{
"description": "Histologie: Befund. Vollständiger Befundbericht des Pathologen.",
"_filename": "StructureDefinition-mii-pr-onko-befund.json",
"package_name": "de.medizininformatikinitiative.kerndatensatz.onkologie",
"date": null,
"derivation": "constraint",
"publisher": "Medizininformatik Initiative",
"fhirVersion": "4.0.1",
"name": "MII_PR_Onko_Befund",
"mapping": [ {
"name": "Mapping FHIR zu oBDS",
"identity": "oBDS"
} ],
"abstract": false,
"type": "DiagnosticReport",
"experimental": null,
"resourceType": "StructureDefinition",
"title": "MII PR Onkologie Befund",
"package_version": "2025.0.2",
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-3",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"
}, {
"key": "dom-6",
"human": "A resource should have narrative for robust management",
"xpath": "exists(f:text/h:div)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "warning",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
} ],
"expression": "text.`div`.exists()"
}, {
"key": "dom-5",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
"severity": "error",
"expression": "contained.meta.security.empty()"
} ],
"path": "DiagnosticReport",
"min": 0,
"definition": "The findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.",
"short": "A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Event",
"identity": "workflow"
}, {
"map": "ORU -> OBR",
"identity": "v2"
}, {
"map": "Observation[classCode=OBS, moodCode=EVN]",
"identity": "rim"
} ],
"alias": [ "Report", "Test", "Result", "Results", "Labs", "Laboratory" ],
"max": "*",
"id": "DiagnosticReport",
"comment": "This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport"
}
}, {
"path": "DiagnosticReport.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"short": "Logical id of this artifact",
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"max": "1",
"id": "DiagnosticReport.id",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
"short": "Metadata about the resource",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Meta"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "1",
"id": "DiagnosticReport.meta",
"condition": [ "ele-1" ],
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"path": "DiagnosticReport.meta.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.meta.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.meta.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.meta.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.versionId",
"min": 0,
"definition": "The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.",
"short": "Version specific identifier",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "DiagnosticReport.meta.versionId",
"condition": [ "ele-1" ],
"comment": "The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.",
"base": {
"max": "1",
"min": 0,
"path": "Meta.versionId"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.lastUpdated",
"min": 0,
"definition": "When the resource last changed - e.g. when the version changed.",
"short": "When the resource version last changed",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "instant"
} ],
"max": "1",
"id": "DiagnosticReport.meta.lastUpdated",
"condition": [ "ele-1" ],
"comment": "This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http.html#read) interaction.",
"base": {
"max": "1",
"min": 0,
"path": "Meta.lastUpdated"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.source",
"min": 0,
"definition": "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.",
"short": "Identifies where the resource comes from",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "DiagnosticReport.meta.source",
"condition": [ "ele-1" ],
"comment": "In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. \n\nThis element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.",
"base": {
"max": "1",
"min": 0,
"path": "Meta.source"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.profile",
"min": 0,
"definition": "A list of profiles (references to [StructureDefinition](structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](structuredefinition-definitions.html#StructureDefinition.url).",
"short": "Profiles this resource claims to conform to",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "canonical",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ]
} ],
"mustSupport": true,
"max": "*",
"id": "DiagnosticReport.meta.profile",
"condition": [ "ele-1" ],
"comment": "It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.profile"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.security",
"min": 0,
"definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
"short": "Security Labels applied to this resource",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6",
"identity": "v2"
}, {
"map": "CV",
"identity": "rim"
}, {
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding",
"identity": "orim"
} ],
"type": [ {
"code": "Coding"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"binding": {
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/security-labels",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "SecurityLabels"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "Security Labels from the Healthcare Privacy and Security Classification System."
},
"max": "*",
"id": "DiagnosticReport.meta.security",
"condition": [ "ele-1" ],
"comment": "The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.security"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.meta.tag",
"min": 0,
"definition": "Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.",
"short": "Tags applied to this resource",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6",
"identity": "v2"
}, {
"map": "CV",
"identity": "rim"
}, {
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding",
"identity": "orim"
} ],
"type": [ {
"code": "Coding"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/common-tags",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Tags"
} ],
"description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\"."
