description: Logical Model for the DNPM DIP MTB Patient Record JSON structure (all 19 top-level keys)
package_name: de.medizininformatikinitiative.kerndatensatz.mtb
derivation: specialization
name: DNPM_LM_PatientRecord
type: https://dnpm-dip.net/fhir/StructureDefinition/dnpm-lm-patient-record
elements:
  ihcReports:
    type: BackboneElement
    short: Immunohistochemistry (IHC) reports
    array: true
    index: 235
    elements:
      id: {type: string, short: IHC report UUID, index: 236}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 237
        elements:
          id: {type: string, short: Patient ID, index: 238}
          type: {type: string, short: Reference type (Patient), index: 239}
        required: [id, type]
      specimen:
        type: BackboneElement
        short: Tumor specimen reference
        index: 240
        elements:
          id: {type: string, short: Specimen ID, index: 241}
          type: {type: string, short: Reference type (TumorSpecimen), index: 242}
        required: [id, type]
      issuedOn: {type: string, short: Report issue date (YYYY-MM-DD), index: 243}
      results:
        type: BackboneElement
        short: IHC results
        index: 244
        elements:
          proteinExpression:
            type: BackboneElement
            short: Protein expression results
            array: true
            index: 245
            elements:
              id: {type: string, short: Result UUID, index: 246}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 247
                elements:
                  id: {type: string, short: Patient ID, index: 248}
                  type: {type: string, short: Reference type (Patient), index: 249}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 250
                elements:
                  id: {type: string, short: Specimen ID, index: 251}
                  type: {type: string, short: Reference type (TumorSpecimen), index: 252}
                required: [id, type]
              protein:
                type: BackboneElement
                short: Protein tested
                index: 253
                elements:
                  code: {type: string, short: Protein code (e.g. BRAFP1), index: 254}
                  display: {type: string, short: Protein display, index: 255}
                  system: {type: string, short: Protein system URI, index: 256}
                required: [system, code]
              value:
                type: BackboneElement
                short: IHC expression value
                index: 257
                elements:
                  code: {type: string, short: Score code (e.g. 1+), index: 258}
                  display: {type: string, short: Score display, index: 259}
                  system: {type: string, short: Score system URI, index: 260}
                required: [system, code]
              tpsScore: {type: integer, short: Tumor proportion score (TPS), index: 261}
              icScore:
                type: BackboneElement
                short: Immune-cell score
                index: 262
                elements:
                  code: {type: string, short: IC score code, index: 263}
                  display: {type: string, short: IC score display, index: 264}
                  system: {type: string, short: IC score system URI, index: 265}
                required: [system, code]
              tcScore:
                type: BackboneElement
                short: Tumor-cell score
                index: 266
                elements:
                  code: {type: string, short: TC score code, index: 267}
                  display: {type: string, short: TC score display, index: 268}
                  system: {type: string, short: TC score system URI, index: 269}
                required: [system, code]
            required: [id, specimen, protein, patient]
          msiMmr:
            type: BackboneElement
            short: MSI / MMR protein expression results
            array: true
            index: 270
            elements:
              id: {type: string, short: Result UUID, index: 271}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 272
                elements:
                  id: {type: string, short: Patient ID, index: 273}
                  type: {type: string, short: Reference type (Patient), index: 274}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 275
                elements:
                  id: {type: string, short: Specimen ID, index: 276}
                  type: {type: string, short: Reference type (TumorSpecimen), index: 277}
                required: [id, type]
              protein:
                type: BackboneElement
                short: MMR protein tested (e.g. MLH1)
                index: 278
                elements:
                  code: {type: string, short: Protein code, index: 279}
                  display: {type: string, short: Protein display, index: 280}
                  system: {type: string, short: Protein system URI, index: 281}
                required: [system, code]
              value:
                type: BackboneElement
                short: Expression result
                index: 282
                elements:
                  code: {type: string, short: Result code (e.g. exp_present), index: 283}
                  display: {type: string, short: Result display, index: 284}
                  system: {type: string, short: Result system URI, index: 285}
                required: [system, code]
            required: [id, specimen, protein, patient]
    required: [id, issuedOn, specimen, patient]
  patient:
    type: BackboneElement
    short: Patient demographics
    index: 0
    elements:
      id: {type: string, short: Patient UUID, index: 1}
      gender:
        type: BackboneElement
        short: Patient gender
        index: 2
        elements:
          code: {type: string, short: Gender code (e.g. female), index: 3}
          display: {type: string, short: Gender display text, index: 4}
          system: {type: string, short: Gender code system, index: 5}
        required: [system, code]
      birthDate: {type: string, short: Date of birth (YYYY-MM), index: 6}
      healthInsurance:
        type: BackboneElement
        short: Health insurance information
        index: 7
        elements:
          type:
            type: BackboneElement
            short: Insurance type coding
            index: 8
            elements:
              code: {type: string, short: Insurance type code (e.g. GKV), index: 9}
              display: {type: string, short: Insurance type display, index: 10}
              system: {type: string, short: Insurance type system URI, index: 11}
            required: [system, code]
          reference:
            type: BackboneElement
            short: Insurance provider reference
            index: 12
            elements:
              id: {type: string, short: Insurance provider ID, index: 13}
              type: {type: string, short: Reference type (HealthInsurance), index: 14}
              display: {type: string, short: Insurance provider display name, index: 15}
              system: {type: string, short: Insurance provider system URI, index: 16}
            required: [id, type]
        required: [type]
      address:
        type: BackboneElement
        short: Patient address (municipality)
        index: 17
        elements:
          municipalityCode: {type: string, short: AGS municipality code (5-digit), index: 18}
      age:
        type: BackboneElement
        short: Calculated patient age
        index: 19
        elements:
          value: {type: integer, short: Age numeric value, index: 20}
          unit: {type: string, short: Age unit (e.g. Years), index: 21}
        required: [value, unit]
      vitalStatus:
        type: BackboneElement
        short: Vital status
        index: 22
        elements:
          code: {type: string, short: Vital status code (e.g. alive), index: 23}
          display: {type: string, short: Vital status display, index: 24}
          system: {type: string, short: Vital status system URI, index: 25}
        required: [system, code]
    required: [vitalStatus, id, gender, birthDate]
  claimResponses:
    type: BackboneElement
    short: Insurance / cost coverage claim response entries
    array: true
    index: 614
    elements:
      id: {type: string, short: Claim response UUID, index: 615}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 616
        elements:
          id: {type: string, short: Patient ID, index: 617}
          type: {type: string, short: Reference type (Patient), index: 618}
        required: [id, type]
      claim:
        type: BackboneElement
        short: Associated claim reference
        index: 619
        elements:
          id: {type: string, short: Claim ID, index: 620}
