PanCareSurPass Project HL7 FHIR Implementation Guide
0.2.0 - CI Build 150

PanCareSurPass Project HL7 FHIR Implementation Guide, published by PanCareSurPass Project. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/pcsp/ and changes regularly. See the Directory of published versions

Logical Model: MajorSurgery - Detailed Descriptions

Draft as of 2024-09-11

Definitions for the MajorSurgery logical model.

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

0. MajorSurgery
Definition

Major Surgery. Maturity Level: 2 - Ready for Review

ShortMajor Surgery
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed

ShortProgressive number of diagnosis
Control0..1
TypeIdentifier
4. MajorSurgery.relatedRelapse
Definition

Progressive number of relapse/progression (after FLT)

ShortProgressive number of relapse/progression (after FLT)
Control0..1
TypeIdentifier
6. MajorSurgery.identifier
Definition

Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.

ShortProgressive Surgery number
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
8. MajorSurgery.istitutionOfTreatment
Definition

Please Identify the institution were surgery was performed

ShortInstitution of treatment
Control0..1
TypeBackboneElement
10. MajorSurgery.istitutionOfTreatment.description
Definition

Institution description

ShortInstitution description
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
12. MajorSurgery.istitutionOfTreatment.name
Definition

Institution name

ShortInstitution name
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. MajorSurgery.istitutionOfTreatment.address
Definition

Institution address

ShortInstitution address
Control0..1
TypeBackboneElement
16. MajorSurgery.istitutionOfTreatment.address.name
Definition

Institution city

ShortInstitution city
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
18. MajorSurgery.istitutionOfTreatment.address.country
Definition

Institution country

ShortInstitution country
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
20. MajorSurgery.date
Definition

Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.

ShortDate of surgery
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
22. MajorSurgery.description
Definition

Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.

ShortSurgery description
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
24. MajorSurgery.affectedOrgan
Definition

Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)

ShortAffected Organs
Control0..*
TypeCodeableConcept
26. MajorSurgery.sacrifiedOrgan
Definition

During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'.

(Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)

ShortSacrified Organs
Control0..*
TypeCodeableConcept
28. MajorSurgery.shuntApplication
Definition

Please report if a cerebrovascular shunt was inserted

ShortShunt application
Control0..*
TypeBackboneElement
30. MajorSurgery.shuntApplication.type
Definition

This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK

ShortType of shunt
Control0..1
TypeCodeableConcept
32. MajorSurgery.shuntApplication.laterality
Definition

Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK

ShortLaterality of shunt
Control0..1
TypeCodeableConcept
34. MajorSurgery.shuntApplication.isRemoved
Definition

Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK

ShortIn place or removed ?
Control0..1
TypeCodeableConcept
36. MajorSurgery.amputation
Definition

Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK

ShortAmputation
Control0..1
TypeCodeableConcept
38. MajorSurgery.prothesis
Definition

Prothesis

ShortProthesis
Control0..1
TypeBackboneElement
40. MajorSurgery.prothesis.status
Definition

Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)

Shortstatus
Control0..1
TypeCodeableConcept
42. MajorSurgery.prothesis.deviceType
Definition

Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK

Shortdevice type
Control0..1
TypeCodeableConcept
44. MajorSurgery.colostomy
Definition

Colostomy

ShortColostomy
Control0..1
TypeBackboneElement
46. MajorSurgery.colostomy.status
Definition

State if a colostomy was created. Details should be reported in the surgery section.

Shortstatus
Control0..1
TypeCodeableConcept
48. MajorSurgery.colostomy.isRemoved
Definition

State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK

ShortIn place or removed ?
Control0..1
TypeCodeableConcept
50. MajorSurgery.gastrostomy
Definition

State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK

ShortGastrostomy
Control0..1
TypeCodeableConcept

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

0. MajorSurgery
Definition

Major Surgery. Maturity Level: 2 - Ready for Review

ShortMajor Surgery
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed

ShortProgressive number of diagnosis
Control0..1
TypeIdentifier
4. MajorSurgery.relatedRelapse
Definition

Progressive number of relapse/progression (after FLT)

ShortProgressive number of relapse/progression (after FLT)
Control0..1
TypeIdentifier
6. MajorSurgery.identifier
Definition

Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.