},
"max": "*",
"id": "DiagnosticReport.meta.tag",
"condition": [ "ele-1" ],
"comment": "The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.",
"base": {
"max": "*",
"min": 0,
"path": "Meta.tag"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "DiagnosticReport.implicitRules",
"condition": [ "ele-1" ],
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"short": "Language of the resource content",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/languages",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language."
},
"max": "1",
"id": "DiagnosticReport.language",
"condition": [ "ele-1" ],
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
}, {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "DiagnosticReport.text",
"condition": [ "ele-1" ],
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
}
}, {
"path": "DiagnosticReport.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"short": "Contained, inline Resources",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "DiagnosticReport.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.modifierExtension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.identifier",
"requirements": "Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.",
"min": 0,
"definition": "Identifiers assigned to this report by the performer or other systems.",
"short": "Business identifier for report",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
"identity": "v2"
}, {
"map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]",
"identity": "rim"
}, {
"map": "Identifier",
"identity": "servd"
}, {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "FiveWs.identifier",
"identity": "w5"
}, {
"map": "OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4",
"identity": "v2"
}, {
"map": "id",
"identity": "rim"
} ],
"type": [ {
"code": "Identifier"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "ReportID", "Filler ID", "Placer ID" ],
"max": "*",
"id": "DiagnosticReport.identifier",
"condition": [ "ele-1" ],
"comment": "Usually assigned by the Information System of the diagnostic service provider (filler id).",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.identifier"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.basedOn",
"requirements": "This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.",
"min": 0,
"definition": "Details concerning a service requested.",
"short": "What was requested",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.basedOn",
"identity": "workflow"
}, {
"map": "ORC? OBR-2/3?",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=FLFS].target",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
},
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/CarePlan", "http://hl7.org/fhir/StructureDefinition/ImmunizationRecommendation", "http://hl7.org/fhir/StructureDefinition/MedicationRequest", "http://hl7.org/fhir/StructureDefinition/NutritionOrder", "http://hl7.org/fhir/StructureDefinition/ServiceRequest" ]
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Request" ],
"max": "*",
"id": "DiagnosticReport.basedOn",
"condition": [ "ele-1" ],
"comment": "Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.basedOn"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.basedOn",
"requirements": "This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.",
"min": 0,
"definition": "Details concerning a service requested.",
"short": "What was requested",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.basedOn",
"identity": "workflow"
}, {
"map": "ORC? OBR-2/3?",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=FLFS].target",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz", "http://hl7.org/fhir/StructureDefinition/CarePlan" ]
} ],
"mustSupport": true,
"sliceName": "tumorkonferenz",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Request" ],
"max": "1",
"id": "DiagnosticReport.basedOn:tumorkonferenz",
"condition": [ "ele-1" ],
"comment": "Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.basedOn"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.status",
"requirements": "Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.",
"min": 1,
"definition": "The status of the diagnostic report.",
"isModifier": true,
"short": "registered | partial | preliminary | final +",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "FiveWs.status",
"identity": "w5"
}, {
"map": "OBR-25 (not 1:1 mapping)",
"identity": "v2"
}, {
"map": "statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type \"revise\"",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"valueSet": "http://hl7.org/fhir/ValueSet/diagnostic-report-status|4.0.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosticReportStatus"
} ],
"description": "The status of the diagnostic report."
},
"max": "1",
"id": "DiagnosticReport.status",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"base": {
"max": "1",
"min": 1,
"path": "DiagnosticReport.status"
},
"isModifierReason": "This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.category",
"min": 0,
"definition": "A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.",
"short": "Service category",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "FiveWs.class",
"identity": "w5"
}, {
"map": "OBR-24",
"identity": "v2"
}, {
"map": "inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/diagnostic-service-sections",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosticServiceSection"
} ],
"description": "Codes for diagnostic service sections."