          type: {type: string, short: Reference type (Claim), index: 621}
        required: [id, type]
      issuedOn: {type: string, short: Response date (YYYY-MM-DD), index: 622}
      status:
        type: BackboneElement
        short: Response status
        index: 623
        elements:
          code: {type: string, short: Status code (e.g. rejected), index: 624}
          display: {type: string, short: Status display, index: 625}
          system: {type: string, short: Status system URI, index: 626}
        required: [system, code]
      statusReason:
        type: BackboneElement
        short: Reason for response status
        index: 627
        elements:
          code: {type: string, short: Reason code, index: 628}
          display: {type: string, short: Reason display, index: 629}
          system: {type: string, short: Reason system URI, index: 630}
        required: [system, code]
    required: [id, issuedOn, claim, status, patient]
  performanceStatus:
    type: BackboneElement
    short: ECOG performance status assessments
    array: true
    index: 158
    elements:
      id: {type: string, short: Performance status UUID, index: 159}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 160
        elements:
          id: {type: string, short: Patient ID, index: 161}
          type: {type: string, short: Reference type (Patient), index: 162}
        required: [id, type]
      effectiveDate: {type: string, short: Assessment date (YYYY-MM-DD), index: 163}
      value:
        type: BackboneElement
        short: ECOG score
        index: 164
        elements:
          code: {type: string, short: ECOG code (e.g. 0–4), index: 165}
          display: {type: string, short: ECOG display, index: 166}
          system: {type: string, short: ECOG system URI, index: 167}
        required: [system, code]
    required: [effectiveDate, id, value, patient]
  ngsReports:
    type: BackboneElement
    short: NGS sequencing reports
    array: true
    index: 306
    elements:
      id: {type: string, short: NGS Report UUID, index: 307}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 308
        elements:
          id: {type: string, short: Patient ID, index: 309}
          type: {type: string, short: Reference type (Patient), index: 310}
        required: [id, type]
      specimen:
        type: BackboneElement
        short: Tumor specimen reference
        index: 311
        elements:
          id: {type: string, short: Specimen ID, index: 312}
          type: {type: string, short: Reference type (TumorSpecimen), index: 313}
        required: [id, type]
      issuedOn: {type: string, short: Report issue date (YYYY-MM-DD), index: 314}
      type:
        type: BackboneElement
        short: NGS analysis type
        index: 315
        elements:
          code: {type: string, short: Type code (e.g. exome), index: 316}
          display: {type: string, short: Type display, index: 317}
          system: {type: string, short: Type system URI, index: 318}
        required: [system, code]
      metadata:
        type: BackboneElement
        short: NGS run metadata
        index: 319
        elements:
          referenceGenome:
            type: BackboneElement
            short: Reference genome
            index: 320
            elements:
              code: {type: string, short: Genome build (e.g. GRCh38), index: 321}
              display: {type: string, short: Genome build display, index: 322}
              system: {type: string, short: Genome build system URI, index: 323}
            required: [system, code]
          sequencer:
            type: BackboneElement
            short: Sequencer instrument
            index: 324
            elements:
              code: {type: string, short: Sequencer code, index: 325}
              display: {type: string, short: Sequencer display, index: 326}
              system: {type: string, short: Sequencer system URI, index: 327}
            required: [system, code]
          kitManufacturer: {type: string, short: Kit manufacturer, index: 328}
          kitType: {type: string, short: Kit type, index: 329}
          pipeline: {type: string, short: Bioinformatics pipeline, index: 330}
          tumorCellContent:
            type: BackboneElement
            short: Pre-sequencing tumor cell content estimate
            index: 331
            elements:
              method:
                type: BackboneElement
                short: Estimation method
                index: 332
                elements:
                  code: {type: string, short: Method code, index: 333}
                  display: {type: string, short: Method display, index: 334}
                  system: {type: string, short: Method system URI, index: 335}
                required: [system, code]
              value: {type: decimal, short: Fraction (0.0 – 1.0), index: 336}
            required: [value]
      results:
        type: BackboneElement
        short: NGS analysis results
        index: 337
        elements:
          tumorCellContent:
            type: BackboneElement
            short: Bioinformatic tumor cell content
            index: 338
            elements:
              id: {type: string, short: Result UUID, index: 339}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 340
                elements:
                  id: {type: string, short: Patient ID, index: 341}
                  type: {type: string, short: Reference type, index: 342}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 343
                elements:
                  id: {type: string, short: Specimen ID, index: 344}
                  type: {type: string, short: Reference type, index: 345}
                required: [id, type]
              method:
                type: BackboneElement
                short: Determination method
                index: 346
                elements:
                  code: {type: string, short: Method code (e.g. bioinformatic), index: 347}
                  display: {type: string, short: Method display, index: 348}
                  system: {type: string, short: Method system URI, index: 349}
                required: [system, code]
              value: {type: decimal, short: Fraction (0.0 – 1.0), index: 350}
            required: [method, id, value, specimen, patient]
          tmb:
            type: BackboneElement
            short: Tumor Mutational Burden
            index: 351
            elements:
              id: {type: string, short: TMB result UUID, index: 352}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 353
                elements:
                  id: {type: string, short: Patient ID, index: 354}
                  type: {type: string, short: Reference type, index: 355}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 356
                elements:
                  id: {type: string, short: Specimen ID, index: 357}
                  type: {type: string, short: Reference type, index: 358}
                required: [id, type]
              value:
                type: BackboneElement
                short: TMB quantity
                index: 359
                elements:
                  value: {type: decimal, short: Numeric value, index: 360}
                  unit: {type: string, short: Unit, index: 361}
                required: [value, unit]
              interpretation:
                type: BackboneElement
                short: TMB interpretation
                index: 362
                elements:
                  code: {type: string, short: Code (e.g. high), index: 363}
                  display: {type: string, short: Display, index: 364}
                  system: {type: string, short: System URI, index: 365}
                required: [system, code]
            required: [id, value, specimen, patient]
          brcaness:
            type: BackboneElement
            short: BRCAness score
            index: 366
            elements:
              id: {type: string, short: BRCAness result UUID, index: 367}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 368
                elements:
                  id: {type: string, short: Patient ID, index: 369}
                  type: {type: string, short: Reference type, index: 370}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 371
                elements:
                  id: {type: string, short: Specimen ID, index: 372}
                  type: {type: string, short: Reference type, index: 373}
                required: [id, type]
              value: {type: decimal, short: BRCAness score (0.0 – 1.0), index: 374}
              confidenceRange:
                type: BackboneElement
                short: Confidence range
                index: 375
                elements:
                  min: {type: decimal, short: Minimum, index: 376}
