiers for laterality.

                                ShortBody Location Qualifier
                                Control0..*
                                TypeExtension(Body Location Qualifier) (Extension Type: CodeableConcept)
                                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())
                                122. Procedure.bodySite.extension:locationQualifier.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
                                124. Procedure.bodySite.extension:locationQualifier.extension
                                Definition

                                An Extension

                                ShortExtension
                                Control0..0
                                TypeExtension
                                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())
                                SlicingThis element introduces a set of slices on Procedure.bodySite.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 126. Procedure.bodySite.extension:locationQualifier.url
                                  Definition

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

                                  Shortidentifies the meaning of the extension
                                  Comments

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

                                  Control1..1
                                  Typeuri
                                  Is Modifierfalse
                                  XML FormatIn the XML format, this property is represented as an attribute.
                                  Summaryfalse
                                  Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-body-location-qualifier
                                  128. Procedure.bodySite.extension:locationQualifier.value[x]
                                  Definition

                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                  ShortValue of extension
                                  Control1..1
                                  BindingThe codes SHALL be taken from Surgery Location Qualifier
                                  (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/surgery-location-qualifier-eu-i4rc)
                                  TypeCodeableConcept
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  130. Procedure.bodySite.extension:lateralityQualifier
                                  Slice NamelateralityQualifier
                                  Definition

                                  Qualifier to specify laterality.

                                  ShortLaterality Qualifier
                                  Control0..1
                                  TypeExtension(Laterality Qualifier) (Extension Type: CodeableConcept)
                                  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())
                                  132. Procedure.bodySite.extension:lateralityQualifier.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
                                  134. Procedure.bodySite.extension:lateralityQualifier.extension
                                  Definition

                                  An Extension

                                  ShortExtension
                                  Control0..0
                                  TypeExtension
                                  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())
                                  SlicingThis element introduces a set of slices on Procedure.bodySite.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 136. Procedure.bodySite.extension:lateralityQualifier.url
                                    Definition

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

                                    Shortidentifies the meaning of the extension
                                    Comments

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

                                    Control1..1
                                    Typeuri
                                    Is Modifierfalse
                                    XML FormatIn the XML format, this property is represented as an attribute.
                                    Summaryfalse
                                    Fixed Valuehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/mcode-laterality-qualifier
                                    138. Procedure.bodySite.extension:lateralityQualifier.value[x]
                                    Definition

                                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                    ShortValue of extension
                                    Control1..1
                                    BindingThe codes SHALL be taken from Radiotherapy Site Laterality Qualifier
                                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/radiotherapy-site-laterality-qualifier-eu-i4rc)
                                    TypeCodeableConcept
                                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    140. Procedure.bodySite.coding
                                    Definition

                                    A reference to a code defined by a terminology system.

                                    ShortCode defined by a terminology system
                                    Comments

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

                                    Control0..*
                                    TypeCoding
                                    Is Modifierfalse
                                    Summarytrue
                                    Requirements

                                    Allows for alternative encodings within a code system, and translations to other code systems.

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

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

                                    ShortPlain text representation of the concept
                                    Comments

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

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

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

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

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

                                    ShortThe result of procedure
                                    Comments

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

                                    Control0..1
                                    BindingThe codes SHALL be taken from Treatment Response
                                    (required to http://hl7.eu/fhir/ig/idea4rc/ValueSet/treatment-response-eu-i4rc)
                                    TypeCodeableConcept
                                    Is Modifierfalse
                                    Summarytrue
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    146. 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()))
                                    148. 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.

                                    ShortComplication 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/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()))
                                    150. Procedure.complicationDetail
                                    Definition

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

                                    ShortA 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()))
                                    152. 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()))
                                    154. Procedure.note
                                    Definition

                                    Any other notes and comments about the procedure.

                                    ShortAdditional information about the Radiotherapy
                                    Control0..*
                                    TypeAnnotation
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    156. 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.

                                    ShortManipulated, 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()))
                                    158. 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
                                    160. 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())
                                    162. 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())
                                    164. 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()))
                                    166. Procedure.focalDevice.manipulated
                                    Definition

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

                                    ShortDevice that was changed
                                    Control1..1
                                    TypeReference(Device)
                                    Is Modifierfalse
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    168. 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()))
                                    170. 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()))