},
"alias": [ "Department", "Sub-department", "Service", "Discipline" ],
"max": "*",
"id": "DiagnosticReport.category",
"condition": [ "ele-1" ],
"comment": "Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.category"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code",
"min": 1,
"definition": "A code or name that describes this diagnostic report.",
"short": "Pathology report code",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "Event.code",
"identity": "workflow"
}, {
"map": "FiveWs.what[x]",
"identity": "w5"
}, {
"map": "OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)",
"identity": "v2"
}, {
"map": "code",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"binding": {
"strength": "preferred",
"valueSet": "http://hl7.org/fhir/ValueSet/report-codes",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "DiagnosticReportCodes"
} ],
"description": "Codes that describe Diagnostic Reports."
},
"alias": [ "Type" ],
"max": "1",
"id": "DiagnosticReport.code",
"condition": [ "ele-1" ],
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"base": {
"max": "1",
"min": 1,
"path": "DiagnosticReport.code"
},
"isSummary": true
}, {
"path": "DiagnosticReport.code.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.code.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.code.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.code.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
"min": 1,
"definition": "A reference to a code defined by a terminology system.",
"short": "Code defined by a terminology system",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6",
"identity": "v2"
}, {
"map": "CV",
"identity": "rim"
}, {
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding",
"identity": "orim"
}, {
"map": "C*E.1-8, C*E.10-22",
"identity": "v2"
}, {
"map": "union(., ./translation)",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding",
"identity": "orim"
} ],
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
},
"type": [ {
"code": "Coding"
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "*",
"id": "DiagnosticReport.code.coding",
"condition": [ "ele-1" ],
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"base": {
"max": "*",
"min": 0,
"path": "CodeableConcept.coding"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
"min": 1,
"definition": "A reference to a code defined by a terminology system.",
"short": "Code defined by a terminology system",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6",
"identity": "v2"
}, {
"map": "CV",
"identity": "rim"
}, {
"map": "fhir:Coding rdfs:subClassOf dt:CDCoding",
"identity": "orim"
}, {
"map": "C*E.1-8, C*E.10-22",
"identity": "v2"
}, {
"map": "union(., ./translation)",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding",
"identity": "orim"
} ],
"type": [ {
"code": "Coding"
} ],
"mustSupport": true,
"sliceName": "pathology-report",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report",
"condition": [ "ele-1" ],
"comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
"patternCoding": {
"code": "22034-3",
"system": "http://loinc.org"
},
"base": {
"max": "*",
"min": 0,
"path": "CodeableConcept.coding"
},
"isSummary": true
}, {
"path": "DiagnosticReport.code.coding.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.code.coding.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.code.coding:pathology-report.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding.system",
"requirements": "Need to be unambiguous about the source of the definition of the symbol.",
"min": 1,
"definition": "The identification of the code system that defines the meaning of the symbol in the code.",
"short": "Identity of the terminology system",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C*E.3",
"identity": "v2"
}, {
"map": "./codeSystem",
"identity": "rim"
}, {
"map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem",
"identity": "orim"
} ],
"type": [ {
"code": "uri"
} ],
"mustSupport": true,
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.system",
"condition": [ "ele-1" ],
"comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.",
"base": {
"max": "1",
"min": 0,
"path": "Coding.system"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding.version",
"min": 0,
"definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
"short": "Version of the system - if relevant",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C*E.7",
"identity": "v2"
}, {
"map": "./codeSystemVersion",
"identity": "rim"
}, {
"map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion",
"identity": "orim"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.version",
"condition": [ "ele-1" ],
"comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
"base": {
"max": "1",
"min": 0,
"path": "Coding.version"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding.code",
"requirements": "Need to refer to a particular code in the system.",
"min": 1,
"definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
"short": "Symbol in syntax defined by the system",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C*E.1",
