Release 4B 5 Ballot

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-ballot: R5 Ballot - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

9.3 Resource Procedure - Content

Patient Care icon Work Group Maturity Level : 3   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner , RelatedPerson

An action that is or was performed on or for a patient. This patient, practitioner, device, organization, or location. For example, this can be a physical intervention on a patient like an operation, or less invasive like long term services, counseling, or hypnotherapy. This can be a quality or safety inspection for a location, organization, or device. This can be an accreditation procedure on a practitioner for licensing.

9.3.1 Scope and Usage

Procedure is one of the event resources in the FHIR workflow specification.

This resource is used to record the details of current and historical procedures performed on or for a patient. A procedure is an activity that is performed on, with, or for a patient as part of the provision of care. patient, practitioner, device, organization, or location. Examples include surgical procedures, diagnostic procedures, endoscopic procedures, biopsies, counseling, physiotherapy, personal support services, adult day care services, non-emergency transportation, home modification, exercise, verification of enrollment qualifications for a social program etc. Procedures may be performed by a healthcare professional, a service provider, a friend or relative or in some cases by the patient themselves.

Procedures can be performed on other non-patient subjects. For example, a procedure can represent an inspection to verify temperature or humidity for storage at a given location. Additionally, a procedure can represent the verification of the practitioner's qualifications for accreditation.

This resource provides summary information about the occurrence of the procedure and is not intended to provide real-time snapshots of a procedure as it unfolds, though for long-running procedures such as psychotherapy, it could represent summary level information about overall progress. The creation of a resource to support detailed real-time procedure information awaits the identification of a specific implementation use-case to share such information.

9.3.2 Boundaries and Relationships

The Procedure resource should not be used to capture an event if a more specific resource already exists - i.e. immunizations , drug administrations and communications . The boundary between determining whether an action is a Procedure (training or counseling) as opposed to a Communication is based on whether there's a specific intent to change the mind-set of the patient. Mere disclosure of information would be considered a Communication. A process that involves verification of the patient's comprehension or to change the patient's mental state would be a Procedure.

Note that many diagnostic processes are procedures that generate Observations and DiagnosticReports . In many cases, such an observation does not require an explicit representation of the procedure used to create the observation, but where there are details of interest about how the diagnostic procedure was performed, the Procedure resource is used to describe the activity.

Some diagnostic procedures might not have a Procedure record. The Procedure record is only necessary when there is a need to capture information about the physical intervention that was performed to capture the diagnostic information (e.g. anesthetic, incision, scope size, etc.)

A Task is a workflow step such as cancelling an order, fulfilling an order, signing an order, merging a set of records, admitting a patient. Procedures are actions that are intended to result in a physical or mental change to or for the subject (e.g. surgery, physiotherapy, training, counseling). A Task resource often exists in parallel with clinical resources. For example, a Task might request fulfillment of a ServiceRequest ordering a Procedure.

9.3.3 References to this Resource

This resource is referenced by

9.3.4 Resource Content

Structure

Person who asserts this procedure The reference to Σ Where 0..* CodeableConcept Coded reason procedure performed Coded items used during
Name Flags Card. Type Description & Constraints doco
. . Procedure TU DomainResource An action that is being or was performed on a patient an individual or entity

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Identifiers for this procedure

. . . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest ) A request for this procedure

. . . partOf Σ 0..* Reference ( Procedure | Observation | MedicationAdministration ) Part of referenced event

. . . status ?! Σ 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus ( Required )
. . . statusReason Σ 0..1 CodeableConcept Reason for current status
Procedure Not Performed Reason (SNOMED-CT) ( Example )
. . . category Σ 0..1 0..* CodeableConcept Classification of the procedure
Procedure Category Codes (SNOMED CT) ( Example )

. . . code Σ 0..1 CodeableConcept Identification of the procedure
Procedure Codes (SNOMED CT) ( Example )
. . . subject Σ 1..1 Reference ( Patient | Group | Device | Practitioner | Organization | Location ) Who Individual or entity the procedure was performed on
. . . encounter focus Σ 0..1 Reference ( Encounter Patient | Group | RelatedPerson | Practitioner | Organization | CareTeam | PractitionerRole ) Encounter created as part Who is the target of the procedure when it is not the subject of record only
. . performed[x] . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Procedure was created
... occurrence[x] Σ 0..1 When the procedure was performed occurred or is occurring
. . . . occurrenceDateTime dateTime
. . . performedDateTime . occurrencePeriod dateTime Period
. . . performedPeriod . occurrenceString Period string
. . . performedString . occurrenceAge string Age
. . . . performedAge occurrenceRange Age Range
. . . . performedRange occurrenceTiming Range Timing
. . recorder . recorded Σ 0..1 dateTime When the procedure was first captured in the subject's record
... recorder Σ 0..1 Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole ) Who recorded the procedure
. . asserter . reported[x] Σ 0..1 Reported rather than primary record
.... reportedBoolean boolean
.... reportedReference Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization )
. . . performer Σ 0..* BackboneElement The people who performed the procedure

. . . . function Σ 0..1 CodeableConcept Type of performance
Procedure Performer Role Codes ( Example )
. . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device | CareTeam | HealthcareService ) Who performed the practitioner procedure
. . . . onBehalfOf 0..1 Reference ( Organization ) Organization the device or practitioner was acting for
. . location . . period 0..1 Reference ( Location Period ) When the performer performed the procedure happened
. . reasonCode . location Σ 0..1 Procedure Reason Codes Reference ( Example Location ) Where the procedure happened
. . reasonReference . reason Σ 0..* Reference CodeableReference ( Condition | Observation | Procedure | DiagnosticReport | DocumentReference ) The justification that the procedure was performed
Procedure Reason Codes ( Example )

. . . bodySite Σ 0..* CodeableConcept Target body sites
SNOMED CT Body Structures ( Example )

. . . outcome Σ 0..1 CodeableConcept The result of procedure
Procedure Outcome Codes (SNOMED CT) ( Example )
. . . report 0..* Reference ( DiagnosticReport | DocumentReference | Composition ) Any report resulting from the procedure

. . . complication 0..* CodeableConcept Complication following the procedure
Condition/Problem/Diagnosis Codes ( Example )