                  max: {type: decimal, short: Maximum, index: 377}
                required: [min, max]
            required: [id, value, specimen, patient]
          hrdScore:
            type: BackboneElement
            short: HRD Score
            index: 378
            elements:
              id: {type: string, short: HRD result UUID, index: 379}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 380
                elements:
                  id: {type: string, short: Patient ID, index: 381}
                  type: {type: string, short: Reference type, index: 382}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 383
                elements:
                  id: {type: string, short: Specimen ID, index: 384}
                  type: {type: string, short: Reference type, index: 385}
                required: [id, type]
              value: {type: decimal, short: HRD composite score, index: 386}
              components:
                type: BackboneElement
                short: HRD component scores
                index: 387
                elements:
                  lst: {type: decimal, short: LST score, index: 388}
                  loh: {type: decimal, short: LOH score, index: 389}
                  tai: {type: decimal, short: TAI score, index: 390}
              interpretation:
                type: BackboneElement
                short: HRD interpretation
                index: 391
                elements:
                  code: {type: string, short: Code (e.g. low), index: 392}
                  display: {type: string, short: Display, index: 393}
                  system: {type: string, short: System URI, index: 394}
                required: [system, code]
            required: [id, value, specimen, patient]
          simpleVariants:
            type: BackboneElement
            short: Simple variants (SNV / small indels)
            array: true
            index: 395
            elements:
              patient:
                type: BackboneElement
                short: Patient reference
                index: 397
                elements:
                  id: {type: string, short: Patient ID, index: 398}
                  type: {type: string, short: Reference type, index: 399}
                required: [id, type]
              chromosome: {type: string, short: Chromosome (e.g. chr4), index: 403}
              readDepth: {type: integer, short: Read depth, index: 423}
              interpretation:
                type: BackboneElement
                short: ClinVar interpretation
                index: 425
                elements:
                  code: {type: string, short: Interpretation code, index: 426}
                  display: {type: string, short: Interpretation display, index: 427}
                  system: {type: string, short: Interpretation system URI, index: 428}
                required: [system, code]
              transcriptId:
                type: BackboneElement
                short: Transcript identifier
                index: 412
                elements:
                  value: {type: string, short: Transcript ID (e.g. ENST...), index: 413}
                  system: {type: string, short: Transcript system URI, index: 414}
                required: [value, system]
              localization:
                type: BackboneElement
                short: Variant localization in gene
                array: true
                index: 408
                elements:
                  code: {type: string, short: Localization code, index: 409}
                  display: {type: string, short: Localization display, index: 410}
                  system: {type: string, short: Localization system URI, index: 411}
                required: [system, code]
              dnaChange: {type: string, short: cDNA change (HGVS), index: 421}
              externalIds:
                type: BackboneElement
                short: External identifiers (e.g. dbSNP)
                array: true
                index: 400
                elements:
                  value: {type: string, short: Identifier value, index: 401}
                  system: {type: string, short: Identifier system URI, index: 402}
                required: [value, system]
              allelicFrequency: {type: decimal, short: Allelic frequency, index: 424}
              id: {type: string, short: Variant UUID, index: 396}
              gene:
                type: BackboneElement
                short: Affected gene
                index: 404
                elements:
                  code: {type: string, short: HGNC gene code, index: 405}
                  display: {type: string, short: Gene symbol, index: 406}
                  system: {type: string, short: Gene nomenclature system URI, index: 407}
                required: [system, code]
              exonId: {type: string, short: Exon identifier, index: 415}
              position:
                type: BackboneElement
                short: Genomic position
                index: 416
                elements:
                  start: {type: integer, short: Start position, index: 417}
                  end: {type: integer, short: End position, index: 418}
                required: [start]
              refAllele: {type: string, short: Reference allele, index: 420}
              proteinChange: {type: string, short: Protein change (HGVS), index: 422}
              altAllele: {type: string, short: Alternate allele, index: 419}
            required: [chromosome, id, gene, altAllele, refAllele, patient]
          copyNumberVariants:
            type: BackboneElement
            short: Copy number variants
            array: true
            index: 429
            elements:
              patient:
                type: BackboneElement
                short: Patient reference
                index: 431
                elements:
                  id: {type: string, short: Patient ID, index: 432}
                  type: {type: string, short: Reference type, index: 433}
                required: [id, type]
              reportedAffectedGenes:
                type: BackboneElement
                short: Affected genes
                array: true
                index: 449
                elements:
                  code: {type: string, short: HGNC gene code, index: 450}
                  display: {type: string, short: Gene symbol, index: 451}
                  system: {type: string, short: Gene nomenclature system URI, index: 452}
                required: [system, code]
              chromosome: {type: string, short: Chromosome (e.g. chr7), index: 434}
              relativeCopyNumber: {type: decimal, short: Relative copy number, index: 446}
              focality:
                type: BackboneElement
                short: CNV focality
                index: 453
                elements:
                  code: {type: string, short: Focality code (e.g. focal), index: 454}
                  display: {type: string, short: Focality display, index: 455}
                  system: {type: string, short: Focality system URI, index: 456}
                required: [system, code]
              totalCopyNumber: {type: integer, short: Total copy number, index: 445}
              cnB: {type: integer, short: Copy number allele B, index: 448}
              startRange:
                type: BackboneElement
                short: Start position range
                index: 439
                elements:
                  start: {type: integer, short: Range start, index: 440}
                  end: {type: integer, short: Range end, index: 441}
                required: [start, end]
              localization:
                type: BackboneElement
                short: CNV localization
                array: true
                index: 435
                elements:
                  code: {type: string, short: Localization code, index: 436}
                  display: {type: string, short: Localization display, index: 437}
                  system: {type: string, short: Localization system URI, index: 438}
                required: [system, code]
              type:
                type: BackboneElement
                short: CNV type
                index: 457
                elements:
                  code: {type: string, short: CNV type code (e.g. gain), index: 458}
                  display: {type: string, short: CNV type display, index: 459}
                  system: {type: string, short: CNV type system URI, index: 460}
                required: [system, code]
              id: {type: string, short: CNV UUID, index: 430}
              endRange:
                type: BackboneElement
                short: End position range
                index: 442
                elements:
                  start: {type: integer, short: Range start, index: 443}