"identity": "v2"
}, {
"map": "./code",
"identity": "rim"
}, {
"map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code",
"identity": "orim"
} ],
"type": [ {
"code": "code"
} ],
"mustSupport": true,
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.code",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coding.code"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding.display",
"requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know the system.",
"min": 0,
"definition": "A representation of the meaning of the code in the system, following the rules of the system.",
"short": "Representation defined by the system",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C*E.2 - but note this is not well followed",
"identity": "v2"
}, {
"map": "CV.displayName",
"identity": "rim"
}, {
"map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName",
"identity": "orim"
} ],
"type": [ {
"code": "string"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
} ],
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.display",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coding.display"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.coding.userSelected",
"requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
"min": 0,
"definition": "Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).",
"short": "If this coding was chosen directly by the user",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "Sometimes implied by being first",
"identity": "v2"
}, {
"map": "CD.codingRationale",
"identity": "rim"
}, {
"map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [ fhir:source \"true\"; fhir:target dt:CDCoding.codingRationale\\#O ]",
"identity": "orim"
} ],
"type": [ {
"code": "boolean"
} ],
"max": "1",
"id": "DiagnosticReport.code.coding:pathology-report.userSelected",
"condition": [ "ele-1" ],
"comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
"base": {
"max": "1",
"min": 0,
"path": "Coding.userSelected"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.code.text",
"requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
"min": 0,
"definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
"short": "Plain text representation of the concept",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C*E.9. But note many systems use C*E.2 for this",
"identity": "v2"
}, {
"map": "./originalText[mediaType/code=\"text/plain\"]/data",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText",
"identity": "orim"
} ],
"type": [ {
"code": "string"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
} ],
"max": "1",
"id": "DiagnosticReport.code.text",
"condition": [ "ele-1" ],
"comment": "Very often the text is the same as a displayName of one of the codings.",
"base": {
"max": "1",
"min": 0,
"path": "CodeableConcept.text"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.subject",
"requirements": "SHALL know the subject context.",
"min": 1,
"definition": "The subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.",
"short": "The subject of the report - usually, but not always, the patient",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "FiveWs.subject[x]",
"identity": "w5"
}, {
"map": "PID-3 (no HL7 v2 mapping for Group or Device)",
"identity": "v2"
}, {
"map": "participation[typeCode=SBJ]",
"identity": "rim"
}, {
"map": "FiveWs.subject",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Patient" ],
"max": "1",
"id": "DiagnosticReport.subject",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.subject"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.encounter",
"requirements": "Links the request to the Encounter context.",
"min": 0,
"definition": "The healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.",
"short": "Health care event when test ordered",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.encounter",
"identity": "workflow"
}, {
"map": "FiveWs.context",
"identity": "w5"
}, {
"map": "PV1-19",
"identity": "v2"
}, {
"map": "inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ]
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Context" ],
"max": "1",
"id": "DiagnosticReport.encounter",
"condition": [ "ele-1" ],
"comment": "This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.encounter"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.effective[x]",
"requirements": "Need to know where in the patient history to file/present this report.",
"min": 0,
"definition": "The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.",
"short": "Clinically relevant time/time-period for report",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "Event.occurrence[x]",
"identity": "workflow"
}, {
"map": "FiveWs.done[x]",
"identity": "w5"
}, {
"map": "OBR-7",
"identity": "v2"
}, {
"map": "effectiveTime",
"identity": "rim"
} ],
"type": [ {
"code": "dateTime"
}, {
"code": "Period"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Observation time", "Effective Time", "Occurrence" ],
"max": "1",
"id": "DiagnosticReport.effective[x]",
"condition": [ "ele-1" ],