. . . complicationDetail 0..* Reference ( Condition ) A condition that is a result of the procedure

. . . followUp 0..* CodeableConcept Instructions for follow up
Procedure Follow up Codes (SNOMED CT) ( Example )

. . . note 0..* Annotation Additional information about the procedure

. . . focalDevice 0..* BackboneElement Manipulated, implanted, or removed device

. . . . action 0..1 CodeableConcept Kind of change to device
Procedure Device Action Codes ( Preferred )
. . . . manipulated 1..1 Reference ( Device ) Device that was changed
. . usedReference . used 0..* Reference CodeableReference ( Device | Medication | Substance | BiologicallyDerivedProduct ) Items used during procedure
Device Type ( Example )

. . usedCode . supportingInfo 0..* CodeableConcept Reference ( Any ) Extra information relevant to the procedure
FHIR Device Types ( Example )

doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

Procedure ( DomainResource ) Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire » The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure instantiatesUri : uri [0..*] A reference to a resource that contains details of the request for this procedure basedOn : Reference [0..*] « CarePlan | ServiceRequest » A larger event of which this particular procedure is a component or step partOf : Reference [0..*] « Procedure | Observation | MedicationAdministration » A code specifying the state of the procedure. Generally, this will be the in-progress or completed state (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) EventStatus ! » Captures the reason for the current state of the procedure statusReason : CodeableConcept [0..1] « null (Strength=Example) ProcedureNotPerformedReason(S... ?? » A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure") category : CodeableConcept [0..1] [0..*] « null (Strength=Example) ProcedureCategoryCodes(SNOMED... ?? » The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy") code : CodeableConcept [0..1] « null (Strength=Example) ProcedureCodes(SNOMEDCT) ?? » The person, animal On whom or group on which what the procedure was performed. This is usually an individual human, but can also be performed on animals, groups of humans or animals, organizations or practitioners (for licensing), locations or devices (for safety inspections or regulatory authorizations). If the actual focus of the procedure is different from the subject, the focus element specifies the actual focus of the procedure subject : Reference [1..1] « Patient | Group | Device | Practitioner | Organization | Location » Who is the target of the procedure when it is not the subject of record only. If focus is not present, then subject is the focus. If focus is present and the subject is one of the targets of the procedure, include subject as a focus as well. If focus is present and the subject is not included in focus, it implies that the procedure was only targeted on the focus. For example, when a caregiver is given education for a patient, the caregiver would be the focus and the procedure record is associated with the subject (e.g. patient). For example, use focus when recording the target of the education, training, or counseling is the parent or relative of a patient focus : Reference [0..1] « Patient | Group | RelatedPerson | Practitioner | Organization | CareTeam | PractitionerRole » The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Estimated or actual date, date-time, period, or age when the procedure was performed. did occur or is occurring. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured performed[x] occurrence[x] : Element DataType [0..1] « dateTime | Period | string | Age | Range | Timing » The date the occurrence of the procedure was first captured in the record regardless of Procedure.status (potentially after the occurrence of the event) recorded : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Patient | RelatedPerson | Practitioner | PractitionerRole » Individual who is making Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the procedure statement source of the report asserter reported[x] : Reference DataType [0..1] « boolean | Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization ) » The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant location : Reference [0..1] « Location » The coded reason or reference why the procedure was performed. This may be a coded entity of some type, or may simply be present as text reasonCode : CodeableConcept [0..*] « null (Strength=Example) ProcedureReasonCodes ?? » The justification text, or be a reference to one of why several resources that justify the procedure was performed reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation | Procedure | DiagnosticReport | DocumentReference ; null (Strength=Example) ProcedureReasonCodes ?? » Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » The outcome of the procedure - did it resolve the reasons for the procedure being performed? outcome : CodeableConcept [0..1] « null (Strength=Example) ProcedureOutcomeCodes(SNOMEDC... ?? » This could be a histology result, pathology report, surgical report, etc report : Reference [0..*] « DiagnosticReport | DocumentReference | Composition » Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues complication : CodeableConcept [0..*] « null (Strength=Example) Condition/Problem/DiagnosisCo... ?? » Any complications that occurred during the procedure, or in the immediate post-performance period complicationDetail : Reference [0..*] « Condition » If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used followUp : CodeableConcept [0..*] « null (Strength=Example) ProcedureFollowUpCodes(SNOMED... ?? » Any other notes and comments about the procedure note : Annotation [0..*] Identifies medications, devices and any other substance used as part of the procedure usedReference used : Reference CodeableReference [0..*] « Device | Medication | Substance | BiologicallyDerivedProduct ; null (Strength=Example) DeviceType ?? » Identifies coded items Other resources from the patient record that were may be relevant to the procedure. The information from these resources was either used as part of to create the procedure instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available usedCode supportingInfo : CodeableConcept Reference [0..*] « null (Strength=Example) FHIRDeviceTypes Any ?? » Performer Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist function : CodeableConcept [0..1] « null (Strength=Example) ProcedurePerformerRoleCodes ?? » The practitioner Indicates who was involved in or what performed the procedure actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device | CareTeam | HealthcareService » The organization the device or practitioner was acting on behalf of onBehalfOf : Reference [0..1] « Organization » Time period during which the performer performed the procedure period : Period [0..1] FocalDevice The kind of change that happened to the device during the procedure action : CodeableConcept [0..1] « null (Strength=Preferred) ProcedureDeviceActionCodes ? » The device that was manipulated (changed) during the procedure manipulated : Reference [1..1] « Device » Limited to "real" people rather than equipment performer [0..*] A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure focalDevice [0..*]

XML Template 

<

<Procedure xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Identifiers for this procedure --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|ServiceRequest) A request for this procedure --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration|Observation|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <</category>

 <category><!-- 0..* CodeableConcept Classification of the procedure --></category>

 <code><!-- 0..1 CodeableConcept Identification of the procedure --></code>
 <</subject>
 <</encounter>
 <</performed[x]>

 <subject><!-- 1..1 Reference(Device|Group|Location|Organization|Patient|
   Practitioner) Individual or entity the procedure was performed on --></subject>