ShortProgressive Surgery number
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
8. MajorSurgery.istitutionOfTreatment
Definition

Please Identify the institution were surgery was performed

ShortInstitution of treatment
Control0..1
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. MajorSurgery.istitutionOfTreatment.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())
12. MajorSurgery.istitutionOfTreatment.description
Definition

Institution description

ShortInstitution description
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
14. MajorSurgery.istitutionOfTreatment.name
Definition

Institution name

ShortInstitution name
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
16. MajorSurgery.istitutionOfTreatment.address
Definition

Institution address

ShortInstitution address
Control0..1
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. MajorSurgery.istitutionOfTreatment.address.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())
20. MajorSurgery.istitutionOfTreatment.address.name
Definition

Institution city

ShortInstitution city
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
22. MajorSurgery.istitutionOfTreatment.address.country
Definition

Institution country

ShortInstitution country
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
24. MajorSurgery.date
Definition

Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.

ShortDate of surgery
Control0..1
TypedateTime
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
26. MajorSurgery.description
Definition

Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.

ShortSurgery description
Control0..1
Typestring
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
28. MajorSurgery.affectedOrgan
Definition

Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)

ShortAffected Organs
Control0..*
TypeCodeableConcept
30. MajorSurgery.sacrifiedOrgan
Definition

During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'.

(Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)

ShortSacrified Organs
Control0..*
TypeCodeableConcept
32. MajorSurgery.shuntApplication
Definition

Please report if a cerebrovascular shunt was inserted

ShortShunt application
Control0..*
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. MajorSurgery.shuntApplication.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())
36. MajorSurgery.shuntApplication.type
Definition

This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK

ShortType of shunt
Control0..1
TypeCodeableConcept
38. MajorSurgery.shuntApplication.laterality
Definition

Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK

ShortLaterality of shunt
Control0..1
TypeCodeableConcept
40. MajorSurgery.shuntApplication.isRemoved
Definition

Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK

ShortIn place or removed ?
Control0..1
TypeCodeableConcept
42. MajorSurgery.amputation
Definition

Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK

ShortAmputation
Control0..1
TypeCodeableConcept
44. MajorSurgery.prothesis
Definition

Prothesis

ShortProthesis
Control0..1
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. MajorSurgery.prothesis.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())
48. MajorSurgery.prothesis.status
Definition

Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)

Shortstatus
Control0..1
TypeCodeableConcept
50. MajorSurgery.prothesis.deviceType
Definition

Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK

Shortdevice type
Control0..1
TypeCodeableConcept
52. MajorSurgery.colostomy
Definition

Colostomy

ShortColostomy
Control0..1
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. MajorSurgery.colostomy.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())
56. MajorSurgery.colostomy.status
Definition

State if a colostomy was created. Details should be reported in the surgery section.

Shortstatus
Control0..1
TypeCodeableConcept
58. MajorSurgery.colostomy.isRemoved
Definition

State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK

ShortIn place or removed ?
Control0..1
TypeCodeableConcept
60. MajorSurgery.gastrostomy
Definition

State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK

ShortGastrostomy
Control0..1
TypeCodeableConcept

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

0. MajorSurgery
Definition

Major Surgery. Maturity Level: 2 - Ready for Review

ShortMajor Surgery
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition

Progressive number of diagnosis (1=first; 2= second; 3 = third; ?).
In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed

ShortProgressive number of diagnosis
Control0..1
TypeIdentifier
4. MajorSurgery.relatedRelapse
Definition

Progressive number of relapse/progression (after FLT)

ShortProgressive number of relapse/progression (after FLT)
Control0..1
TypeIdentifier
6. MajorSurgery.identifier
Definition

Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.

