AU Core Implementation Guide
1.0.0-preview - Preview Australia flag

This page is part of the AU Core (v1.0.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: AUCoreProcedure - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the au-core-procedure resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Procedure
2. Procedure.status
Must Supporttrue
Obligations
    ObligationsActor
    SHALL:populate-if-knownAU Core Responder
    SHALL:no-errorAU Core Requester
    4. Procedure.code
    Control1..?
    BindingUnless not suitable, these codes SHALL be taken from Procedure .
    (extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
    Must Supporttrue
    Obligations
      ObligationsActor
      SHALL:populate-if-knownAU Core Responder
      SHALL:no-errorAU Core Requester
      6. Procedure.subject
      TypeReference(AU Core Patient)
      Must Supporttrue
      Obligations
        ObligationsActor
        SHALL:populate-if-knownAU Core Responder
        SHALL:no-errorAU Core Requester
        8. Procedure.encounter
        TypeReference(AU Core Encounter)
        Must Supporttrue
        Obligations
          ObligationsActor
          SHALL:populate-if-knownAU Core Responder
          SHALL:no-errorAU Core Requester
          10. Procedure.performed[x]
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Must Supporttrue
          Obligations
            ObligationsActor
            SHALL:populate-if-knownAU Core Responder
            SHALL:no-errorAU Core Requester
            12. Procedure.reasonCode
            Must Supporttrue
            Obligations
              ObligationsActor
              SHALL:populate-if-knownAU Core Responder
              SHALL:no-errorAU Core Requester
              14. Procedure.reasonReference
              TypeReference(AU Core Condition, Observation, AU Core Procedure, DocumentReference)
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Obligations
                ObligationsActor
                SHALL:populate-if-knownAU Core Responder
                SHALL:no-errorAU Core Requester
                16. Procedure.bodySite
                BindingUnless not suitable, these codes SHALL be taken from Body Site .
                (extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                Invariantsicon Added:au-core-pro-01: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
                icon Removed:au-core-pro-04: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())

                Guidance on how to interpret the contents of this table can be found here

                0. Procedure
                Definition

                An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

                ShortA procedure in an Australian healthcare contextAn action that is being or was performed on a patient
                Control0..*
                Is Modifierfalse
                Summaryfalse
                Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                dom-3: 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 (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())
                dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                dom-6: A resource should have narrative for robust management (text.`div`.exists())
                2. Procedure.implicitRules
                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.

                ShortA set of rules under which this content was created
                Comments

                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.

                Control0..1
                Typeuri
                Is Modifiertrue because 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
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                4. Procedure.extension:targetBodyStructure
                Slice NametargetBodyStructure
                Definition

                The target body site used for this procedure. Multiple locations are allowed.

                ShortThe target point for this procedure
                Control0..*
                TypeExtension(Procedure Target Body Structure) (Extension Type: Reference(BodyStructure))
                Is Modifierfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                6. Procedure.modifierExtension
                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.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored
                Comments

                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.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Summaryfalse
                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.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                8. Procedure.status
                Definition

                A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.

                Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
                Comments

                The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from EventStatushttp://hl7.org/fhir/ValueSet/event-status|4.0.1
                (required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

                A code specifying the state of the procedure.

                Typecode
                Is Modifiertrue because This element is labelled 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
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Obligations
                  ObligationsActor
                  SHALL:populate-if-knownAU Core Responder
                  SHALL:no-errorAU Core Requester
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  10. Procedure.code
                  Definition

                  The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

                  ShortIdentification of the procedure
                  Control10..1
                  BindingUnless not suitable, these codes SHALL be taken from For example codes, see Procedure .http://hl7.org/fhir/ValueSet/procedure-code
                  (extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Obligations
                    ObligationsActor
                    SHALL:populate-if-knownAU Core Responder
                    SHALL:no-errorAU Core Requester
                    Summarytrue
                    Requirements

                    0..1 to account for primarily narrative only resources.

                    Alternate Namestype
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    12. Procedure.subject
                    Definition

                    The person, animal or group on which the procedure was performed.

                    ShortWho the procedure was performed on
                    Control1..1
                    TypeReference(AU Core Patient, Patient, Group)
                    Is Modifierfalse
                    Must Supporttrue
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownAU Core Responder
                      SHALL:no-errorAU Core Requester
                      Summarytrue
                      Alternate Namespatient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      14. Procedure.encounter
                      Definition

                      The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.