 <focus><!-- 0..1 Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who is the target of the procedure when it is not the subject of record only --></focus>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Procedure was created --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period|string|Age|Range|Timing When the procedure occurred or is occurring --></occurrence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the procedure was first captured in the subject's record -->

 <recorder><!-- 0..1 Reference(Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who recorded the procedure --></recorder>
 <|
   </asserter>

 <reported[x]><!-- 0..1 boolean|Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Reported rather than primary record --></reported[x]>
 <performer>  <!-- 0..* The people who performed the procedure -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the procedure --></actor>
  <onBehalfOf><!-- 0..1 Reference(Organization) Organization the device or practitioner was acting for --></onBehalfOf>
  <period><!-- 0..1 Period When the performer performed the procedure --></period>

 </performer>
 <location><!-- 0..1 Reference(Location) Where the procedure happened --></location>
 <</reasonCode>
 <|
   </reasonReference>

 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation|Procedure) The justification that the procedure was performed --></reason>
 <bodySite><!-- 0..* CodeableConcept Target body sites --></bodySite>
 <outcome><!-- 0..1 CodeableConcept The result of procedure --></outcome>
 <report><!-- 0..* Reference(Composition|DiagnosticReport|DocumentReference) Any report resulting from the procedure --></report>
 <complication><!-- 0..* CodeableConcept Complication following the procedure --></complication>
 <complicationDetail><!-- 0..* Reference(Condition) A condition that is a result of the procedure --></complicationDetail>
 <followUp><!-- 0..* CodeableConcept Instructions for follow up --></followUp>
 <note><!-- 0..* Annotation Additional information about the procedure --></note>
 <focalDevice>  <!-- 0..* Manipulated, implanted, or removed device -->
  <action><!-- 0..1 CodeableConcept Kind of change to device --></action>
  <manipulated><!-- 1..1 Reference(Device) Device that was changed --></manipulated>
 </focalDevice>
 <</usedReference>
 <</usedCode>

 <used><!-- 0..* CodeableReference(BiologicallyDerivedProduct|Device|Medication|
   Substance) Items used during procedure --></used>

 <supportingInfo><!-- 0..* Reference(Any) Extra information relevant to the procedure --></supportingInfo>

</Procedure>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Procedure",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Identifiers for this procedure
  "|
   

  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|ServiceRequest) }], // A request for this procedure
  "partOf" : [{ Reference(MedicationAdministration|Observation|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "

  "category" : [{ CodeableConcept }], // Classification of the procedure

  "code" : { CodeableConcept }, // Identification of the procedure
  "
  "
  
  ">",
  " },
  ">",
  " },
  " },

  "subject" : { Reference(Device|Group|Location|Organization|Patient|
   Practitioner) }, // R!  Individual or entity the procedure was performed on

  "focus" : { Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who is the target of the procedure when it is not the subject of record only

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Procedure was created
  // occurrence[x]: When the procedure occurred or is occurring. One of these 6:

  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceString" : "<string>",
  "occurrenceAge" : { Age },
  "occurrenceRange" : { Range },
  "occurrenceTiming" : { Timing },
  "recorded" : "<dateTime>", // When the procedure was first captured in the subject's record

  "recorder" : { Reference(Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who recorded the procedure
  "|
   

  // reported[x]: Reported rather than primary record. One of these 2:
  "reportedBoolean" : <boolean>,
  "reportedReference" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) },
  "performer" : [{ // The people who performed the procedure
    "function" : { CodeableConcept }, // Type of performance
    "|
    
    "

    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) }, // R!  Who performed the procedure

    "onBehalfOf" : { Reference(Organization) }, // Organization the device or practitioner was acting for
    "period" : { Period } // When the performer performed the procedure

  }],
  "location" : { Reference(Location) }, // Where the procedure happened
  "
  "|
   

  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation|Procedure) }], // The justification that the procedure was performed
  "bodySite" : [{ CodeableConcept }], // Target body sites
  "outcome" : { CodeableConcept }, // The result of procedure
  "report" : [{ Reference(Composition|DiagnosticReport|DocumentReference) }], // Any report resulting from the procedure
  "complication" : [{ CodeableConcept }], // Complication following the procedure
  "complicationDetail" : [{ Reference(Condition) }], // A condition that is a result of the procedure
  "followUp" : [{ CodeableConcept }], // Instructions for follow up
  "note" : [{ Annotation }], // Additional information about the procedure
  "focalDevice" : [{ // Manipulated, implanted, or removed device
    "action" : { CodeableConcept }, // Kind of change to device
    "manipulated" : { Reference(Device) } // R!  Device that was changed
  }],
  "
  "

  "used" : [{ CodeableReference(BiologicallyDerivedProduct|Device|Medication|
   Substance) }], // Items used during procedure

  "supportingInfo" : [{ Reference(Any) }] // Extra information relevant to the procedure

}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:;

[ a fhir:Procedure;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Procedure.identifier [ Identifier ], ... ; # 0..* External Identifiers for this procedure
  fhir:Procedure.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Procedure.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:Procedure.basedOn [ Reference(CarePlan|ServiceRequest) ], ... ; # 0..* A request for this procedure
  fhir:Procedure.partOf [ Reference(MedicationAdministration|Observation|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:Procedure.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Procedure.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:

  fhir:Procedure.category [ CodeableConcept ], ... ; # 0..* Classification of the procedure

  fhir:Procedure.code [ CodeableConcept ]; # 0..1 Identification of the procedure
  fhir:
  fhir:
  # . One of these 5
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]

  fhir:Procedure.subject [ Reference(Device|Group|Location|Organization|Patient|Practitioner) ]; # 1..1 Individual or entity the procedure was performed on
  fhir:Procedure.focus [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who is the target of the procedure when it is not the subject of record only
  fhir:Procedure.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Procedure was created
  # Procedure.occurrence[x] : 0..1 When the procedure occurred or is occurring. One of these 6
    fhir:Procedure.occurrenceDateTime [ dateTime ]
    fhir:Procedure.occurrencePeriod [ Period ]
    fhir:Procedure.occurrenceString [ string ]
    fhir:Procedure.occurrenceAge [ Age ]
    fhir:Procedure.occurrenceRange [ Range ]
    fhir:Procedure.occurrenceTiming [ Timing ]
  fhir:Procedure.recorded [ dateTime ]; # 0..1 When the procedure was first captured in the subject's record

  fhir:Procedure.recorder [ Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who recorded the procedure
  fhir:

  # Procedure.reported[x] : 0..1 Reported rather than primary record. One of these 2
    fhir:Procedure.reportedBoolean [ boolean ]
    fhir:Procedure.reportedReference [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]

  fhir:Procedure.performer [ # 0..* The people who performed the procedure
    fhir:Procedure.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:

    fhir:Procedure.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the procedure
    fhir:Procedure.performer.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization the device or practitioner was acting for
    fhir:Procedure.performer.period [ Period ]; # 0..1 When the performer performed the procedure

  ], ...;
  fhir:Procedure.location [ Reference(Location) ]; # 0..1 Where the procedure happened
  fhir:
  fhir:

  fhir:Procedure.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation|Procedure) ], ... ; # 0..* The justification that the procedure was performed

  fhir:Procedure.bodySite [ CodeableConcept ], ... ; # 0..* Target body sites
  fhir:Procedure.outcome [ CodeableConcept ]; # 0..1 The result of procedure
  fhir:Procedure.report [ Reference(Composition|DiagnosticReport|DocumentReference) ], ... ; # 0..* Any report resulting from the procedure
  fhir:Procedure.complication [ CodeableConcept ], ... ; # 0..* Complication following the procedure
  fhir:Procedure.complicationDetail [ Reference(Condition) ], ... ; # 0..* A condition that is a result of the procedure
  fhir:Procedure.followUp [ CodeableConcept ], ... ; # 0..* Instructions for follow up
  fhir:Procedure.note [ Annotation ], ... ; # 0..* Additional information about the procedure
  fhir:Procedure.focalDevice [ # 0..* Manipulated, implanted, or removed device
    fhir:Procedure.focalDevice.action [ CodeableConcept ]; # 0..1 Kind of change to device
    fhir:Procedure.focalDevice.manipulated [ Reference(Device) ]; # 1..1 Device that was changed
  ], ...;
  fhir:
  fhir:

  fhir:Procedure.used [ CodeableReference(BiologicallyDerivedProduct|Device|Medication|Substance) ], ... ; # 0..* Items used during procedure
  fhir:Procedure.supportingInfo [ Reference(Any) ], ... ; # 0..* Extra information relevant to the procedure

]

Changes since R4

Procedure
Procedure.category
  • No Changes Max Cardinality changed from 1 to *
  • Max Cardinality changed from 1 to *
Procedure.subject
  • Type Reference: Added Target Types Device, Practitioner, Organization, Location
  • Type Reference: Added Target Types Device, Practitioner, Organization, Location
Procedure.focus
  • Added Element
Procedure.occurrence[x]
  • Added Element
Procedure.recorded
  • Added Element
Procedure.reported[x]
  • Added Element
Procedure.performer.actor
  • Type Reference: Added Target Types CareTeam, HealthcareService
  • Type Reference: Added Target Types CareTeam, HealthcareService
Procedure.performer.period
  • Added Element
Procedure.reason
  • Added Element
Procedure.used
  • Added Element
Procedure.supportingInfo
  • Added Element
Procedure.performed[x]
  • deleted
Procedure.asserter
  • deleted
Procedure.reasonCode
  • deleted
Procedure.reasonReference
  • deleted
Procedure.usedReference
  • deleted
Procedure.usedCode
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 See R3 <--> R4 Conversion Maps (status = 15 tests that all execute ok. 3 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

Structure

Person who asserts this procedure The reference to Σ Where 0..* CodeableConcept Coded reason procedure performed Coded items used during
Name Flags Card. Type Description & Constraints doco
. . Procedure TU DomainResource An action that is being or was performed on a patient an individual or entity

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier Σ 0..* Identifier External Identifiers for this procedure

. . . instantiatesCanonical Σ 0..* canonical ( PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire ) Instantiates FHIR protocol or definition

. . . instantiatesUri Σ 0..* uri Instantiates external protocol or definition

. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest ) A request for this procedure

. . . partOf Σ 0..* Reference ( Procedure | Observation | MedicationAdministration ) Part of referenced event

. . . status ?! Σ 1..1 code preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
EventStatus ( Required )
. . . statusReason Σ 0..1 CodeableConcept Reason for current status
Procedure Not Performed Reason (SNOMED-CT) ( Example )
. . . category Σ 0..1 0..* CodeableConcept Classification of the procedure
Procedure Category Codes (SNOMED CT) ( Example )

. . . code Σ 0..1 CodeableConcept Identification of the procedure
Procedure Codes (SNOMED CT) ( Example )
. . . subject Σ 1..1 Reference ( Patient | Group | Device | Practitioner | Organization | Location ) Who Individual or entity the procedure was performed on
. . . encounter focus Σ 0..1 Reference ( Encounter Patient | Group | RelatedPerson | Practitioner | Organization | CareTeam | PractitionerRole ) Encounter created as part Who is the target of the procedure when it is not the subject of record only
. . performed[x] . encounter Σ 0..1 Reference ( Encounter ) The Encounter during which this Procedure was created
... occurrence[x] Σ 0..1 When the procedure was performed occurred or is occurring
. . . . occurrenceDateTime dateTime
. . . performedDateTime . occurrencePeriod dateTime Period
. . . performedPeriod . occurrenceString Period string
. . . performedString . occurrenceAge string Age
. . . . performedAge occurrenceRange Age Range
. . . . performedRange occurrenceTiming Range Timing
. . recorder . recorded Σ 0..1 dateTime When the procedure was first captured in the subject's record
... recorder Σ 0..1 Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole ) Who recorded the procedure
. . asserter . reported[x] Σ 0..1 Reported rather than primary record
.... reportedBoolean boolean
. . . . reportedReference Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization )
. . . performer Σ 0..* BackboneElement The people who performed the procedure