ShortProgressive Surgery number
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
8. MajorSurgery.istitutionOfTreatment
Definition

Please Identify the institution were surgery was performed

ShortInstitution of treatment
Control0..1
TypeBackboneElement
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. MajorSurgery.istitutionOfTreatment.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
12. MajorSurgery.istitutionOfTreatment.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 MajorSurgery.istitutionOfTreatment.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 14. MajorSurgery.istitutionOfTreatment.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())
    16. MajorSurgery.istitutionOfTreatment.description
    Definition

    Institution description

    ShortInstitution description
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    18. MajorSurgery.istitutionOfTreatment.name
    Definition

    Institution name

    ShortInstitution name
    Control0..1
    Typestring
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    20. MajorSurgery.istitutionOfTreatment.address
    Definition

    Institution address

    ShortInstitution address
    Control0..1
    TypeBackboneElement
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. MajorSurgery.istitutionOfTreatment.address.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
    24. MajorSurgery.istitutionOfTreatment.address.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 MajorSurgery.istitutionOfTreatment.address.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 26. MajorSurgery.istitutionOfTreatment.address.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())
      28. MajorSurgery.istitutionOfTreatment.address.name
      Definition

      Institution city

      ShortInstitution city
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      30. MajorSurgery.istitutionOfTreatment.address.country
      Definition

      Institution country

      ShortInstitution country
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      32. MajorSurgery.date
      Definition

      Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.

      ShortDate of surgery
      Control0..1
      TypedateTime
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      34. MajorSurgery.description
      Definition

      Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.

      ShortSurgery description
      Control0..1
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      36. MajorSurgery.affectedOrgan
      Definition

      Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)

      ShortAffected Organs
      Control0..*
      TypeCodeableConcept
      38. MajorSurgery.sacrifiedOrgan
      Definition

      During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'.

      (Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)

      ShortSacrified Organs
      Control0..*
      TypeCodeableConcept
      40. MajorSurgery.shuntApplication
      Definition

      Please report if a cerebrovascular shunt was inserted

      ShortShunt application
      Control0..*
      TypeBackboneElement
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. MajorSurgery.shuntApplication.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
      44. MajorSurgery.shuntApplication.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 MajorSurgery.shuntApplication.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 46. MajorSurgery.shuntApplication.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())
        48. MajorSurgery.shuntApplication.type
        Definition

        This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK

        ShortType of shunt
        Control0..1
        TypeCodeableConcept
        50. MajorSurgery.shuntApplication.laterality
        Definition

        Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK

        ShortLaterality of shunt
        Control0..1
        TypeCodeableConcept
        52. MajorSurgery.shuntApplication.isRemoved
        Definition

        Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK

        ShortIn place or removed ?
        Control0..1
        TypeCodeableConcept
        54. MajorSurgery.amputation
        Definition

        Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK

        ShortAmputation
        Control0..1
        TypeCodeableConcept
        56. MajorSurgery.prothesis
        Definition

        Prothesis

        ShortProthesis
        Control0..1
        TypeBackboneElement
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. MajorSurgery.prothesis.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
        60. MajorSurgery.prothesis.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 MajorSurgery.prothesis.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 62. MajorSurgery.prothesis.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())
          64. MajorSurgery.prothesis.status
          Definition

          Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)

          Shortstatus
          Control0..1
          TypeCodeableConcept
          66. MajorSurgery.prothesis.deviceType
          Definition

          Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK

          Shortdevice type
          Control0..1
          TypeCodeableConcept
          68. MajorSurgery.colostomy
          Definition

          Colostomy

          ShortColostomy
          Control0..1
          TypeBackboneElement
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. MajorSurgery.colostomy.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
          72. MajorSurgery.colostomy.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 MajorSurgery.colostomy.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 74. MajorSurgery.colostomy.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())
            76. MajorSurgery.colostomy.status
            Definition

            State if a colostomy was created. Details should be reported in the surgery section.

            Shortstatus
            Control0..1
            TypeCodeableConcept
            78. MajorSurgery.colostomy.isRemoved
            Definition

            State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK

            ShortIn place or removed ?
            Control0..1
            TypeCodeableConcept
            80. MajorSurgery.gastrostomy
            Definition

            State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK

            ShortGastrostomy
            Control0..1
            TypeCodeableConcept