                      ShortEncounter created as part of
                      Comments

                      This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                      Control0..1
                      TypeReference(AU Core Encounter, Encounter)
                      Is Modifierfalse
                      Must Supporttrue
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownAU Core Responder
                        SHALL:no-errorAU Core Requester
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        16. Procedure.performed[x]
                        Definition

                        Estimated or actual date, date-time, period, or age when the procedure was performed. 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.

                        ShortWhen the procedure was performed
                        Comments

                        Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

                        Control0..1
                        TypeChoice of: dateTime, Period, string, Age, Range
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownAU Core Responder
                          SHALL:no-errorAU Core Requester
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          18. Procedure.reasonCode
                          Definition

                          The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.

                          ShortCoded reason procedure performed
                          Comments

                          Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                          Control0..*
                          BindingFor example codes, see ProcedureReasonCodeshttp://hl7.org/fhir/ValueSet/procedure-reason
                          (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                          A code that identifies the reason a procedure is required.

                          TypeCodeableConcept
                          Is Modifierfalse
                          Must Supporttrue
                          Obligations
                            ObligationsActor
                            SHALL:populate-if-knownAU Core Responder
                            SHALL:no-errorAU Core Requester
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            20. Procedure.reasonReference
                            Definition

                            The justification of why the procedure was performed.

                            ShortThe justification that the procedure was performed
                            Comments

                            It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                            Control0..*
                            TypeReference(AU Core Condition, Observation, AU Core Procedure, DocumentReference, Condition, Procedure, DiagnosticReport)
                            Is Modifierfalse
                            Must Supporttrue
                            Must Support TypesNo must-support rules about the choice of types/profiles
                            Obligations
                              ObligationsActor
                              SHALL:populate-if-knownAU Core Responder
                              SHALL:no-errorAU Core Requester
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              22. Procedure.bodySite
                              Definition

                              Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

                              ShortTarget body sites
                              Comments

                              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

                              Control0..*
                              This element is affected by the following invariants: au-core-pro-01
                              BindingUnless not suitable, these codes SHALL be taken from For example codes, see Body Site .http://hl7.org/fhir/ValueSet/body-site
                              (extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              au-core-pro-01: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())

                              Guidance on how to interpret the contents of this table can be found here

                              0. Procedure
                              Definition

                              An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.

                              ShortA procedure in an Australian healthcare context
                              Control0..*
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                              dom-3: 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 (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())
                              dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                              dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                              dom-6: A resource should have narrative for robust management (text.`div`.exists())
                              2. Procedure.id
                              Definition

                              The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                              ShortLogical id of this artifact
                              Comments

                              The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                              Control0..1
                              Typeid
                              Is Modifierfalse
                              Summarytrue
                              4. Procedure.meta
                              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.

                              ShortMetadata about the resource
                              Control0..1
                              TypeMeta
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              6. Procedure.implicitRules
                              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.

                              ShortA set of rules under which this content was created
                              Comments

                              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.

                              Control0..1
                              Typeuri
                              Is Modifiertrue because 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
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              8. Procedure.language
                              Definition

                              The base language in which the resource is written.

                              ShortLanguage of the resource content
                              Comments

                              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).

                              Control0..1
                              BindingThe codes SHOULD be taken from CommonLanguages
                              (preferred to http://hl7.org/fhir/ValueSet/languages)

                              A human language.

                              Additional BindingsPurpose
                              AllLanguagesMax Binding
                              Typecode
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              10. Procedure.text
                              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.

                              ShortText summary of the resource, for human interpretation
                              Comments

                              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.

                              Control0..1
                              TypeNarrative
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesnarrative, html, xhtml, display
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              12. Procedure.contained
                              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.

                              ShortContained, inline Resources
                              Comments

                              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.

                              Control0..*
                              TypeResource
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesinline resources, anonymous resources, contained resources
                              14. Procedure.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on Procedure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 16. Procedure.extension:targetBodyStructure
                                Slice NametargetBodyStructure
                                Definition

                                The target body site used for this procedure. Multiple locations are allowed.

                                ShortThe target point for this procedure
                                Control0..*
                                TypeExtension(Procedure Target Body Structure) (Extension Type: Reference(BodyStructure))
                                Is Modifierfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                18. Procedure.modifierExtension
                                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.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                ShortExtensions that cannot be ignored
                                Comments

                                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.

                                Control0..*
                                TypeExtension
                                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                Summaryfalse
                                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.

                                Alternate Namesextensions, user content
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                20. Procedure.identifier
                                Definition

                                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.