. . . . function Σ 0..1 CodeableConcept Type of performance
Procedure Performer Role Codes ( Example )
. . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device | CareTeam | HealthcareService ) Who performed the practitioner procedure
. . . . onBehalfOf 0..1 Reference ( Organization ) Organization the device or practitioner was acting for
. . location . . period 0..1 Reference ( Location Period ) When the performer performed the procedure happened
. . reasonCode . location Σ 0..1 Procedure Reason Codes Reference ( Example Location ) Where the procedure happened
. . reasonReference . reason Σ 0..* Reference CodeableReference ( Condition | Observation | Procedure | DiagnosticReport | DocumentReference ) The justification that the procedure was performed
Procedure Reason Codes ( Example )

. . . bodySite Σ 0..* CodeableConcept Target body sites
SNOMED CT Body Structures ( Example )

. . . outcome Σ 0..1 CodeableConcept The result of procedure
Procedure Outcome Codes (SNOMED CT) ( Example )
. . . report 0..* Reference ( DiagnosticReport | DocumentReference | Composition ) Any report resulting from the procedure

. . . complication 0..* CodeableConcept Complication following the procedure
Condition/Problem/Diagnosis Codes ( Example )

. . . complicationDetail 0..* Reference ( Condition ) A condition that is a result of the procedure

. . . followUp 0..* CodeableConcept Instructions for follow up
Procedure Follow up Codes (SNOMED CT) ( Example )

. . . note 0..* Annotation Additional information about the procedure

. . . focalDevice 0..* BackboneElement Manipulated, implanted, or removed device

. . . . action 0..1 CodeableConcept Kind of change to device
Procedure Device Action Codes ( Preferred )
. . . . manipulated 1..1 Reference ( Device ) Device that was changed
. . usedReference . used 0..* Reference CodeableReference ( Device | Medication | Substance | BiologicallyDerivedProduct ) Items used during procedure
Device Type ( Example )

. . usedCode . supportingInfo 0..* CodeableConcept Reference ( Any ) Extra information relevant to the procedure
FHIR Device Types ( Example )

doco Documentation for this format

See the Extensions for this resource

UML Diagram ( Legend )

Procedure ( DomainResource ) Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure instantiatesCanonical : canonical [0..*] « PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire » The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure instantiatesUri : uri [0..*] A reference to a resource that contains details of the request for this procedure basedOn : Reference [0..*] « CarePlan | ServiceRequest » A larger event of which this particular procedure is a component or step partOf : Reference [0..*] « Procedure | Observation | MedicationAdministration » A code specifying the state of the procedure. Generally, this will be the in-progress or completed state (this element modifies the meaning of other elements) status : code [1..1] « null (Strength=Required) EventStatus ! » Captures the reason for the current state of the procedure statusReason : CodeableConcept [0..1] « null (Strength=Example) ProcedureNotPerformedReason(S... ?? » A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure") category : CodeableConcept [0..1] [0..*] « null (Strength=Example) ProcedureCategoryCodes(SNOMED... ?? » The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy") code : CodeableConcept [0..1] « null (Strength=Example) ProcedureCodes(SNOMEDCT) ?? » The person, animal On whom or group on which what the procedure was performed. This is usually an individual human, but can also be performed on animals, groups of humans or animals, organizations or practitioners (for licensing), locations or devices (for safety inspections or regulatory authorizations). If the actual focus of the procedure is different from the subject, the focus element specifies the actual focus of the procedure subject : Reference [1..1] « Patient | Group | Device | Practitioner | Organization | Location » Who is the target of the procedure when it is not the subject of record only. If focus is not present, then subject is the focus. If focus is present and the subject is one of the targets of the procedure, include subject as a focus as well. If focus is present and the subject is not included in focus, it implies that the procedure was only targeted on the focus. For example, when a caregiver is given education for a patient, the caregiver would be the focus and the procedure record is associated with the subject (e.g. patient). For example, use focus when recording the target of the education, training, or counseling is the parent or relative of a patient focus : Reference [0..1] « Patient | Group | RelatedPerson | Practitioner | Organization | CareTeam | PractitionerRole » The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated encounter : Reference [0..1] « Encounter » Estimated or actual date, date-time, period, or age when the procedure was performed. did occur or is occurring. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured performed[x] occurrence[x] : Element DataType [0..1] « dateTime | Period | string | Age | Range | Timing » The date the occurrence of the procedure was first captured in the record regardless of Procedure.status (potentially after the occurrence of the event) recorded : dateTime [0..1] Individual who recorded the record and takes responsibility for its content recorder : Reference [0..1] « Patient | RelatedPerson | Practitioner | PractitionerRole » Individual who is making Indicates if this record was captured as a secondary 'reported' record rather than as an original primary source-of-truth record. It may also indicate the procedure statement source of the report asserter reported[x] : Reference DataType [0..1] « boolean | Reference ( Patient | RelatedPerson | Practitioner | PractitionerRole | Organization ) » The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant location : Reference [0..1] « Location » The coded reason or reference why the procedure was performed. This may be a coded entity of some type, or may simply be present as text reasonCode : CodeableConcept [0..*] « null (Strength=Example) ProcedureReasonCodes ?? » The justification text, or be a reference to one of why several resources that justify the procedure was performed reasonReference reason : Reference CodeableReference [0..*] « Condition | Observation | Procedure | DiagnosticReport | DocumentReference ; null (Strength=Example) ProcedureReasonCodes ?? » Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion bodySite : CodeableConcept [0..*] « null (Strength=Example) SNOMEDCTBodyStructures ?? » The outcome of the procedure - did it resolve the reasons for the procedure being performed? outcome : CodeableConcept [0..1] « null (Strength=Example) ProcedureOutcomeCodes(SNOMEDC... ?? » This could be a histology result, pathology report, surgical report, etc report : Reference [0..*] « DiagnosticReport | DocumentReference | Composition » Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues complication : CodeableConcept [0..*] « null (Strength=Example) Condition/Problem/DiagnosisCo... ?? » Any complications that occurred during the procedure, or in the immediate post-performance period complicationDetail : Reference [0..*] « Condition » If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used followUp : CodeableConcept [0..*] « null (Strength=Example) ProcedureFollowUpCodes(SNOMED... ?? » Any other notes and comments about the procedure note : Annotation [0..*] Identifies medications, devices and any other substance used as part of the procedure usedReference used : Reference CodeableReference [0..*] « Device | Medication | Substance | BiologicallyDerivedProduct ; null (Strength=Example) DeviceType ?? » Identifies coded items Other resources from the patient record that were may be relevant to the procedure. The information from these resources was either used as part of to create the procedure instance or is provided to help with its interpretation. This extension should not be used if more specific inline elements or extensions are available usedCode supportingInfo : CodeableConcept Reference [0..*] « null (Strength=Example) FHIRDeviceTypes Any ?? » Performer Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist function : CodeableConcept [0..1] « null (Strength=Example) ProcedurePerformerRoleCodes ?? » The practitioner Indicates who was involved in or what performed the procedure actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device | CareTeam | HealthcareService » The organization the device or practitioner was acting on behalf of onBehalfOf : Reference [0..1] « Organization » Time period during which the performer performed the procedure period : Period [0..1] FocalDevice The kind of change that happened to the device during the procedure action : CodeableConcept [0..1] « null (Strength=Preferred) ProcedureDeviceActionCodes ? » The device that was manipulated (changed) during the procedure manipulated : Reference [1..1] « Device » Limited to "real" people rather than equipment performer [0..*] A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure focalDevice [0..*]