"comment": "If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.effective[x]"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.issued",
"requirements": "Clinicians need to be able to check the date that the report was released.",
"min": 0,
"definition": "The date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.",
"short": "DateTime this version was made",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "FiveWs.recorded",
"identity": "w5"
}, {
"map": "OBR-22",
"identity": "v2"
}, {
"map": "participation[typeCode=VRF or AUT].time",
"identity": "rim"
} ],
"type": [ {
"code": "instant"
} ],
"alias": [ "Date published", "Date Issued", "Date Verified" ],
"max": "1",
"id": "DiagnosticReport.issued",
"condition": [ "ele-1" ],
"comment": "May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.issued"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.performer",
"requirements": "Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.",
"min": 0,
"definition": "The diagnostic service that is responsible for issuing the report.",
"short": "Responsible Diagnostic Service",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.performer.actor",
"identity": "workflow"
}, {
"map": "FiveWs.actor",
"identity": "w5"
}, {
"map": "PRT-8 (where this PRT-4-Participation = \"PO\")",
"identity": "v2"
}, {
"map": ".participation[typeCode=PRF]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/CareTeam" ]
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Laboratory", "Service", "Practitioner", "Department", "Company", "Authorized by", "Director" ],
"max": "*",
"id": "DiagnosticReport.performer",
"condition": [ "ele-1" ],
"comment": "This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.performer"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.resultsInterpreter",
"requirements": "Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.",
"min": 0,
"definition": "The practitioner or organization that is responsible for the report's conclusions and interpretations.",
"short": "Primary result interpreter",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.performer.actor",
"identity": "workflow"
}, {
"map": "FiveWs.actor",
"identity": "w5"
}, {
"map": "OBR-32, PRT-8 (where this PRT-4-Participation = \"PI\")",
"identity": "v2"
}, {
"map": ".participation[typeCode=PRF]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Organization", "http://hl7.org/fhir/StructureDefinition/CareTeam" ]
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Analyzed by", "Reported by" ],
"max": "*",
"id": "DiagnosticReport.resultsInterpreter",
"condition": [ "ele-1" ],
"comment": "Might not be the same entity that takes responsibility for the clinical report.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.resultsInterpreter"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.specimen",
"requirements": "Need to be able to report information about the collected specimens on which the report is based.",
"min": 0,
"definition": "Details about the specimens on which this diagnostic report is based.",
"short": "Specimens this report is based on",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "SPM",
"identity": "v2"
}, {
"map": "participation[typeCode=SBJ]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-specimen", "http://hl7.org/fhir/StructureDefinition/Specimen" ]
} ],
"mustSupport": true,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "*",
"id": "DiagnosticReport.specimen",
"condition": [ "ele-1" ],
"comment": "If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.specimen"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.result",
"requirements": "Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.",
"min": 0,
"definition": "[Observations](observation.html) that are part of this diagnostic report.",
"short": "Observations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "OBXs",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=COMP].target",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Observation" ]
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "Data", "Atomic Value", "Result", "Atomic result", "Data", "Test", "Analyte", "Battery", "Organizer" ],
"max": "*",
"id": "DiagnosticReport.result",
"condition": [ "ele-1" ],
"comment": "Observations can contain observations.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.result"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.imagingStudy",
"min": 0,
"definition": "One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.",
"short": "Reference to full details of imaging associated with the diagnostic report",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/ImagingStudy" ]
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "*",
"id": "DiagnosticReport.imagingStudy",
"condition": [ "ele-1" ],
"comment": "ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.imagingStudy"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.media",
"requirements": "Many diagnostic services include images in the report as part of their service.",
"min": 0,
"definition": "A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).",