                  end: {type: integer, short: Range end, index: 444}
                required: [start, end]
              cnA: {type: integer, short: Copy number allele A, index: 447}
            required: [chromosome, id, type, patient]
          dnaFusions:
            type: BackboneElement
            short: DNA-level gene fusions
            array: true
            index: 461
            elements:
              id: {type: string, short: DNA fusion UUID, index: 462}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 463
                elements:
                  id: {type: string, short: Patient ID, index: 464}
                  type: {type: string, short: Reference type, index: 465}
                required: [id, type]
              localization:
                type: BackboneElement
                short: Fusion localization
                array: true
                index: 466
                elements:
                  code: {type: string, short: Localization code, index: 467}
                  display: {type: string, short: Localization display, index: 468}
                  system: {type: string, short: Localization system URI, index: 469}
                required: [system, code]
              fusionPartner5prime:
                type: BackboneElement
                short: 5-prime fusion partner
                index: 470
                elements:
                  gene:
                    type: BackboneElement
                    short: 5-prime partner gene
                    index: 471
                    elements:
                      code: {type: string, short: HGNC gene code, index: 472}
                      display: {type: string, short: Gene symbol, index: 473}
                      system: {type: string, short: Gene nomenclature system URI, index: 474}
                    required: [system, code]
                  position: {type: integer, short: Breakpoint position, index: 475}
                required: [gene, position]
              fusionPartner3prime:
                type: BackboneElement
                short: 3-prime fusion partner
                index: 476
                elements:
                  gene:
                    type: BackboneElement
                    short: 3-prime partner gene
                    index: 477
                    elements:
                      code: {type: string, short: HGNC gene code, index: 478}
                      display: {type: string, short: Gene symbol, index: 479}
                      system: {type: string, short: Gene nomenclature system URI, index: 480}
                    required: [system, code]
                  position: {type: integer, short: Breakpoint position, index: 481}
                required: [gene, position]
              reportedNumReads: {type: integer, short: Supporting read count, index: 482}
            required: [id, patient]
          rnaFusions:
            type: BackboneElement
            short: RNA-level gene fusions
            array: true
            index: 483
            elements:
              id: {type: string, short: RNA fusion UUID, index: 484}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 485
                elements:
                  id: {type: string, short: Patient ID, index: 486}
                  type: {type: string, short: Reference type, index: 487}
                required: [id, type]
              externalIds:
                type: BackboneElement
                short: External identifiers (e.g. COSMIC)
                array: true
                index: 488
                elements:
                  value: {type: string, short: Identifier value, index: 489}
                  system: {type: string, short: Identifier system URI, index: 490}
                required: [value, system]
              localization:
                type: BackboneElement
                short: Fusion localization
                array: true
                index: 491
                elements:
                  code: {type: string, short: Localization code, index: 492}
                  display: {type: string, short: Localization display, index: 493}
                  system: {type: string, short: Localization system URI, index: 494}
                required: [system, code]
              fusionPartner5prime:
                type: BackboneElement
                short: 5-prime fusion partner
                index: 495
                elements:
                  gene:
                    type: BackboneElement
                    short: 5-prime partner gene
                    index: 496
                    elements:
                      code: {type: string, short: HGNC gene code, index: 497}
                      display: {type: string, short: Gene symbol, index: 498}
                      system: {type: string, short: Gene nomenclature system URI, index: 499}
                    required: [system, code]
                  transcript:
                    type: BackboneElement
                    short: 5-prime transcript
                    index: 500
                    elements:
                      value: {type: string, short: Transcript ID (e.g. ENST...), index: 501}
                      system: {type: string, short: Transcript system URI, index: 502}
                    required: [value, system]
                  exon: {type: string, short: Exon identifier, index: 503}
                  position: {type: integer, short: Breakpoint position, index: 504}
                  strand: {type: string, short: Strand (+ or -), index: 505}
                required: [gene, position]
              fusionPartner3prime:
                type: BackboneElement
                short: 3-prime fusion partner
                index: 506
                elements:
                  gene:
                    type: BackboneElement
                    short: 3-prime partner gene
                    index: 507
                    elements:
                      code: {type: string, short: HGNC gene code, index: 508}
                      display: {type: string, short: Gene symbol, index: 509}
                      system: {type: string, short: Gene nomenclature system URI, index: 510}
                    required: [system, code]
                  transcript:
                    type: BackboneElement
                    short: 3-prime transcript
                    index: 511
                    elements:
                      value: {type: string, short: Transcript ID (e.g. ENST...), index: 512}
                      system: {type: string, short: Transcript system URI, index: 513}
                    required: [value, system]
                  exon: {type: string, short: Exon identifier, index: 514}
                  position: {type: integer, short: Breakpoint position, index: 515}
                  strand: {type: string, short: Strand (+ or -), index: 516}
                required: [gene, position]
              effect:
                type: BackboneElement
                short: RNA fusion effect
                index: 517
                elements:
                  code: {type: string, short: Effect code (e.g. in-frame), index: 518}
                  display: {type: string, short: Effect display, index: 519}
                  system: {type: string, short: Effect system URI, index: 520}
                required: [system, code]
              reportedNumReads: {type: integer, short: Supporting read count, index: 521}
            required: [id, patient]
    required: [id, results, issuedOn, specimen, type, patient]
  claims:
    type: BackboneElement
    short: Insurance / cost coverage claim entries
    array: true
    index: 605
    elements:
      id: {type: string, short: Claim UUID, index: 606}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 607
        elements:
          id: {type: string, short: Patient ID, index: 608}
          type: {type: string, short: Reference type (Patient), index: 609}
        required: [id, type]
      recommendation:
        type: BackboneElement
        short: Associated medication recommendation reference
        index: 610
        elements:
          id: {type: string, short: Recommendation ID, index: 611}
          type: {type: string, short: Reference type (MTBMedicationRecommendation), index: 612}
        required: [id, type]
      issuedOn: {type: string, short: Claim issue date (YYYY-MM-DD), index: 613}
    required: [id, issuedOn, recommendation, patient]
  diagnoses:
    type: BackboneElement
    short: MTB tumor diagnoses
    array: true
    index: 37
    elements:
      patient:
        type: BackboneElement
        short: Patient reference
        index: 39
        elements:
          id: {type: string, short: Patient ID, index: 40}
          type: {type: string, short: Reference type (Patient), index: 41}