XML Template 

<

<Procedure xmlns="http://hl7.org/fhir"> doco

 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier External Identifiers for this procedure --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|Measure|
   OperationDefinition|PlanDefinition|Questionnaire) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|ServiceRequest) A request for this procedure --></basedOn>
 <partOf><!-- 0..* Reference(MedicationAdministration|Observation|Procedure) Part of referenced event --></partOf>
 <status value="[code]"/><!-- 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown -->
 <statusReason><!-- 0..1 CodeableConcept Reason for current status --></statusReason>
 <</category>

 <category><!-- 0..* CodeableConcept Classification of the procedure --></category>

 <code><!-- 0..1 CodeableConcept Identification of the procedure --></code>
 <</subject>
 <</encounter>
 <</performed[x]>

 <subject><!-- 1..1 Reference(Device|Group|Location|Organization|Patient|
   Practitioner) Individual or entity the procedure was performed on --></subject>

 <focus><!-- 0..1 Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Who is the target of the procedure when it is not the subject of record only --></focus>

 <encounter><!-- 0..1 Reference(Encounter) The Encounter during which this Procedure was created --></encounter>
 <occurrence[x]><!-- 0..1 dateTime|Period|string|Age|Range|Timing When the procedure occurred or is occurring --></occurrence[x]>
 <recorded value="[dateTime]"/><!-- 0..1 When the procedure was first captured in the subject's record -->

 <recorder><!-- 0..1 Reference(Patient|Practitioner|PractitionerRole|
   RelatedPerson) Who recorded the procedure --></recorder>
 <|
   </asserter>

 <reported[x]><!-- 0..1 boolean|Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) Reported rather than primary record --></reported[x]>
 <performer>  <!-- 0..* The people who performed the procedure -->
  <function><!-- 0..1 CodeableConcept Type of performance --></function>
  <|
    </actor>

  <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the procedure --></actor>
  <onBehalfOf><!-- 0..1 Reference(Organization) Organization the device or practitioner was acting for --></onBehalfOf>
  <period><!-- 0..1 Period When the performer performed the procedure --></period>

 </performer>
 <location><!-- 0..1 Reference(Location) Where the procedure happened --></location>
 <</reasonCode>
 <|
   </reasonReference>

 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation|Procedure) The justification that the procedure was performed --></reason>
 <bodySite><!-- 0..* CodeableConcept Target body sites --></bodySite>
 <outcome><!-- 0..1 CodeableConcept The result of procedure --></outcome>
 <report><!-- 0..* Reference(Composition|DiagnosticReport|DocumentReference) Any report resulting from the procedure --></report>
 <complication><!-- 0..* CodeableConcept Complication following the procedure --></complication>
 <complicationDetail><!-- 0..* Reference(Condition) A condition that is a result of the procedure --></complicationDetail>
 <followUp><!-- 0..* CodeableConcept Instructions for follow up --></followUp>
 <note><!-- 0..* Annotation Additional information about the procedure --></note>
 <focalDevice>  <!-- 0..* Manipulated, implanted, or removed device -->
  <action><!-- 0..1 CodeableConcept Kind of change to device --></action>
  <manipulated><!-- 1..1 Reference(Device) Device that was changed --></manipulated>
 </focalDevice>
 <</usedReference>
 <</usedCode>

 <used><!-- 0..* CodeableReference(BiologicallyDerivedProduct|Device|Medication|
   Substance) Items used during procedure --></used>

 <supportingInfo><!-- 0..* Reference(Any) Extra information relevant to the procedure --></supportingInfo>

</Procedure>

JSON Template 

{doco
  "resourceType" : "",

  "resourceType" : "Procedure",

  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // External Identifiers for this procedure
  "|
   

  "instantiatesCanonical" : ["<canonical(PlanDefinition|ActivityDefinition|Measure|OperationDefinition|Questionnaire)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "basedOn" : [{ Reference(CarePlan|ServiceRequest) }], // A request for this procedure
  "partOf" : [{ Reference(MedicationAdministration|Observation|Procedure) }], // Part of referenced event
  "status" : "<code>", // R!  preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  "statusReason" : { CodeableConcept }, // Reason for current status
  "

  "category" : [{ CodeableConcept }], // Classification of the procedure

  "code" : { CodeableConcept }, // Identification of the procedure
  "
  "
  
  ">",
  " },
  ">",
  " },
  " },

  "subject" : { Reference(Device|Group|Location|Organization|Patient|
   Practitioner) }, // R!  Individual or entity the procedure was performed on

  "focus" : { Reference(CareTeam|Group|Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) }, // Who is the target of the procedure when it is not the subject of record only

  "encounter" : { Reference(Encounter) }, // The Encounter during which this Procedure was created
  // occurrence[x]: When the procedure occurred or is occurring. One of these 6:

  "occurrenceDateTime" : "<dateTime>",
  "occurrencePeriod" : { Period },
  "occurrenceString" : "<string>",
  "occurrenceAge" : { Age },
  "occurrenceRange" : { Range },
  "occurrenceTiming" : { Timing },
  "recorded" : "<dateTime>", // When the procedure was first captured in the subject's record