"short": "Key images associated with this report",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "OBX?",
"identity": "v2"
}, {
"map": "outboundRelationship[typeCode=COMP].target",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "DICOM", "Slides", "Scans" ],
"max": "*",
"id": "DiagnosticReport.media",
"condition": [ "ele-1" ],
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.media"
},
"isSummary": true
}, {
"path": "DiagnosticReport.media.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.media.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.media.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.media.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.media.modifierExtension",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"isModifier": true,
"short": "Extensions that cannot be ignored even if unrecognized",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "DiagnosticReport.media.modifierExtension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.media.comment",
"requirements": "The provider of the report should make a comment about each image included in the report.",
"min": 0,
"definition": "A comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.",
"short": "Comment about the image (e.g. explanation)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": ".inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "DiagnosticReport.media.comment",
"condition": [ "ele-1" ],
"comment": "The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.media.comment"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"source": "http://hl7.org/fhir/StructureDefinition/Reference",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))"
} ],
"path": "DiagnosticReport.media.link",
"min": 1,
"definition": "Reference to the image source.",
"short": "Reference to the image source",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": ".value.reference",
"identity": "rim"
} ],
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Media" ]
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "1",
"id": "DiagnosticReport.media.link",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 1,
"path": "DiagnosticReport.media.link"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.conclusion",
"requirements": "Need to be able to provide a conclusion that is not lost among the basic result data.",
"min": 1,
"definition": "Befund als Freitext nach 6.11 oBDS 2021",
"short": "Befund als Freitext",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "OBX",
"identity": "v2"
}, {
"map": "inboundRelationship[typeCode=\"SPRT\"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)",
"identity": "rim"
}, {
"map": "6.11",
"comment": "Befund",
"identity": "oBDS"
} ],
"type": [ {
"code": "string"
} ],
"mustSupport": true,
"_short": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [ {
"url": "lang",
"valueCode": "de-DE"
}, {
"url": "content",
"valueString": "Befund als Freitext"
} ]
} ]
},
"alias": [ "Report" ],
"max": "1",
"id": "DiagnosticReport.conclusion",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings SHALL NOT exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "DiagnosticReport.conclusion"
}
}, {
"path": "DiagnosticReport.conclusion.id",
"min": 0,
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "Unique id for inter-element referencing",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.conclusion.id",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "DiagnosticReport.conclusion.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "DiagnosticReport.conclusion.extension",
"condition": [ "ele-1" ],
"comment": "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.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"path": "DiagnosticReport.conclusion.value",
"min": 0,
"short": "Primitive value for string",
"_definition": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [ {
"url": "lang",
"valueCode": "de-DE"
}, {
"url": "content",
"valueString": "Befund als Freitext nach 6.11 oBDS 2021"
} ]
} ]
},
"type": [ {
"code": "http://hl7.org/fhirpath/System.String",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/regex",
"valueString": "[ \\r\\n\\t\\S]+"
} ]
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "DiagnosticReport.conclusion.value",
"maxLength": 1048576,
"base": {
"max": "1",
"min": 0,
"path": "string.value"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
} ],
"path": "DiagnosticReport.conclusionCode",
"min": 0,
"definition": "One or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.",
"short": "Codes for the clinical conclusion of test results",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "OBX",
"identity": "v2"
}, {
"map": "inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)",
"identity": "rim"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"binding": {
"strength": "example",
"valueSet": "http://hl7.org/fhir/ValueSet/clinical-findings",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "AdjunctDiagnosis"
} ],
"description": "Diagnosis codes provided as adjuncts to the report."