        required: [id, type]
      histology:
        type: BackboneElement
        short: Histology report references
        array: true
        index: 91
        elements:
          id: {type: string, short: Histology report ID, index: 92}
          type: {type: string, short: Reference type (HistologyReport), index: 93}
        required: [id, type]
      guidelineTreatmentStatus:
        type: BackboneElement
        short: Guideline treatment exhaustion status
        index: 87
        elements:
          code: {type: string, short: Status code (e.g. non-exhausted), index: 88}
          display: {type: string, short: Status display, index: 89}
          system: {type: string, short: Status system URI, index: 90}
        required: [system, code]
      type:
        type: BackboneElement
        short: Diagnosis type history (main / secondary)
        index: 43
        elements:
          history:
            type: BackboneElement
            short: History entries for diagnosis type
            array: true
            index: 44
            elements:
              date: {type: string, short: Entry date, index: 45}
              value:
                type: BackboneElement
                short: Diagnosis type value
                index: 46
                elements:
                  code: {type: string, short: Type code (e.g. main), index: 47}
                  display: {type: string, short: Type display, index: 48}
                  system: {type: string, short: Type system URI, index: 49}
                required: [system, code]
      id: {type: string, short: Diagnosis UUID, index: 38}
      notes: {type: string, short: Free-text clinical notes, array: true, index: 94}
      recordedOn: {type: string, short: Date diagnosis was recorded (YYYY-MM-DD), index: 42}
      code:
        type: BackboneElement
        short: ICD-10-GM tumor diagnosis code
        index: 50
        elements:
          code: {type: string, short: ICD-10-GM code (e.g. C75.8), index: 51}
          display: {type: string, short: Diagnosis display text, index: 52}
          system: {type: string, short: ICD-10-GM code system URI, index: 53}
          version: {type: string, short: ICD-10-GM version year, index: 54}
        required: [system, code]
      staging:
        type: BackboneElement
        short: Tumor staging history
        index: 67
        elements:
          history:
            type: BackboneElement
            short: Staging history entries
            array: true
            index: 68
            elements:
              date: {type: string, short: Staging date, index: 69}
              method:
                type: BackboneElement
                short: Staging method
                index: 70
                elements:
                  code: {type: string, short: Method code (e.g. clinical), index: 71}
                  system: {type: string, short: Method system URI, index: 72}
                required: [system, code]
              tnmClassification:
                type: BackboneElement
                short: TNM classification
                index: 73
                elements:
                  tumor:
                    type: BackboneElement
                    short: T category
                    index: 74
                    elements:
                      code: {type: string, short: T code (e.g. T0), index: 75}
                      system: {type: string, short: TNM system (UICC), index: 76}
                    required: [system, code]
                  nodes:
                    type: BackboneElement
                    short: N category
                    index: 77
                    elements:
                      code: {type: string, short: N code (e.g. N2), index: 78}
                      system: {type: string, short: TNM system (UICC), index: 79}
                    required: [system, code]
                  metastasis:
                    type: BackboneElement
                    short: M category
                    index: 80
                    elements:
                      code: {type: string, short: M code (e.g. M0), index: 81}
                      system: {type: string, short: TNM system (UICC), index: 82}
                    required: [system, code]
              otherClassifications:
                type: BackboneElement
                short: Other classification systems
                array: true
                index: 83
                elements:
                  code: {type: string, short: Classification code, index: 84}
                  display: {type: string, short: Classification display, index: 85}
                  system: {type: string, short: Classification system URI, index: 86}
                required: [system, code]
      topography:
        type: BackboneElement
        short: ICD-O-3 topography code
        index: 55
        elements:
          code: {type: string, short: Topography code, index: 56}
          display: {type: string, short: Topography display, index: 57}
          system: {type: string, short: Topography system URI (ICD-O-3), index: 58}
          version: {type: string, short: ICD-O-3 version, index: 59}
        required: [system, code]
      grading:
        type: BackboneElement
        short: Tumor grading history
        index: 60
        elements:
          history:
            type: BackboneElement
            short: Grading history entries
            array: true
            index: 61
            elements:
              date: {type: string, short: Grading date, index: 62}
              codes:
                type: BackboneElement
                short: Grading codes
                array: true
                index: 63
                elements:
                  code: {type: string, short: Grade code, index: 64}
                  display: {type: string, short: Grade display, index: 65}
                  system: {type: string, short: Grading system URI, index: 66}
                required: [system, code]
    required: [id, patient, code]
  episodesOfCare:
    type: BackboneElement
    short: MTB episodes of care
    array: true
    index: 26
    elements:
      id: {type: string, short: Episode UUID, index: 27}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 28
        elements:
          id: {type: string, short: Patient ID, index: 29}
          type: {type: string, short: Reference type (Patient), index: 30}
        required: [id, type]
      period:
        type: BackboneElement
        short: Episode period
        index: 31
        elements:
          start: {type: string, short: Start date (YYYY-MM-DD), index: 32}
          end: {type: string, short: End date (YYYY-MM-DD), index: 33}
        required: [start]
      diagnoses:
        type: BackboneElement
        short: Diagnosis references within this episode
        array: true
        index: 34
        elements:
          id: {type: string, short: Diagnosis ID, index: 35}
          type: {type: string, short: Reference type (MTBDiagnosis), index: 36}
        required: [id, type]
    required: [id, patient]
  guidelineProcedures:
    type: BackboneElement
    short: Guideline-based non-medication procedures
    array: true
    index: 134
    elements:
      id: {type: string, short: Procedure UUID, index: 135}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 136
        elements:
          id: {type: string, short: Patient ID, index: 137}
          type: {type: string, short: Reference type (Patient), index: 138}
        required: [id, type]
      indication:
        type: BackboneElement
        short: Indication (MTBDiagnosis) reference
        index: 139
        elements:
          id: {type: string, short: Diagnosis ID, index: 140}
          type: {type: string, short: Reference type (MTBDiagnosis), index: 141}
        required: [id, type]
      code:
        type: BackboneElement
        short: Procedure type code
        index: 142
        elements:
          code: {type: string, short: Procedure code (e.g. radiotherapy), index: 143}
          display: {type: string, short: Procedure display, index: 144}
          system: {type: string, short: Procedure system URI, index: 145}
        required: [system, code]
      status:
        type: BackboneElement
        short: Procedure status
        index: 146
        elements:
          code: {type: string, short: Status code (e.g. ongoing), index: 147}
          display: {type: string, short: Status display, index: 148}
          system: {type: string, short: Status system URI, index: 149}
        required: [system, code]
      period:
        type: BackboneElement
        short: Procedure period
        index: 150
        elements:
          start: {type: string, short: Start date (YYYY-MM-DD), index: 151}
          end: {type: string, short: End date (YYYY-MM-DD), index: 152}