  "recorder" : { Reference(Patient|Practitioner|PractitionerRole|
   RelatedPerson) }, // Who recorded the procedure
  "|
   

  // reported[x]: Reported rather than primary record. One of these 2:
  "reportedBoolean" : <boolean>,
  "reportedReference" : { Reference(Organization|Patient|Practitioner|
   PractitionerRole|RelatedPerson) },
  "performer" : [{ // The people who performed the procedure
    "function" : { CodeableConcept }, // Type of performance
    "|
    
    "

    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) }, // R!  Who performed the procedure

    "onBehalfOf" : { Reference(Organization) }, // Organization the device or practitioner was acting for
    "period" : { Period } // When the performer performed the procedure

  }],
  "location" : { Reference(Location) }, // Where the procedure happened
  "
  "|
   

  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation|Procedure) }], // The justification that the procedure was performed
  "bodySite" : [{ CodeableConcept }], // Target body sites
  "outcome" : { CodeableConcept }, // The result of procedure
  "report" : [{ Reference(Composition|DiagnosticReport|DocumentReference) }], // Any report resulting from the procedure
  "complication" : [{ CodeableConcept }], // Complication following the procedure
  "complicationDetail" : [{ Reference(Condition) }], // A condition that is a result of the procedure
  "followUp" : [{ CodeableConcept }], // Instructions for follow up
  "note" : [{ Annotation }], // Additional information about the procedure
  "focalDevice" : [{ // Manipulated, implanted, or removed device
    "action" : { CodeableConcept }, // Kind of change to device
    "manipulated" : { Reference(Device) } // R!  Device that was changed
  }],
  "
  "

  "used" : [{ CodeableReference(BiologicallyDerivedProduct|Device|Medication|
   Substance) }], // Items used during procedure

  "supportingInfo" : [{ Reference(Any) }] // Extra information relevant to the procedure

}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:;

[ a fhir:Procedure;

  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Procedure.identifier [ Identifier ], ... ; # 0..* External Identifiers for this procedure
  fhir:Procedure.instantiatesCanonical [ canonical(ActivityDefinition|Measure|OperationDefinition|PlanDefinition|Questionnaire) ], ... ; # 0..* Instantiates FHIR protocol or definition
  fhir:Procedure.instantiatesUri [ uri ], ... ; # 0..* Instantiates external protocol or definition
  fhir:Procedure.basedOn [ Reference(CarePlan|ServiceRequest) ], ... ; # 0..* A request for this procedure
  fhir:Procedure.partOf [ Reference(MedicationAdministration|Observation|Procedure) ], ... ; # 0..* Part of referenced event
  fhir:Procedure.status [ code ]; # 1..1 preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
  fhir:Procedure.statusReason [ CodeableConcept ]; # 0..1 Reason for current status
  fhir:

  fhir:Procedure.category [ CodeableConcept ], ... ; # 0..* Classification of the procedure

  fhir:Procedure.code [ CodeableConcept ]; # 0..1 Identification of the procedure
  fhir:
  fhir:
  # . One of these 5
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]
    fhir: ]

  fhir:Procedure.subject [ Reference(Device|Group|Location|Organization|Patient|Practitioner) ]; # 1..1 Individual or entity the procedure was performed on
  fhir:Procedure.focus [ Reference(CareTeam|Group|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who is the target of the procedure when it is not the subject of record only
  fhir:Procedure.encounter [ Reference(Encounter) ]; # 0..1 The Encounter during which this Procedure was created
  # Procedure.occurrence[x] : 0..1 When the procedure occurred or is occurring. One of these 6
    fhir:Procedure.occurrenceDateTime [ dateTime ]
    fhir:Procedure.occurrencePeriod [ Period ]
    fhir:Procedure.occurrenceString [ string ]
    fhir:Procedure.occurrenceAge [ Age ]
    fhir:Procedure.occurrenceRange [ Range ]
    fhir:Procedure.occurrenceTiming [ Timing ]
  fhir:Procedure.recorded [ dateTime ]; # 0..1 When the procedure was first captured in the subject's record

  fhir:Procedure.recorder [ Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 0..1 Who recorded the procedure
  fhir:

  # Procedure.reported[x] : 0..1 Reported rather than primary record. One of these 2
    fhir:Procedure.reportedBoolean [ boolean ]
    fhir:Procedure.reportedReference [ Reference(Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]

  fhir:Procedure.performer [ # 0..* The people who performed the procedure
    fhir:Procedure.performer.function [ CodeableConcept ]; # 0..1 Type of performance
    fhir:

    fhir:Procedure.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the procedure
    fhir:Procedure.performer.onBehalfOf [ Reference(Organization) ]; # 0..1 Organization the device or practitioner was acting for
    fhir:Procedure.performer.period [ Period ]; # 0..1 When the performer performed the procedure

  ], ...;
  fhir:Procedure.location [ Reference(Location) ]; # 0..1 Where the procedure happened
  fhir:
  fhir:

  fhir:Procedure.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation|Procedure) ], ... ; # 0..* The justification that the procedure was performed

  fhir:Procedure.bodySite [ CodeableConcept ], ... ; # 0..* Target body sites
  fhir:Procedure.outcome [ CodeableConcept ]; # 0..1 The result of procedure
  fhir:Procedure.report [ Reference(Composition|DiagnosticReport|DocumentReference) ], ... ; # 0..* Any report resulting from the procedure
  fhir:Procedure.complication [ CodeableConcept ], ... ; # 0..* Complication following the procedure
  fhir:Procedure.complicationDetail [ Reference(Condition) ], ... ; # 0..* A condition that is a result of the procedure
  fhir:Procedure.followUp [ CodeableConcept ], ... ; # 0..* Instructions for follow up
  fhir:Procedure.note [ Annotation ], ... ; # 0..* Additional information about the procedure
  fhir:Procedure.focalDevice [ # 0..* Manipulated, implanted, or removed device
    fhir:Procedure.focalDevice.action [ CodeableConcept ]; # 0..1 Kind of change to device
    fhir:Procedure.focalDevice.manipulated [ Reference(Device) ]; # 1..1 Device that was changed
  ], ...;
  fhir:
  fhir:

  fhir:Procedure.used [ CodeableReference(BiologicallyDerivedProduct|Device|Medication|Substance) ], ... ; # 0..* Items used during procedure
  fhir:Procedure.supportingInfo [ Reference(Any) ], ... ; # 0..* Extra information relevant to the procedure