                                ShortExternal Identifiers for this procedure
                                Comments

                                This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.

                                NoteThis is a business identifier, not a resource identifier (see discussion)
                                Control0..*
                                TypeIdentifier
                                Is Modifierfalse
                                Summarytrue
                                Requirements

                                Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.

                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                22. Procedure.instantiatesCanonical
                                Definition

                                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.

                                ShortInstantiates FHIR protocol or definition
                                Control0..*
                                Typecanonical(PlanDefinition, ActivityDefinition, Measure, OperationDefinition, Questionnaire)
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                24. Procedure.instantiatesUri
                                Definition

                                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.

                                ShortInstantiates external protocol or definition
                                Comments

                                This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

                                Control0..*
                                Typeuri
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summarytrue
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                26. Procedure.basedOn
                                Definition

                                A reference to a resource that contains details of the request for this procedure.

                                ShortA request for this procedure
                                Control0..*
                                TypeReference(CarePlan, ServiceRequest)
                                Is Modifierfalse
                                Summarytrue
                                Alternate Namesfulfills
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                28. Procedure.partOf
                                Definition

                                A larger event of which this particular procedure is a component or step.

                                ShortPart of referenced event
                                Comments

                                The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).

                                Control0..*
                                TypeReference(Procedure, Observation, MedicationAdministration)
                                Is Modifierfalse
                                Summarytrue
                                Alternate Namescontainer
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                30. Procedure.status
                                Definition

                                A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.

                                Shortpreparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
                                Comments

                                The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

                                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                Control1..1
                                BindingThe codes SHALL be taken from EventStatus
                                (required to http://hl7.org/fhir/ValueSet/event-status|4.0.1)

                                A code specifying the state of the procedure.

                                Typecode
                                Is Modifiertrue because This element is labelled 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
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Obligations
                                  ObligationsActor
                                  SHALL:populate-if-knownAU Core Responder
                                  SHALL:no-errorAU Core Requester
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  32. Procedure.statusReason
                                  Definition

                                  Captures the reason for the current state of the procedure.

                                  ShortReason for current status
                                  Comments

                                  This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

                                  Control0..1
                                  BindingFor example codes, see ProcedureNotPerformedReason(SNOMED-CT)
                                  (example to http://hl7.org/fhir/ValueSet/procedure-not-performed-reason)

                                  A code that identifies the reason a procedure was not performed.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Alternate NamesSuspended Reason, Cancelled Reason
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  34. Procedure.category
                                  Definition

                                  A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").

                                  ShortClassification of the procedure
                                  Control0..1
                                  BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)
                                  (example to http://hl7.org/fhir/ValueSet/procedure-category)

                                  A code that classifies a procedure for searching, sorting and display purposes.

                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  36. Procedure.code
                                  Definition

                                  The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").

                                  ShortIdentification of the procedure
                                  Control1..1
                                  BindingUnless not suitable, these codes SHALL be taken from Procedure .
                                  (extensible to https://healthterminologies.gov.au/fhir/ValueSet/procedure-1)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Must Supporttrue
                                  Obligations
                                    ObligationsActor
                                    SHALL:populate-if-knownAU Core Responder
                                    SHALL:no-errorAU Core Requester
                                    Summarytrue
                                    Requirements

                                    0..1 to account for primarily narrative only resources.

                                    Alternate Namestype
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    38. Procedure.subject
                                    Definition

                                    The person, animal or group on which the procedure was performed.

                                    ShortWho the procedure was performed on
                                    Control1..1
                                    TypeReference(AU Core Patient)
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Obligations
                                      ObligationsActor
                                      SHALL:populate-if-knownAU Core Responder
                                      SHALL:no-errorAU Core Requester
                                      Summarytrue
                                      Alternate Namespatient
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      40. Procedure.encounter
                                      Definition

                                      The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.

                                      ShortEncounter created as part of
                                      Comments

                                      This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

                                      Control0..1
                                      TypeReference(AU Core Encounter)
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Obligations
                                        ObligationsActor
                                        SHALL:populate-if-knownAU Core Responder
                                        SHALL:no-errorAU Core Requester
                                        Summarytrue
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        42. Procedure.performed[x]
                                        Definition

                                        Estimated or actual date, date-time, period, or age when the procedure was performed. 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.