},
"max": "*",
"id": "DiagnosticReport.conclusionCode",
"condition": [ "ele-1" ],
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.conclusionCode"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element",
"severity": "error",
"expression": "hasValue() or (children().count() > id.count())"
}, {
"key": "att-1",
"human": "If the Attachment has data, it SHALL have a contentType",
"xpath": "not(exists(f:data)) or exists(f:contentType)",
"source": "http://hl7.org/fhir/StructureDefinition/Attachment",
"severity": "error",
"expression": "data.empty() or contentType.exists()"
} ],
"path": "DiagnosticReport.presentedForm",
"requirements": "Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.",
"min": 0,
"definition": "Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.",
"short": "Entire report as issued",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "ED/RP",
"identity": "v2"
}, {
"map": "ED",
"identity": "rim"
}, {
"map": "OBX",
"identity": "v2"
}, {
"map": "text (type=ED)",
"identity": "rim"
} ],
"type": [ {
"code": "Attachment"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
} ],
"max": "*",
"id": "DiagnosticReport.presentedForm",
"condition": [ "ele-1" ],
"comment": "\"application/pdf\" is recommended as the most reliable and interoperable in this context.",
"base": {
"max": "*",
"min": 0,
"path": "DiagnosticReport.presentedForm"
}
} ]
},
"status": "active",
"id": "e6a35852-5658-43ae-af4d-30e13e5fbbe6",
"kind": "resource",
"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-befund",
"version": "2025.0.0",
"differential": {
"element": [ {
"id": "DiagnosticReport.meta.profile",
"path": "DiagnosticReport.meta.profile",
"mustSupport": true
}, {
"id": "DiagnosticReport.basedOn",
"path": "DiagnosticReport.basedOn",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
},
"mustSupport": true
}, {
"id": "DiagnosticReport.basedOn:tumorkonferenz",
"max": "1",
"min": 0,
"path": "DiagnosticReport.basedOn",
"type": [ {
"code": "Reference",
"targetProfile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-tumorkonferenz", "http://hl7.org/fhir/StructureDefinition/CarePlan" ]
} ],
"sliceName": "tumorkonferenz",
"mustSupport": true
}, {
"id": "DiagnosticReport.code",
"path": "DiagnosticReport.code",
"short": "Pathology report code",
"mustSupport": true
}, {
"id": "DiagnosticReport.code.coding",
"min": 1,
"path": "DiagnosticReport.code.coding",
"slicing": {
"rules": "open",
"discriminator": [ {
"path": "$this",
"type": "pattern"
} ]
},
"mustSupport": true
}, {
"id": "DiagnosticReport.code.coding:pathology-report",
"max": "1",
"min": 1,
"path": "DiagnosticReport.code.coding",
"sliceName": "pathology-report",
"mustSupport": true,
"patternCoding": {
"code": "22034-3",
"system": "http://loinc.org"
}
}, {
"id": "DiagnosticReport.code.coding:pathology-report.system",
"min": 1,
"path": "DiagnosticReport.code.coding.system",
"mustSupport": true
}, {
"id": "DiagnosticReport.code.coding:pathology-report.code",
"min": 1,
"path": "DiagnosticReport.code.coding.code",
"mustSupport": true
}, {
"id": "DiagnosticReport.subject",
"min": 1,
"path": "DiagnosticReport.subject",
"type": [ {
"code": "Reference",
"targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ]
} ],
"mustSupport": true
}, {
"id": "DiagnosticReport.encounter",
"path": "DiagnosticReport.encounter",
"mustSupport": true
}, {
"id": "DiagnosticReport.specimen",
"path": "DiagnosticReport.specimen",
"type": [ {
"code": "Reference",
"targetProfile": [ "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-specimen", "http://hl7.org/fhir/StructureDefinition/Specimen" ]
} ],
"mustSupport": true
}, {
"id": "DiagnosticReport.conclusion",
"min": 1,
"path": "DiagnosticReport.conclusion",
"short": "Befund als Freitext",
"_short": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [ {
"url": "lang",
"valueCode": "de-DE"
}, {
"url": "content",
"valueString": "Befund als Freitext"
} ]
} ]
},
"mapping": [ {
"map": "6.11",
"comment": "Befund",
"identity": "oBDS"
} ],
"definition": "Befund als Freitext nach 6.11 oBDS 2021",
"mustSupport": true
}, {
"id": "DiagnosticReport.conclusion.value",
"path": "DiagnosticReport.conclusion.value",
"_definition": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [ {
"url": "lang",
"valueCode": "de-DE"
}, {
"url": "content",
"valueString": "Befund als Freitext nach 6.11 oBDS 2021"
} ]
} ]
}
} ]
},
"contact": [ {
"telecom": [ {
"value": "https://www.medizininformatik-initiative.de",
"system": "url"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/DiagnosticReport"
}