]

Changes since Release 4

Procedure
Procedure.category
  • No Changes Max Cardinality changed from 1 to *
  • Max Cardinality changed from 1 to *
Procedure.subject
  • Type Reference: Added Target Types Device, Practitioner, Organization, Location
  • Type Reference: Added Target Types Device, Practitioner, Organization, Location
Procedure.focus
  • Added Element
Procedure.occurrence[x]
  • Added Element
Procedure.recorded
  • Added Element
Procedure.reported[x]
  • Added Element
Procedure.performer.actor
  • Type Reference: Added Target Types CareTeam, HealthcareService
  • Type Reference: Added Target Types CareTeam, HealthcareService
Procedure.performer.period
  • Added Element
Procedure.reason
  • Added Element
Procedure.used
  • Added Element
Procedure.supportingInfo
  • Added Element
Procedure.performed[x]
  • deleted
Procedure.asserter
  • deleted
Procedure.reasonCode
  • deleted
Procedure.reasonReference
  • deleted
Procedure.usedReference
  • deleted
Procedure.usedCode
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

Conversions between R3 and R4 See R3 <--> R4 Conversion Maps (status = 15 tests that all execute ok. 3 fail round-trip testing and 1 r3 resources are invalid (0 errors). )

 

See the Profiles & Extensions and the alternate Additional definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions , the spreadsheet version & the dependency analysis

9.3.4.1 Terminology Bindings

Procedure.usedCode
Path Definition Type Reference
Procedure.status

Codes identifying the lifecycle stage of an event.

Required EventStatus
Procedure.statusReason

Situation codes describing the reason that a procedure, which might otherwise be expected, was not performed, or a procedure that was started and was not completed. Consists of SNOMED CT codes, children of procedure contraindicated (183932001), procedure discontinued (416406003), procedure not done (416237000), procedure not indicated (428119001), procedure not offered (416064006), procedure not wanted (416432009), procedure refused (183944003), and procedure stopped (394908001) as well as 410536001 Contraindicated (qualifier value).

Example ProcedureNotPerformedReason(SNOMED-CT)
Procedure.category

Procedure Category code: A selection of relevant SNOMED CT codes.

Example ProcedureCategoryCodes(SNOMEDCT)
Procedure.code

Procedure Code: All SNOMED CT procedure codes.

Example ProcedureCodes(SNOMEDCT)
Procedure.performer.function

This example value set defines the set of codes that can be used to indicate a role of a procedure performer.

Example ProcedurePerformerRoleCodes
Procedure.reasonCode Procedure.reason

This example value set defines the set of codes that can be used to indicate a reason for a procedure.

Example ProcedureReasonCodes
Procedure.bodySite

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).

Example SNOMEDCTBodyStructures
Procedure.outcome

Procedure Outcome code: A selection of relevant SNOMED CT codes.

Example ProcedureOutcomeCodes(SNOMEDCT)
Procedure.complication

Example value set for Condition/Problem/Diagnosis codes.

Example Condition/Problem/DiagnosisCodes
Procedure.followUp

Procedure follow up codes: A selection of SNOMED CT codes relevant to procedure follow up.

Example ProcedureFollowUpCodes(SNOMEDCT)
Procedure.focalDevice.action

Example codes indicating the change that happened to the device during the procedure. Note that these are in no way complete and might not even be appropriate for some uses.

Preferred ProcedureDeviceActionCodes
Procedure.used

Codes used to identify medical devices. Includes concepts from SNOMED CT (http://www.snomed.org/) where concept is-a 49062001 (Device) and is provided as a suggestive example.

Example FHIRDeviceTypes DeviceType

9.3.4.2 Use of Procedure properties

Many of the elements of Procedure have inherent relationships and may be conveyed by the Procedure.code or in the text element of the Procedure.code property. I.e. you may be able to infer category, bodySite and even indication. Whether these other properties will be populated may vary by implementation.

Care should be taken to avoid nonsensical combinations/statements; e.g. "name=amputation, bodySite=heart".

9.3.4.3 Use of Procedure.used

For devices, these are devices that are incidental to / or used to perform the procedure - scalpels, gauze, endoscopes, etc. Devices that are the focus of the procedure should appear in Procedure.device instead.

9.3.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
based-on reference A request for this procedure Procedure.basedOn
( CarePlan , ServiceRequest )
category token Classification of the procedure Procedure.category
code token A code to identify a procedure Procedure.code
date date When the procedure was performed occurred or is occurring Procedure.performed Procedure.occurrence
encounter reference The Encounter during which this Procedure was created as part of Procedure.encounter
( Encounter )
identifier token A unique identifier for a procedure Procedure.identifier
instantiates-canonical N reference Instantiates FHIR protocol or definition Procedure.instantiatesCanonical
( Questionnaire , Measure , PlanDefinition , OperationDefinition , ActivityDefinition )
instantiates-uri N uri Instantiates external protocol or definition Procedure.instantiatesUri
location reference Where the procedure happened Procedure.location
( Location )
part-of reference Part of referenced event Procedure.partOf
( Observation , Procedure , MedicationAdministration )
patient reference Search by subject - a patient Procedure.subject.where(resolve() is Patient)
( Patient )
performer reference The reference to Who performed the practitioner procedure Procedure.performer.actor
( Practitioner , Organization , CareTeam , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson )
reason-code D token Coded reason procedure performed Reference to a concept (by class) Procedure.reasonCode Procedure.reason.concept
reason-reference D reference The justification that Reference to a resource (by instance) Procedure.reason.reference
report reference Any report resulting from the procedure was performed Procedure.reasonReference Procedure.report
( Condition , Observation , Procedure Composition , DiagnosticReport , DocumentReference )
status N token preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Procedure.status
subject reference Search by subject Procedure.subject
( Practitioner , Group , Organization , Device , Patient , Location )