        required: [start]
      intent:
        type: BackboneElement
        short: Therapy intent
        index: 153
        elements:
          code: {type: string, short: Intent code (e.g. palliative), index: 154}
          display: {type: string, short: Intent display, index: 155}
          system: {type: string, short: Intent system URI, index: 156}
        required: [system, code]
      notes: {type: string, short: Free-text procedure notes, array: true, index: 157}
    required: [id, patient, code]
  guidelineTherapies:
    type: BackboneElement
    short: Guideline-based therapy entries
    array: true
    index: 104
    elements:
      patient:
        type: BackboneElement
        short: Patient reference
        index: 106
        elements:
          id: {type: string, short: Patient ID, index: 107}
          type: {type: string, short: Reference type (Patient), index: 108}
        required: [id, type]
      category:
        type: BackboneElement
        short: Therapy category
        index: 130
        elements:
          code: {type: string, short: Category code, index: 131}
          display: {type: string, short: Category display, index: 132}
          system: {type: string, short: Category system URI, index: 133}
        required: [system, code]
      indication:
        type: BackboneElement
        short: Indication (MTBDiagnosis) reference
        index: 109
        elements:
          id: {type: string, short: Diagnosis ID, index: 110}
          type: {type: string, short: Reference type (MTBDiagnosis), index: 111}
        required: [id, type]
      statusReason:
        type: BackboneElement
        short: Reason for therapy status
        index: 117
        elements:
          code: {type: string, short: Status reason code (e.g. progression), index: 118}
          display: {type: string, short: Status reason display, index: 119}
          system: {type: string, short: Status reason system URI, index: 120}
        required: [system, code]
      status:
        type: BackboneElement
        short: Therapy status
        index: 113
        elements:
          code: {type: string, short: Status code (e.g. stopped), index: 114}
          display: {type: string, short: Status display, index: 115}
          system: {type: string, short: Status system URI, index: 116}
        required: [system, code]
      therapyLine: {type: integer, short: Therapy line number, index: 112}
      id: {type: string, short: Therapy UUID, index: 105}
      notes: {type: string, short: Free-text therapy notes, array: true, index: 129}
      period:
        type: BackboneElement
        short: Therapy period
        index: 121
        elements:
          start: {type: string, short: Start date (YYYY-MM-DD), index: 122}
          end: {type: string, short: End date (YYYY-MM-DD), index: 123}
        required: [start]
      medication:
        type: BackboneElement
        short: Medication codes (ATC)
        array: true
        index: 124
        elements:
          code: {type: string, short: ATC code, index: 125}
          display: {type: string, short: Medication display name, index: 126}
          system: {type: string, short: ATC code system URI, index: 127}
          version: {type: string, short: ATC version, index: 128}
        required: [system, code]
    required: [id, patient]
  systemicTherapies:
    type: BackboneElement
    short: Systemic (molecular) therapy entries (each wraps a history)
    array: true
    index: 631
    elements:
      history:
        type: BackboneElement
        short: Therapy version history entries
        array: true
        index: 632
        elements:
          patient:
            type: BackboneElement
            short: Patient reference
            index: 634
            elements:
              id: {type: string, short: Patient ID, index: 635}
              type: {type: string, short: Reference type (Patient), index: 636}
            required: [id, type]
          indication:
            type: BackboneElement
            short: Indication reference
            index: 637
            elements:
              id: {type: string, short: Diagnosis ID, index: 638}
              type: {type: string, short: Reference type (MTBDiagnosis), index: 639}
            required: [id, type]
          statusReason:
            type: BackboneElement
            short: Reason for therapy status
            index: 648
            elements:
              code: {type: string, short: Status reason code, index: 649}
              display: {type: string, short: Status reason display, index: 650}
              system: {type: string, short: Status reason system URI, index: 651}
            required: [system, code]
          status:
            type: BackboneElement
            short: Therapy status
            index: 644
            elements:
              code: {type: string, short: Status code (e.g. completed), index: 645}
              display: {type: string, short: Status display, index: 646}
              system: {type: string, short: Status system URI, index: 647}
            required: [system, code]
          therapyLine: {type: integer, short: Therapy line number, index: 643}
          id: {type: string, short: Therapy entry UUID, index: 633}
          notes: {type: string, short: Free-text therapy notes, array: true, index: 660}
          period:
            type: BackboneElement
            short: Therapy period
            index: 652
            elements:
              start: {type: string, short: Start date (YYYY-MM-DD), index: 653}
              end: {type: string, short: End date (YYYY-MM-DD), index: 654}
            required: [start]
          basedOn:
            type: BackboneElement
            short: Medication recommendation reference
            index: 640
            elements:
              id: {type: string, short: Recommendation ID, index: 641}
              type: {type: string, short: Reference type (MTBMedicationRecommendation), index: 642}
            required: [id, type]
          medication:
            type: BackboneElement
            short: Medication codes (ATC)
            array: true
            index: 655
            elements:
              code: {type: string, short: ATC code, index: 656}
              display: {type: string, short: Medication display, index: 657}
              system: {type: string, short: ATC system URI, index: 658}
              version: {type: string, short: ATC version, index: 659}
            required: [system, code]
        required: [id, patient]
  responses:
    type: BackboneElement
    short: Therapy response assessments
    array: true
    index: 661
    elements:
      id: {type: string, short: Response UUID, index: 662}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 663
        elements:
          id: {type: string, short: Patient ID, index: 664}
          type: {type: string, short: Reference type (Patient), index: 665}
        required: [id, type]
      therapy:
        type: BackboneElement
        short: Associated systemic therapy reference
        index: 666
        elements:
          id: {type: string, short: Therapy ID, index: 667}
          type: {type: string, short: Reference type (MTBSystemicTherapy), index: 668}
        required: [id, type]
      effectiveDate: {type: string, short: Response assessment date (YYYY-MM-DD), index: 669}
      value:
        type: BackboneElement
        short: RECIST response category
        index: 670
        elements:
          code: {type: string, short: 'RECIST code (e.g. SD, PR, CR, PD)', index: 671}
          display: {type: string, short: RECIST display (e.g. Stable Disease), index: 672}
          system: {type: string, short: RECIST system (e.g. RECIST), index: 673}
        required: [system, code]
    required: [effectiveDate, id, value, patient, therapy]
  followUps:
    type: BackboneElement
    short: Follow-up visit entries
    array: true
    index: 590
    elements:
      id: {type: string, short: Follow-up UUID, index: 591}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 592
        elements:
          id: {type: string, short: Patient ID, index: 593}
          type: {type: string, short: Reference type (Patient), index: 594}
        required: [id, type]
      date: {type: string, short: Follow-up date (YYYY-MM-DD), index: 595}
      lastContactDate: {type: string, short: Date of last patient contact (YYYY-MM-DD), index: 596}
      patientStatus:
        type: BackboneElement
        short: Patient status at follow-up
        index: 597
        elements:
          code: {type: string, short: Status code (e.g. alive), index: 598}
          display: {type: string, short: Status display, index: 599}
          system: {type: string, short: Status system URI, index: 600}
        required: [system, code]
