MajorSurgery
type: StructureDefinition
node role: treeRoot
id:
  v: MajorSurgery
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: StructureDefinition MajorSurgery Name Flags Card. Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> MajorSurgery 0..* Base Major Surgery #xD; relatedDiagnosis 0..1 Identifier Progressive number of diagnosis #xD; relatedRelapse 0..1 Identifier Progressive number of relapse/progression (after FLT) #xD; identifier 0..* Identifier Progressive Surgery number #xD; istitutionOfTreatment 0..1 BackboneElement Institution of treatment #xD; description 0..1 string Institution description #xD; name 0..1 string Institution name #xD; address 0..1 BackboneElement Institution address #xD; name 0..1 string Institution city #xD; country 0..1 string Institution country #xD; date 0..1 dateTime Date of surgery #xD; description 0..1 string Surgery description #xD; affectedOrgan 0..* CodeableConcept Affected Organs #xD; <a href="StructureDefinition-MajorSurgery-definitions.html#MajorSurgery.sacrifiedOrgan" title="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.#xA;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' #xA;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'.#xA;#xA;(Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)">sacrifiedOrgan 0..* CodeableConcept Sacrified Organs #xD; shuntApplication 0..* BackboneElement Shunt application #xD; Ventriculo-peritoneal#xA;2 => Ventriculo atrial#xA;3 => Subdural_peritoneal#xA;4 => Cisternostomy (III ventricule)#xA;5 => Other#xA;-9922 => NK">type 0..1 CodeableConcept Type of shunt #xD; NK">laterality 0..1 CodeableConcept Laterality of shunt #xD; Still in place#xA;2 => Removed#xA; -9911 => …
url:
  v: http://hl7.eu/fhir/ig/pcsp/StructureDefinition/MajorSurgery
  l: MajorSurgery
version:
  v: 1.0.0
name:
  v: MajorSurgery
title:
  v: Major Surgery
status:
  v: active
date:
  v: 2026-01-16T12:01:48+00:00
publisher:
  v: PanCareSurPass Project
contact:
  name:
    v: PanCareSurPass Project
  telecom:
    system:
      v: url
    value:
      v: https://www.pancaresurpass.eu/
contact:
  name:
    v: PanCareSurPass Project
  telecom:
    system:
      v: url
    value:
      v: https://www.pancaresurpass.eu/
description:
  v: Major Surgery.
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 150
    display:
      v: Europe
fhir version:
  v: 4.0.1
mapping:
  identity:
    v: fhir
  uri:
    v: hl7.org/fhir/r4
    l: r4
  name:
    v: MajorSurgery model to PCSP HL7 FHIR R4 Profiles
kind:
  v: logical
abstract:
  v: false
type:
  v: http://hl7.eu/fhir/ig/pcsp/StructureDefinition/MajorSurgery
  l: MajorSurgery
base definition:
  v: http://hl7.org/fhir/StructureDefinition/Base
  l: Base
derivation:
  v: specialization
snapshot:
  extension:
    url:
      v: http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version
      l: snapshot-base-version
    value: String
      v: 4.0.1
  element:
    id:
      v: MajorSurgery
    path:
      v: MajorSurgery
    short:
      v: Major Surgery
    definition:
      v: Major Surgery.
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    max:
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    base:
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        v: Base
      min:
        v: 0
      max:
        v: *
    is modifier:
      v: false
    mapping:
      identity:
        v: fhir
      map:
        v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp')
  element:
    id:
      v: MajorSurgery.relatedDiagnosis
    path:
      v: MajorSurgery.relatedDiagnosis
    short:
      v: Progressive number of diagnosis
    definition:
      v: 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
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    max:
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        v: MajorSurgery.relatedDiagnosis
      min:
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    type:
      code:
        v: Identifier
        l: Identifier
    mapping:
      identity:
        v: fhir
      map:
        v: .reasonReference
  element:
    id:
      v: MajorSurgery.relatedRelapse
    path:
      v: MajorSurgery.relatedRelapse
    short:
      v: Progressive number of relapse/progression (after FLT)
    definition:
      v: Progressive number of relapse/progression (after FLT)
    min:
      v: 0
    max:
      v: 1
    base:
      path:
        v: MajorSurgery.relatedRelapse
      min:
        v: 0
      max:
        v: 1
    type:
      code:
        v: Identifier
        l: Identifier
    mapping:
      identity:
        v: fhir
      map:
        v: .reasonReference
  element:
    id:
      v: MajorSurgery.identifier
    path:
      v: MajorSurgery.identifier
    short:
      v: Progressive Surgery number
    definition:
      v: Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.
    min:
      v: 0
    max:
      v: *
    base:
      path:
        v: MajorSurgery.identifier
      min:
        v: 0
      max:
        v: *
    type:
      code:
        v: Identifier
        l: Identifier
    mapping:
      identity:
        v: fhir
      map:
        v: .identifier
  element:
    id:
      v: MajorSurgery.istitutionOfTreatment
    path:
      v: MajorSurgery.istitutionOfTreatment
    short:
      v: Institution of treatment
    definition:
      v: Please Identify the institution were surgery was performed