                                        ShortWhen the procedure was performed
                                        Comments

                                        Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

                                        Control0..1
                                        TypeChoice of: dateTime, Period, string, Age, Range
                                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                        Is Modifierfalse
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Must Supporttrue
                                        Must Support TypesNo must-support rules about the choice of types/profiles
                                        Obligations
                                          ObligationsActor
                                          SHALL:populate-if-knownAU Core Responder
                                          SHALL:no-errorAU Core Requester
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          44. Procedure.recorder
                                          Definition

                                          Individual who recorded the record and takes responsibility for its content.

                                          ShortWho recorded the procedure
                                          Control0..1
                                          TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          46. Procedure.asserter
                                          Definition

                                          Individual who is making the procedure statement.

                                          ShortPerson who asserts this procedure
                                          Control0..1
                                          TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          48. Procedure.performer
                                          Definition

                                          Limited to "real" people rather than equipment.

                                          ShortThe people who performed the procedure
                                          Control0..*
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Summarytrue
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          50. Procedure.performer.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          ShortUnique id for inter-element referencing
                                          Control0..1
                                          Typestring
                                          Is Modifierfalse
                                          XML FormatIn the XML format, this property is represented as an attribute.
                                          Summaryfalse
                                          52. Procedure.performer.extension
                                          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.

                                          ShortAdditional content defined by implementations
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifierfalse
                                          Summaryfalse
                                          Alternate Namesextensions, user content
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          54. Procedure.performer.modifierExtension
                                          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.

                                          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                          ShortExtensions that cannot be ignored even if unrecognized
                                          Comments

                                          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.

                                          Control0..*
                                          TypeExtension
                                          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                          Summarytrue
                                          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.

                                          Alternate Namesextensions, user content, modifiers
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          56. Procedure.performer.function
                                          Definition

                                          Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.

                                          ShortType of performance
                                          Control0..1
                                          BindingFor example codes, see ProcedurePerformerRoleCodes
                                          (example to http://hl7.org/fhir/ValueSet/performer-role)

                                          A code that identifies the role of a performer of the procedure.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Summarytrue
                                          Requirements

                                          Allows disambiguation of the types of involvement of different performers.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          58. Procedure.performer.actor
                                          Definition

                                          The practitioner who was involved in the procedure.

                                          ShortThe reference to the practitioner
                                          Control1..1
                                          TypeReference(Practitioner, PractitionerRole, Organization, Patient, RelatedPerson, Device)
                                          Is Modifierfalse
                                          Summarytrue
                                          Requirements

                                          A reference to Device supports use cases, such as pacemakers.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          60. Procedure.performer.onBehalfOf
                                          Definition

                                          The organization the device or practitioner was acting on behalf of.

                                          ShortOrganization the device or practitioner was acting for
                                          Control0..1
                                          TypeReference(Organization)
                                          Is Modifierfalse
                                          Summaryfalse
                                          Requirements

                                          Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          62. Procedure.location
                                          Definition

                                          The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.

                                          ShortWhere the procedure happened
                                          Control0..1
                                          TypeReference(Location)
                                          Is Modifierfalse
                                          Summarytrue
                                          Requirements

                                          Ties a procedure to where the records are likely kept.

                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          64. Procedure.reasonCode
                                          Definition

                                          The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.

                                          ShortCoded reason procedure performed
                                          Comments

                                          Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                                          Control0..*
                                          BindingFor example codes, see ProcedureReasonCodes
                                          (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                                          A code that identifies the reason a procedure is required.

                                          TypeCodeableConcept
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Obligations
                                            ObligationsActor
                                            SHALL:populate-if-knownAU Core Responder
                                            SHALL:no-errorAU Core Requester
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            66. Procedure.reasonReference
                                            Definition

                                            The justification of why the procedure was performed.

                                            ShortThe justification that the procedure was performed
                                            Comments

                                            It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

                                            Control0..*
                                            TypeReference(AU Core Condition, Observation, AU Core Procedure, DocumentReference)
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                            Obligations
                                              ObligationsActor
                                              SHALL:populate-if-knownAU Core Responder
                                              SHALL:no-errorAU Core Requester
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              68. Procedure.bodySite
                                              Definition

                                              Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.

                                              ShortTarget body sites
                                              Comments

                                              If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

                                              Control0..*
                                              This element is affected by the following invariants: au-core-pro-01
                                              BindingUnless not suitable, these codes SHALL be taken from Body Site .
                                              (extensible to https://healthterminologies.gov.au/fhir/ValueSet/body-site-1)
                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              au-core-pro-01: If a coded body site is provided, at least one code shall be from SNOMED CT (coding.exists() implies coding.where(system='http://snomed.info/sct').exists())
                                              70. Procedure.outcome
                                              Definition

                                              The outcome of the procedure - did it resolve the reasons for the procedure being performed?

