{
  "description": "Information and data communicated to the performing site that may affect execution of the order or interpretation of the results.",
  "_filename": "StructureDefinition-LMEnClinicalInformationCz.json",
  "package_name": "hl7.fhir.cz.order",
  "date": "2026-10-17T08:41:28+02:00",
  "derivation": "specialization",
  "publisher": "HL7 Czech Republic",
  "fhirVersion": "4.0.1",
  "jurisdiction": [ {
    "coding": [ {
      "code": "CZ",
      "system": "urn:iso:std:iso:3166",
      "display": "Czechia"
    } ]
  } ],
  "name": "LMEnOrderClinicalInformationCz",
  "abstract": false,
  "type": "https://hl7.cz/fhir/order/StructureDefinition/LMEnClinicalInformationCz",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": "A.3.1 - Clinical Information (Medical History)",
  "package_version": "1.0.0",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger": 2
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode": "trial-use"
  } ],
  "snapshot": {
    "element": [ {
      "id": "LMEnClinicalInformationCz",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "Base"
      },
      "path": "LMEnClinicalInformationCz",
      "short": "A.3.1 - Clinical Information (Medical History)",
      "definition": "Information and data communicated to the performing site that may affect execution of the order or interpretation of the results.",
      "isModifier": false
    }, {
      "id": "LMEnClinicalInformationCz.clinicalInformationText",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.clinicalInformationText"
      },
      "path": "LMEnClinicalInformationCz.clinicalInformationText",
      "type": [ {
        "code": "string"
      } ],
      "short": "A.3.1.1 - Clinical information in free text",
      "definition": "Clinical information necessary for correct execution of the order or interpretation of the results."
    }, {
      "id": "LMEnClinicalInformationCz.clinicalInformationCode",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.clinicalInformationCode"
      },
      "path": "LMEnClinicalInformationCz.clinicalInformationCode",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.2 - Clinical information (medical history), formalized",
      "definition": "Formalized clinical information (medical history)."
    }, {
      "id": "LMEnClinicalInformationCz.description",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "LMEnClinicalInformationCz.description"
      },
      "path": "LMEnClinicalInformationCz.description",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.3 - Description of problem / diagnosis / condition",
      "definition": "Diagnoses and other clinical information affecting the course or outcome of the examination.\n- Preferred systems: ICD-10\n- Preferred systems: Orphacode"
    }, {
      "id": "LMEnClinicalInformationCz.medication",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "LMEnClinicalInformationCz.medication"
      },
      "path": "LMEnClinicalInformationCz.medication",
      "type": [ {
        "code": "Base"
      } ],
      "short": "A.3.1.4 - Medication",
      "definition": "Medication block containing information on medication affecting the course or outcome of the examination or its interpretation.\n- Preferred systems: DLP\n- Preferred systems: ATC"
    }, {
      "id": "LMEnClinicalInformationCz.medication.id",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "LMEnClinicalInformationCz.medication.id"
      },
      "path": "LMEnClinicalInformationCz.medication.id",
      "type": [ {
        "code": "Identifier"
      } ],
      "short": "A.3.1.4.1 - Medication ID",
      "definition": "Medication ID."
    }, {
      "id": "LMEnClinicalInformationCz.medication.code",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "LMEnClinicalInformationCz.medication.code"
      },
      "path": "LMEnClinicalInformationCz.medication.code",
      "type": [ {
        "code": "code"
      } ],
      "short": "A.3.1.4.2 - Medication code",
      "definition": "Medication code."
    }, {
      "id": "LMEnClinicalInformationCz.medication.quantity",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.medication.quantity"
      },
      "path": "LMEnClinicalInformationCz.medication.quantity",
      "type": [ {
        "code": "Ratio"
      } ],
      "short": "A.3.1.4.3 - Quantity",
      "definition": "Medication quantity."
    }, {
      "id": "LMEnClinicalInformationCz.vaccination",
      "max": "*",
      "min": 0,
      "base": {
        "max": "*",
        "min": 0,
        "path": "LMEnClinicalInformationCz.vaccination"
      },
      "path": "LMEnClinicalInformationCz.vaccination",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.5 - Vaccination",
      "definition": "Vaccination."
    }, {
      "id": "LMEnClinicalInformationCz.additionalData",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.additionalData"
      },
      "path": "LMEnClinicalInformationCz.additionalData",
      "type": [ {
        "code": "Base"
      } ],
      "short": "A.3.1.6 - Additional formalized data",
      "definition": "A.3.1.6 - Additional formalized data"
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.date",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.additionalData.date"
      },
      "path": "LMEnClinicalInformationCz.additionalData.date",
      "type": [ {
        "code": "dateTime"
      } ],
      "short": "A.3.1.6.1 - Date",
      "definition": "Date when the data was determined; provided if different from the order issue date."