v: 0

v: 1

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code:
  v: BackboneElement
  l: BackboneElement

key:
  v: ele-1
severity:
  v: error
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  v: All FHIR elements must have a @value or children
expression:
  v: hasValue() or (children().count() > id.count())
xpath:
  v: @value|f:*|h:div
source:
  v: http://hl7.org/fhir/StructureDefinition/Element
  l: Element

identity:
  v: fhir
map:
  v: location.resolve().conformsTo(http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Location-eu-pcsp)

id:
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path:
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short:
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definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MajorSurgery.istitutionOfTreatment.extension
path:
  v: MajorSurgery.istitutionOfTreatment.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
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  path:
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    l: Extension
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    v: extension.exists() != value.exists()
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  v: false
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id:
  v: MajorSurgery.istitutionOfTreatment.modifierExtension
path:
  v: MajorSurgery.istitutionOfTreatment.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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    l: Extension
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  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MajorSurgery.istitutionOfTreatment.description
path:
  v: MajorSurgery.istitutionOfTreatment.description
short:
  v: Institution description
definition:
  v: Institution description
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id:
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  v: MajorSurgery.istitutionOfTreatment.name
short:
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definition:
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id:
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    v: Location.address.city

id:
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path:
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  v: xmlAttr
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  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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      v: string
      l: string
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    l: System.String
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definition:
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comment:
  v: 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.
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id:
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path:
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short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
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comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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id:
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path:
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short:
  v: Institution city
definition:
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type:
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id:
  v: MajorSurgery.istitutionOfTreatment.address.country
path:
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short:
  v: Institution country
definition:
  v: Institution country
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type:
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    v: string
    l: string
mapping:
  identity:
    v: fhir
  map:
    v: Location.address.country

id:
  v: MajorSurgery.date
path:
  v: MajorSurgery.date
short:
  v: Date of surgery
definition:
  v: Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.
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  v: 0
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    v: MajorSurgery.date
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type:
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    v: dateTime
    l: dateTime
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.performedDateTime

id:
  v: MajorSurgery.description
path:
  v: MajorSurgery.description
short:
  v: Surgery description
definition:
  v: 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.
min:
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type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: fhir
  map:
    v: .text

id:
  v: MajorSurgery.affectedOrgan
path:
  v: MajorSurgery.affectedOrgan
short:
  v: Affected Organs
definition:
  v: Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)
min:
  v: 0
max:
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base:
  path:
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    v: 0
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type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .bodySite
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.sacrifiedOrgan
path:
  v: MajorSurgery.sacrifiedOrgan
short:
  v: Sacrified Organs
definition:
  v: 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)
min:
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max:
  v: *
base:
  path:
    v: MajorSurgery.sacrifiedOrgan
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    v: 0
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    v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .extension('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/surgery-sacrifiedOrgan').valueCodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.shuntApplication
path:
  v: MajorSurgery.shuntApplication
short:
  v: Shunt application
definition:
  v: Please report if a cerebrovascular shunt was inserted
min:
  v: 0
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  v: *
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  path:
    v: MajorSurgery.shuntApplication
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    v: 0
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    v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ShuntProcedureTypeVs))

id:
  v: MajorSurgery.shuntApplication.id
path:
  v: MajorSurgery.shuntApplication.id
representation:
  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
  code:
    v: http://hl7.org/fhirpath/System.String
    l: System.String
is modifier:
  v: false
is summary:
  v: false
mapping:
  identity:
    v: rim
  map:
    v: n/a