                                              ShortThe result of procedure
                                              Comments

                                              If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

                                              Control0..1
                                              BindingFor example codes, see ProcedureOutcomeCodes(SNOMEDCT)
                                              (example to http://hl7.org/fhir/ValueSet/procedure-outcome)

                                              An outcome of a procedure - whether it was resolved or otherwise.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summarytrue
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              72. Procedure.report
                                              Definition

                                              This could be a histology result, pathology report, surgical report, etc.

                                              ShortAny report resulting from the procedure
                                              Comments

                                              There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

                                              Control0..*
                                              TypeReference(DiagnosticReport, DocumentReference, Composition)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              74. Procedure.complication
                                              Definition

                                              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.

                                              ShortComplication following the procedure
                                              Comments

                                              If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

                                              Control0..*
                                              BindingFor example codes, see Condition/Problem/DiagnosisCodes
                                              (example to http://hl7.org/fhir/ValueSet/condition-code)

                                              Codes describing complications that resulted from a procedure.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              76. Procedure.complicationDetail
                                              Definition

                                              Any complications that occurred during the procedure, or in the immediate post-performance period.

                                              ShortA condition that is a result of the procedure
                                              Control0..*
                                              TypeReference(Condition)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              78. Procedure.followUp
                                              Definition

                                              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.

                                              ShortInstructions for follow up
                                              Control0..*
                                              BindingFor example codes, see ProcedureFollowUpCodes(SNOMEDCT)
                                              (example to http://hl7.org/fhir/ValueSet/procedure-followup)

                                              Specific follow up required for a procedure e.g. removal of sutures.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              80. Procedure.note
                                              Definition

                                              Any other notes and comments about the procedure.

                                              ShortAdditional information about the procedure
                                              Control0..*
                                              TypeAnnotation
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              82. Procedure.focalDevice
                                              Definition

                                              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.

                                              ShortManipulated, implanted, or removed device
                                              Control0..*
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              84. Procedure.focalDevice.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              ShortUnique id for inter-element referencing
                                              Control0..1
                                              Typestring
                                              Is Modifierfalse
                                              XML FormatIn the XML format, this property is represented as an attribute.
                                              Summaryfalse
                                              86. Procedure.focalDevice.extension
                                              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.

                                              ShortAdditional content defined by implementations
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifierfalse
                                              Summaryfalse
                                              Alternate Namesextensions, user content
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              88. Procedure.focalDevice.modifierExtension
                                              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.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              ShortExtensions that cannot be ignored even if unrecognized
                                              Comments

                                              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.

                                              Control0..*
                                              TypeExtension
                                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summarytrue
                                              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.

                                              Alternate Namesextensions, user content, modifiers
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              90. Procedure.focalDevice.action
                                              Definition

                                              The kind of change that happened to the device during the procedure.

                                              ShortKind of change to device
                                              Control0..1
                                              BindingThe codes SHOULD be taken from ProcedureDeviceActionCodes
                                              (preferred to http://hl7.org/fhir/ValueSet/device-action)

                                              A kind of change that happened to the device during the procedure.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              92. Procedure.focalDevice.manipulated
                                              Definition

                                              The device that was manipulated (changed) during the procedure.

                                              ShortDevice that was changed
                                              Control1..1
                                              TypeReference(Device)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              94. Procedure.usedReference
                                              Definition

                                              Identifies medications, devices and any other substance used as part of the procedure.

                                              ShortItems used during procedure
                                              Comments

                                              For devices actually implanted or removed, use Procedure.device.

                                              Control0..*
                                              TypeReference(Device, Medication, Substance)
                                              Is Modifierfalse
                                              Summaryfalse
                                              Requirements

                                              Used for tracking contamination, etc.

                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              96. Procedure.usedCode
                                              Definition

                                              Identifies coded items that were used as part of the procedure.

                                              ShortCoded items used during the procedure
                                              Comments

                                              For devices actually implanted or removed, use Procedure.device.

                                              Control0..*
                                              BindingFor example codes, see FHIRDeviceTypes
                                              (example to http://hl7.org/fhir/ValueSet/device-kind)

                                              Codes describing items used during a procedure.

                                              TypeCodeableConcept
                                              Is Modifierfalse
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))