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.code",
      "max": "1",
      "min": 1,
      "base": {
        "max": "1",
        "min": 1,
        "path": "LMEnClinicalInformationCz.additionalData.code"
      },
      "path": "LMEnClinicalInformationCz.additionalData.code",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.6.2 - Code",
      "definition": "Observation code identifying the meaning of the data item (height, weight, week of pregnancy, etc.).\n- Preferred systems: NCLP\n- Preferred systems: SNOMED CT"
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.value",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "LMEnClinicalInformationCz.additionalData.value"
      },
      "path": "LMEnClinicalInformationCz.additionalData.value",
      "type": [ {
        "code": "Narrative"
      } ],
      "short": "A.3.1.6.3 - Value",
      "definition": "Value of the data item including measurement unit."
    } ],
    "extension": [ {
      "url": "http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version",
      "valueString": "4.0.1"
    } ]
  },
  "status": "active",
  "id": "62a11cc5-7ac2-4cc0-a6e0-04cf02c7bacb",
  "kind": "logical",
  "url": "https://hl7.cz/fhir/order/StructureDefinition/LMEnClinicalInformationCz",
  "version": "1.0.0",
  "differential": {
    "element": [ {
      "id": "LMEnClinicalInformationCz",
      "path": "LMEnClinicalInformationCz",
      "short": "A.3.1 - Clinical Information (Medical History)",
      "definition": "Information and data communicated to the performing site that may affect execution of the order or interpretation of the results."
    }, {
      "id": "LMEnClinicalInformationCz.clinicalInformationText",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.clinicalInformationText",
      "type": [ {
        "code": "string"
      } ],
      "short": "A.3.1.1 - Clinical information in free text",
      "definition": "Clinical information necessary for correct execution of the order or interpretation of the results."
    }, {
      "id": "LMEnClinicalInformationCz.clinicalInformationCode",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.clinicalInformationCode",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.2 - Clinical information (medical history), formalized",
      "definition": "Formalized clinical information (medical history)."
    }, {
      "id": "LMEnClinicalInformationCz.description",
      "max": "*",
      "min": 0,
      "path": "LMEnClinicalInformationCz.description",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.3 - Description of problem / diagnosis / condition",
      "definition": "Diagnoses and other clinical information affecting the course or outcome of the examination.\n- Preferred systems: ICD-10\n- Preferred systems: Orphacode"
    }, {
      "id": "LMEnClinicalInformationCz.medication",
      "max": "*",
      "min": 0,
      "path": "LMEnClinicalInformationCz.medication",
      "type": [ {
        "code": "Base"
      } ],
      "short": "A.3.1.4 - Medication",
      "definition": "Medication block containing information on medication affecting the course or outcome of the examination or its interpretation.\n- Preferred systems: DLP\n- Preferred systems: ATC"
    }, {
      "id": "LMEnClinicalInformationCz.medication.id",
      "max": "*",
      "min": 0,
      "path": "LMEnClinicalInformationCz.medication.id",
      "type": [ {
        "code": "Identifier"
      } ],
      "short": "A.3.1.4.1 - Medication ID",
      "definition": "Medication ID."
    }, {
      "id": "LMEnClinicalInformationCz.medication.code",
      "max": "*",
      "min": 0,
      "path": "LMEnClinicalInformationCz.medication.code",
      "type": [ {
        "code": "code"
      } ],
      "short": "A.3.1.4.2 - Medication code",
      "definition": "Medication code."
    }, {
      "id": "LMEnClinicalInformationCz.medication.quantity",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.medication.quantity",
      "type": [ {
        "code": "Ratio"
      } ],
      "short": "A.3.1.4.3 - Quantity",
      "definition": "Medication quantity."
    }, {
      "id": "LMEnClinicalInformationCz.vaccination",
      "max": "*",
      "min": 0,
      "path": "LMEnClinicalInformationCz.vaccination",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.5 - Vaccination",
      "definition": "Vaccination."
    }, {
      "id": "LMEnClinicalInformationCz.additionalData",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.additionalData",
      "type": [ {
        "code": "Base"
      } ],
      "short": "A.3.1.6 - Additional formalized data",
      "definition": "A.3.1.6 - Additional formalized data"
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.date",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.additionalData.date",
      "type": [ {
        "code": "dateTime"
      } ],
      "short": "A.3.1.6.1 - Date",
      "definition": "Date when the data was determined; provided if different from the order issue date."
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.code",
      "max": "1",
      "min": 1,
      "path": "LMEnClinicalInformationCz.additionalData.code",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "short": "A.3.1.6.2 - Code",
      "definition": "Observation code identifying the meaning of the data item (height, weight, week of pregnancy, etc.).\n- Preferred systems: NCLP\n- Preferred systems: SNOMED CT"
    }, {
      "id": "LMEnClinicalInformationCz.additionalData.value",
      "max": "1",
      "min": 0,
      "path": "LMEnClinicalInformationCz.additionalData.value",
      "type": [ {
        "code": "Narrative"
      } ],
      "short": "A.3.1.6.3 - Value",
      "definition": "Value of the data item including measurement unit."
    } ]
  },
  "contact": [ {
    "name": "HL7 Czech Republic",
    "telecom": [ {
      "value": "https://www.hl7.cz/",
      "system": "url"
    } ]
  } ],
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Base"
}