id:
  v: MajorSurgery.shuntApplication.extension
path:
  v: MajorSurgery.shuntApplication.extension
slicing:
  discriminator:
    type:
      v: value
    path:
      v: url
  description:
    v: Extensions are always sliced by (at least) url
  rules:
    v: open
short:
  v: Additional content defined by implementations
definition:
  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
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  v: 0
max:
  v: *
base:
  path:
    v: Element.extension
  min:
    v: 0
  max:
    v: *
type:
  code:
    v: Extension
    l: Extension
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
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  key:
    v: ext-1
  severity:
    v: error
  human:
    v: Must have either extensions or value[x], not both
  expression:
    v: extension.exists() != value.exists()
  xpath:
    v: exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
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  v: false
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  identity:
    v: rim
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id:
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path:
  v: MajorSurgery.shuntApplication.modifierExtension
short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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alias:
  v: user content
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  v: modifiers
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    v: Extension
    l: Extension
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  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MajorSurgery.shuntApplication.type
path:
  v: MajorSurgery.shuntApplication.type
short:
  v: Type of shunt
definition:
  v: 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
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type:
  code:
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    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.shuntApplication.laterality
path:
  v: MajorSurgery.shuntApplication.laterality
short:
  v: Laterality of shunt
definition:
  v: Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.shuntApplication.laterality
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    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .extension('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/mcode-laterality-qualifier').valueCodeableConcept

id:
  v: MajorSurgery.shuntApplication.isRemoved
path:
  v: MajorSurgery.shuntApplication.isRemoved
short:
  v: In place or removed ?
definition:
  v: Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.shuntApplication.isRemoved
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    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .focalDevice.action

id:
  v: MajorSurgery.amputation
path:
  v: MajorSurgery.amputation
short:
  v: Amputation
definition:
  v: 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
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.amputation
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(AmputationProcedureTypeVs)).exists()

id:
  v: MajorSurgery.prothesis
path:
  v: MajorSurgery.prothesis
short:
  v: Prothesis
definition:
  v: Prothesis
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.prothesis
  min:
    v: 0
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    v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
constraint:
  key:
    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
  xpath:
    v: @value|f:*|h:div
  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ProstheticProcedureTypeVs))

id:
  v: MajorSurgery.prothesis.id
path:
  v: MajorSurgery.prothesis.id
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  v: xmlAttr
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  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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  v: 0
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  v: 1
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    v: Element.id
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    v: 0
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    v: 1
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  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type
      l: structuredefinition-fhir-type
    value: Url
      v: string
      l: string
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    v: http://hl7.org/fhirpath/System.String
    l: System.String
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  v: false
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  v: false
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  identity:
    v: rim
  map:
    v: n/a

id:
  v: MajorSurgery.prothesis.extension
path:
  v: MajorSurgery.prothesis.extension
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      v: value
    path:
      v: url
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    v: Extensions are always sliced by (at least) url
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  v: Additional content defined by implementations
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  v: 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.
comment:
  v: 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.
alias:
  v: extensions
alias:
  v: user content
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  v: 0
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  v: *
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    v: 0
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  code:
    v: Extension
    l: Extension
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    v: hasValue() or (children().count() > id.count())
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    v: http://hl7.org/fhir/StructureDefinition/Element
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    v: ext-1
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    v: error
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    v: Must have either extensions or value[x], not both
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  v: false
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id:
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path:
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short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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  v: user content
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is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
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id:
  v: MajorSurgery.prothesis.status
path:
  v: MajorSurgery.prothesis.status
short:
  v: status
definition:
  v: Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)
min:
  v: 0
max:
  v: 1
base:
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type:
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mapping:
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id:
  v: MajorSurgery.prothesis.deviceType
path:
  v: MajorSurgery.prothesis.deviceType
short:
  v: device type
definition:
  v: 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
min:
  v: 0
max:
  v: 1
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mapping:
  identity:
    v: fhir
  map:
    v: usedCode

id:
  v: MajorSurgery.colostomy
path:
  v: MajorSurgery.colostomy
short:
  v: Colostomy
definition:
  v: Colostomy
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.colostomy
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    v: ele-1
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  source:
    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ColostomyProcedureTypeVs))