      claims:
        type: BackboneElement
        short: Claim references at follow-up
        array: true
        index: 601
        elements:
          id: {type: string, short: Claim ID, index: 602}
          type: {type: string, short: Reference type (Claim), index: 603}
        required: [id, type]
      therapyChanged: {type: boolean, short: Whether therapy was changed at this follow-up, index: 604}
    required: [id, date, patient]
  histologyReports:
    type: BackboneElement
    short: Histology report entries
    array: true
    index: 198
    elements:
      id: {type: string, short: Histology report UUID, index: 199}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 200
        elements:
          id: {type: string, short: Patient ID, index: 201}
          type: {type: string, short: Reference type (Patient), index: 202}
        required: [id, type]
      specimen:
        type: BackboneElement
        short: Tumor specimen reference
        index: 203
        elements:
          id: {type: string, short: Specimen ID, index: 204}
          type: {type: string, short: Reference type (TumorSpecimen), index: 205}
        required: [id, type]
      issuedOn: {type: string, short: Report issue date (YYYY-MM-DD), index: 206}
      results:
        type: BackboneElement
        short: Histology results
        index: 207
        elements:
          tumorCellContent:
            type: BackboneElement
            short: Histologic tumor cell content
            index: 208
            elements:
              id: {type: string, short: Result UUID, index: 209}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 210
                elements:
                  id: {type: string, short: Patient ID, index: 211}
                  type: {type: string, short: Reference type (Patient), index: 212}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 213
                elements:
                  id: {type: string, short: Specimen ID, index: 214}
                  type: {type: string, short: Reference type (TumorSpecimen), index: 215}
                required: [id, type]
              method:
                type: BackboneElement
                short: Determination method
                index: 216
                elements:
                  code: {type: string, short: Method code (e.g. histologic), index: 217}
                  display: {type: string, short: Method display, index: 218}
                  system: {type: string, short: Method system URI, index: 219}
                required: [system, code]
              value: {type: decimal, short: Tumor cell content fraction (0.0 – 1.0), index: 220}
            required: [id, value, specimen, patient]
          tumorMorphology:
            type: BackboneElement
            short: Tumor morphology
            index: 221
            elements:
              id: {type: string, short: Morphology result UUID, index: 222}
              patient:
                type: BackboneElement
                short: Patient reference
                index: 223
                elements:
                  id: {type: string, short: Patient ID, index: 224}
                  type: {type: string, short: Reference type (Patient), index: 225}
                required: [id, type]
              specimen:
                type: BackboneElement
                short: Specimen reference
                index: 226
                elements:
                  id: {type: string, short: Specimen ID, index: 227}
                  type: {type: string, short: Reference type (TumorSpecimen), index: 228}
                required: [id, type]
              morphology:
                type: BackboneElement
                short: ICD-O-3 morphology codes
                array: true
                index: 229
                elements:
                  code: {type: string, short: Morphology code, index: 230}
                  display: {type: string, short: Morphology display, index: 231}
                  system: {type: string, short: Morphology system URI (ICD-O-3), index: 232}
                  version: {type: string, short: ICD-O-3 version, index: 233}
                required: [system, code]
              notes: {type: string, short: Free-text morphology notes, array: true, index: 234}
            required: [id, specimen, patient]
    required: [id, issuedOn, specimen, patient]
  specimens:
    type: BackboneElement
    short: Tumor specimen entries
    array: true
    index: 168
    elements:
      id: {type: string, short: Specimen UUID, index: 169}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 170
        elements:
          id: {type: string, short: Patient ID, index: 171}
          type: {type: string, short: Reference type (Patient), index: 172}
        required: [id, type]
      diagnosis:
        type: BackboneElement
        short: Associated diagnosis reference
        index: 173
        elements:
          id: {type: string, short: Diagnosis ID, index: 174}
          type: {type: string, short: Reference type (MTBDiagnosis), index: 175}
        required: [id, type]
      type:
        type: BackboneElement
        short: Specimen type
        index: 176
        elements:
          code: {type: string, short: Specimen type code (e.g. fresh-tissue), index: 177}
          display: {type: string, short: Specimen type display, index: 178}
          system: {type: string, short: Specimen type system URI, index: 179}
        required: [system, code]
      collection:
        type: BackboneElement
        short: Specimen collection details
        index: 180
        elements:
          date: {type: string, short: Collection date (YYYY-MM-DD), index: 181}
          site:
            type: BackboneElement
            short: Collection site (ICD-O-3 topography)
            index: 182
            elements:
              code: {type: string, short: Site code, index: 183}
              display: {type: string, short: Site display, index: 184}
              system: {type: string, short: Site system URI, index: 185}
              version: {type: string, short: ICD-O-3 version, index: 186}
            required: [system, code]
          method:
            type: BackboneElement
            short: Collection method
            index: 187
            elements:
              code: {type: string, short: Method code (e.g. biopsy), index: 188}
              display: {type: string, short: Method display, index: 189}
              system: {type: string, short: Method system URI, index: 190}
            required: [system, code]
    required: [id, patient]
  priorDiagnosticReports:
    type: BackboneElement
    short: Prior diagnostic reports (free-text)
    array: true
    index: 191
    elements:
      id: {type: string, short: Report UUID, index: 192}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 193
        elements:
          id: {type: string, short: Patient ID, index: 194}
          type: {type: string, short: Reference type (Patient), index: 195}
        required: [id, type]
      issuedOn: {type: string, short: Report issue date (YYYY-MM-DD), index: 196}
      results: {type: string, short: Free-text diagnostic result strings, array: true, index: 197}
    required: [id, issuedOn, patient]
  msiFindings:
    type: BackboneElement
    short: Microsatellite instability (MSI) findings
    array: true
    index: 286
    elements:
      id: {type: string, short: MSI finding UUID, index: 287}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 288
        elements:
          id: {type: string, short: Patient ID, index: 289}
          type: {type: string, short: Reference type (Patient), index: 290}
        required: [id, type]
      specimen:
        type: BackboneElement
        short: Tumor specimen reference
        index: 291
        elements:
          id: {type: string, short: Specimen ID, index: 292}
          type: {type: string, short: Reference type (TumorSpecimen), index: 293}
        required: [id, type]
      ngsReport:
        type: BackboneElement
        short: Associated NGS report reference
        index: 294
        elements:
          id: {type: string, short: NGS report ID, index: 295}
          type: {type: string, short: Reference type (NGSReport), index: 296}
        required: [id, type]
      issuedOn: {type: string, short: Finding date (YYYY-MM-DD), index: 297}
      value:
        type: BackboneElement
        short: MSI result value
        index: 298
        elements:
          code: {type: string, short: MSI code (e.g. MSI-H), index: 299}
          display: {type: string, short: MSI display, index: 300}
          system: {type: string, short: MSI system URI, index: 301}
        required: [system, code]
      method:
        type: BackboneElement
        short: MSI determination method
        index: 302
        elements:
          code: {type: string, short: Method code (e.g. bioinformatics), index: 303}
          display: {type: string, short: Method display, index: 304}
          system: {type: string, short: Method system URI, index: 305}
        required: [system, code]
    required: [id, issuedOn, value, specimen, patient]
  carePlans:
    type: BackboneElement
    short: MTB care plans
    array: true
    index: 522
    elements:
      id: {type: string, short: Care plan UUID, index: 523}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 524
        elements:
          id: {type: string, short: Patient ID, index: 525}
          type: {type: string, short: Reference type (Patient), index: 526}
        required: [id, type]
      issuedOn: {type: string, short: Issue date (YYYY-MM-DD), index: 527}
      reason:
        type: BackboneElement
        short: Indication (MTBDiagnosis) reference
        index: 528
        elements:
          id: {type: string, short: Diagnosis ID, index: 529}
          type: {type: string, short: Reference type (MTBDiagnosis), index: 530}
        required: [id, type]
      noTargetFinding: {type: boolean, short: True when no actionable target was found, index: 531}
      geneticCounselingRecommendation:
        type: BackboneElement
        short: Genetic counselling recommendation
        index: 532
        elements:
          id: {type: string, short: Recommendation UUID, index: 533}
          patient:
            type: BackboneElement
            short: Patient reference
            index: 534
            elements:
              id: {type: string, short: Patient ID, index: 535}
              type: {type: string, short: Reference type (Patient), index: 536}
            required: [id, type]
          issuedOn: {type: string, short: Recommendation date (YYYY-MM-DD), index: 537}
          reason:
            type: BackboneElement
            short: Counselling reason
            index: 538
            elements:
              code: {type: string, short: Reason code, index: 539}
              display: {type: string, short: Reason display, index: 540}
              system: {type: string, short: Reason system URI, index: 541}
            required: [system, code]
        required: [id, issuedOn, patient]
      medicationRecommendations:
        type: BackboneElement
        short: Medication therapy recommendations
        array: true
        index: 542
        elements:
          id: {type: string, short: Recommendation UUID, index: 543}
          patient:
            type: BackboneElement
            short: Patient reference
            index: 544
            elements:
              id: {type: string, short: Patient ID, index: 545}
              type: {type: string, short: Reference type (Patient), index: 546}
            required: [id, type]
          issuedOn: {type: string, short: Recommendation date (YYYY-MM-DD), index: 547}
          indication:
            type: BackboneElement
            short: Indication reference
            index: 548
            elements:
              id: {type: string, short: Diagnosis ID, index: 549}
              type: {type: string, short: Reference type (MTBDiagnosis), index: 550}
            required: [id, type]
          priority:
            type: BackboneElement
            short: Recommendation priority
            index: 551
            elements:
              code: {type: string, short: Priority code (e.g. 1), index: 552}
              display: {type: string, short: Priority display, index: 553}
              system: {type: string, short: Priority system URI, index: 554}
            required: [system, code]
          medication:
            type: BackboneElement
            short: Recommended medications (ATC)
            array: true
            index: 555
            elements:
              code: {type: string, short: ATC code, index: 556}
              display: {type: string, short: Medication display, index: 557}
              system: {type: string, short: ATC system URI, index: 558}
              version: {type: string, short: ATC version, index: 559}
            required: [system, code]
          supportingVariants:
            type: BackboneElement
            short: Supporting variants
            array: true
            index: 560
            elements:
              id: {type: string, short: Variant ID, index: 561}
              type: {type: string, short: Variant type (SNV | CNV | DNAFusion | RNAFusion), index: 562}
            required: [id, type]
          levelOfEvidence:
            type: BackboneElement
            short: Level of evidence
            index: 563
            elements:
              grading:
                type: BackboneElement
                short: Evidence grading
                index: 564
                elements:
                  code: {type: string, short: Grade code (e.g. m1A), index: 565}
                  display: {type: string, short: Grade display, index: 566}
                  system: {type: string, short: Grade system URI, index: 567}
                required: [system, code]
              addendums:
                type: BackboneElement
                short: Evidence addendums
                array: true
                index: 568
                elements:
                  code: {type: string, short: Addendum code, index: 569}
                  display: {type: string, short: Addendum display, index: 570}
                  system: {type: string, short: Addendum system URI, index: 571}
                required: [system, code]
              publications:
                type: BackboneElement
                short: Supporting publications
                array: true
                index: 572
                elements:
                  pmid: {type: string, short: PubMed ID, index: 573}
                  doi: {type: string, short: Digital Object Identifier, index: 574}
        required: [id, issuedOn, patient]
      studyEnrollmentRecommendations:
        type: BackboneElement
        short: Study enrollment recommendations
        array: true
        index: 575
        elements:
          id: {type: string, short: Recommendation UUID, index: 576}
          patient:
            type: BackboneElement
            short: Patient reference
            index: 577
            elements:
              id: {type: string, short: Patient ID, index: 578}
              type: {type: string, short: Reference type (Patient), index: 579}
            required: [id, type]
          issuedOn: {type: string, short: Recommendation date (YYYY-MM-DD), index: 580}
          indication:
            type: BackboneElement
            short: Indication reference
            index: 581
            elements:
              id: {type: string, short: Diagnosis ID, index: 582}
              type: {type: string, short: Reference type (MTBDiagnosis), index: 583}
            required: [id, type]
          supportingVariants:
            type: BackboneElement
            short: Supporting variants
            array: true
            index: 584
            elements:
              id: {type: string, short: Variant ID, index: 585}
              type: {type: string, short: Variant type, index: 586}
            required: [id, type]
          studies:
            type: BackboneElement
            short: Recommended studies
            array: true
            index: 587
            elements:
              id: {type: string, short: Study ID (e.g. NCT number), index: 588}
              system: {type: string, short: Study registry system URI, index: 589}
            required: [id, system]
        required: [id, issuedOn, patient]
    required: [id, issuedOn, patient]
  familyMemberHistories:
    type: BackboneElement
    short: Family member cancer history entries
    array: true
    index: 95
    elements:
      id: {type: string, short: Family member history UUID, index: 96}
      patient:
        type: BackboneElement
        short: Patient reference
        index: 97
        elements:
          id: {type: string, short: Patient ID, index: 98}
          type: {type: string, short: Reference type (Patient), index: 99}
        required: [id, type]
      relationship:
        type: BackboneElement
        short: Family relationship type
        index: 100
        elements:
          code: {type: string, short: Relationship code, index: 101}
          display: {type: string, short: Relationship display, index: 102}
          system: {type: string, short: Relationship system URI, index: 103}
        required: [system, code]
    required: [id, relationship, patient]
package_version: 2027.0.0-ballot.1
class: logical
kind: logical
url: https://dnpm-dip.net/fhir/StructureDefinition/dnpm-lm-patient-record
base: http://hl7.org/fhir/StructureDefinition/Element
version: 2027.0.0-ballot.1
required: [patient]