id:
  v: MajorSurgery.colostomy.id
path:
  v: MajorSurgery.colostomy.id
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  v: xmlAttr
short:
  v: Unique id for inter-element referencing
definition:
  v: Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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    url:
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    value: Url
      v: string
      l: string
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    v: http://hl7.org/fhirpath/System.String
    l: System.String
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is summary:
  v: false
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  identity:
    v: rim
  map:
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id:
  v: MajorSurgery.colostomy.extension
path:
  v: MajorSurgery.colostomy.extension
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    path:
      v: url
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  v: Additional content defined by implementations
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  v: 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.
comment:
  v: 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.
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alias:
  v: user content
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max:
  v: *
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    v: 0
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    v: *
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    v: Extension
    l: Extension
constraint:
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    v: ele-1
  severity:
    v: error
  human:
    v: All FHIR elements must have a @value or children
  expression:
    v: hasValue() or (children().count() > id.count())
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    v: http://hl7.org/fhir/StructureDefinition/Element
    l: Element
constraint:
  key:
    v: ext-1
  severity:
    v: error
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    v: Must have either extensions or value[x], not both
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  v: false
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  v: false
mapping:
  identity:
    v: rim
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id:
  v: MajorSurgery.colostomy.modifierExtension
path:
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short:
  v: Extensions that cannot be ignored even if unrecognized
definition:
  v: 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).
comment:
  v: 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.
requirements:
  v: 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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
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alias:
  v: user content
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  v: modifiers
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  v: 0
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    v: *
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    l: Extension
constraint:
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  severity:
    v: error
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  v: true
is modifier reason:
  v: Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
is summary:
  v: true
mapping:
  identity:
    v: rim
  map:
    v: N/A

id:
  v: MajorSurgery.colostomy.status
path:
  v: MajorSurgery.colostomy.status
short:
  v: status
definition:
  v: State if a colostomy was created. Details should be reported in the surgery section.
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.colostomy.status
  min:
    v: 0
  max:
    v: 1
type:
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    l: CodeableConcept
mapping:
  identity:
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  map:
    v: .exists()

id:
  v: MajorSurgery.colostomy.isRemoved
path:
  v: MajorSurgery.colostomy.isRemoved
short:
  v: In place or removed ?
definition:
  v: State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.colostomy.isRemoved
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .focalDevice.action

id:
  v: MajorSurgery.gastrostomy
path:
  v: MajorSurgery.gastrostomy
short:
  v: Gastrostomy
definition:
  v: State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK
min:
  v: 0
max:
  v: 1
base:
  path:
    v: MajorSurgery.gastrostomy
  min:
    v: 0
  max:
    v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(GastrostomyProcedureTypeVs)).exists()

element:
  id:
    v: MajorSurgery
  path:
    v: MajorSurgery
  short:
    v: Major Surgery
  definition:
    v: Major Surgery.
  mapping:
    identity:
      v: fhir
    map:
      v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp')
element:
  id:
    v: MajorSurgery.relatedDiagnosis
  path:
    v: MajorSurgery.relatedDiagnosis
  short:
    v: Progressive number of diagnosis
  definition:
    v: 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
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Identifier
      l: Identifier
  mapping:
    identity:
      v: fhir
    map:
      v: .reasonReference
element:
  id:
    v: MajorSurgery.relatedRelapse
  path:
    v: MajorSurgery.relatedRelapse
  short:
    v: Progressive number of relapse/progression (after FLT)
  definition:
    v: Progressive number of relapse/progression (after FLT)
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: Identifier
      l: Identifier
  mapping:
    identity:
      v: fhir
    map:
      v: .reasonReference
element:
  id:
    v: MajorSurgery.identifier
  path:
    v: MajorSurgery.identifier
  short:
    v: Progressive Surgery number
  definition:
    v: Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.
  min:
    v: 0
  max:
    v: *
  type:
    code:
      v: Identifier
      l: Identifier
  mapping:
    identity:
      v: fhir
    map:
      v: .identifier
element:
  id:
    v: MajorSurgery.istitutionOfTreatment
  path:
    v: MajorSurgery.istitutionOfTreatment
  short:
    v: Institution of treatment
  definition:
    v: Please Identify the institution were surgery was performed
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: BackboneElement
      l: BackboneElement
  mapping:
    identity:
      v: fhir
    map:
      v: location.resolve().conformsTo(http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Location-eu-pcsp)
element:
  id:
    v: MajorSurgery.istitutionOfTreatment.description
  path:
    v: MajorSurgery.istitutionOfTreatment.description
  short:
    v: Institution description
  definition:
    v: Institution description
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string
  mapping:
    identity:
      v: fhir
    map:
      v: Location.description
element:
  id:
    v: MajorSurgery.istitutionOfTreatment.name
  path:
    v: MajorSurgery.istitutionOfTreatment.name
  short:
    v: Institution name
  definition:
    v: Institution name
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string
  mapping:
    identity:
      v: fhir
    map:
      v: Location.name
element:
  id:
    v: MajorSurgery.istitutionOfTreatment.address
  path:
    v: MajorSurgery.istitutionOfTreatment.address
  short:
    v: Institution address
  definition:
    v: Institution address
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: BackboneElement
      l: BackboneElement
  mapping:
    identity:
      v: fhir
    map:
      v: Location.address.city
element:
  id:
    v: MajorSurgery.istitutionOfTreatment.address.name
  path:
    v: MajorSurgery.istitutionOfTreatment.address.name
  short:
    v: Institution city
  definition:
    v: Institution city
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string
element:
  id:
    v: MajorSurgery.istitutionOfTreatment.address.country
  path:
    v: MajorSurgery.istitutionOfTreatment.address.country
  short:
    v: Institution country
  definition:
    v: Institution country
  min:
    v: 0
  max:
    v: 1
  type:
    code:
      v: string
      l: string

identity:
  v: fhir
map:
  v: Location.address.country

id:
  v: MajorSurgery.date
path:
  v: MajorSurgery.date
short:
  v: Date of surgery
definition:
  v: Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: dateTime
    l: dateTime
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.performedDateTime

id:
  v: MajorSurgery.description
path:
  v: MajorSurgery.description
short:
  v: Surgery description
definition:
  v: 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.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: string
    l: string
mapping:
  identity:
    v: fhir
  map:
    v: .text

id:
  v: MajorSurgery.affectedOrgan
path:
  v: MajorSurgery.affectedOrgan
short:
  v: Affected Organs
definition:
  v: Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)
min:
  v: 0
max:
  v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .bodySite
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.sacrifiedOrgan
path:
  v: MajorSurgery.sacrifiedOrgan
short:
  v: Sacrified Organs
definition:
  v: 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)
min:
  v: 0
max:
  v: *
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .extension('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/surgery-sacrifiedOrgan').valueCodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.shuntApplication
path:
  v: MajorSurgery.shuntApplication
short:
  v: Shunt application
definition:
  v: Please report if a cerebrovascular shunt was inserted
min:
  v: 0
max:
  v: *
type:
  code:
    v: BackboneElement
    l: BackboneElement
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ShuntProcedureTypeVs))

id:
  v: MajorSurgery.shuntApplication.type
path:
  v: MajorSurgery.shuntApplication.type
short:
  v: Type of shunt
definition:
  v: 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
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .code

id:
  v: MajorSurgery.shuntApplication.laterality
path:
  v: MajorSurgery.shuntApplication.laterality
short:
  v: Laterality of shunt
definition:
  v: Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .extension('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/mcode-laterality-qualifier').valueCodeableConcept

id:
  v: MajorSurgery.shuntApplication.isRemoved
path:
  v: MajorSurgery.shuntApplication.isRemoved
short:
  v: In place or removed ?
definition:
  v: Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .focalDevice.action

id:
  v: MajorSurgery.amputation
path:
  v: MajorSurgery.amputation
short:
  v: Amputation
definition:
  v: 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
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(AmputationProcedureTypeVs)).exists()

id:
  v: MajorSurgery.prothesis
path:
  v: MajorSurgery.prothesis
short:
  v: Prothesis
definition:
  v: Prothesis
min:
  v: 0
max:
  v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ProstheticProcedureTypeVs))

id:
  v: MajorSurgery.prothesis.status
path:
  v: MajorSurgery.prothesis.status
short:
  v: status
definition:
  v: Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .exists()

id:
  v: MajorSurgery.prothesis.deviceType
path:
  v: MajorSurgery.prothesis.deviceType
short:
  v: device type
definition:
  v: 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
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: usedCode

id:
  v: MajorSurgery.colostomy
path:
  v: MajorSurgery.colostomy
short:
  v: Colostomy
definition:
  v: Colostomy
min:
  v: 0
max:
  v: 1
type:
  code:
    v: BackboneElement
    l: BackboneElement
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(ColostomyProcedureTypeVs))

id:
  v: MajorSurgery.colostomy.status
path:
  v: MajorSurgery.colostomy.status
short:
  v: status
definition:
  v: State if a colostomy was created. Details should be reported in the surgery section.
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .exists()

id:
  v: MajorSurgery.colostomy.isRemoved
path:
  v: MajorSurgery.colostomy.isRemoved
short:
  v: In place or removed ?
definition:
  v: State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: .focalDevice.action

id:
  v: MajorSurgery.gastrostomy
path:
  v: MajorSurgery.gastrostomy
short:
  v: Gastrostomy
definition:
  v: State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK
min:
  v: 0
max:
  v: 1
type:
  code:
    v: CodeableConcept
    l: CodeableConcept
mapping:
  identity:
    v: fhir
  map:
    v: Procedure.conformsTo('http://hl7.eu/fhir/ig/pcsp/StructureDefinition/Procedure-surgery-eu-pcsp').where(code.memberOf(GastrostomyProcedureTypeVs)).exists()