Status: DRAFT: For Review

Introduction

This profile sets minimum expectations for the Procedure resource. We use the procedure structure definition as a base to this profile.

This Resource will give consumer the ability to see information on a procedure. The procedure Resource will contain information that has been used to describe something that has actually been done to a Patient. There are other FHIR Resources which are more appropriate for observations, assessments, opinions etc.

The Procedure resource returns medical and surgical procedures performed on or for a patient. 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.

It is also noted that a pragmatic approach is needed to specifying mandatory fields for this resource. The reality is that it may often be populated from a “clinical coding” system - that does not necessarily have access to the full contextual richness that might ideally be hoped for.

Mandatory fields

The following mandatory fields are defined in order to properly describe a Procedure:

1. Status - This is most likely to be “completed” to provide a historical list of procedures performed. However other codes about future or aborted procedures MAY be used where relevant – as long as they are kept up-to-date.
   • “unknown” should be avoided if at all possible

2. Subject - every Procedure must be linked to a Patient (not a Group)

3. Code - Essential to describe what the procedure actually is. Based on SNOMED codes eg "Excision of lesion of artery". The list from UkCore which aligns with PRSB standards and extends FHIR with extra codes for social care

Must Support fields

In addition the following fields are "Must Support" - ie they must be populated if relevant and known:

1. Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

2. StatusReason - relevent with status codes such as "suspended" or "aborted" to provide reason for suspension / aborting the procedure.

3. Category - A simple and short list of SNOMED codes to describe the overall category of procedure eg “Surgical Procedure”, “Diagnostic Procedure”. We pre-adopt the R4 list which adds one extra code for "Social Service Procedure".

4. Encounter - A reference to the Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated. This is likely to be very useful and should be provided if at all possible. 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.

5. Performed - when the Procedure was performed. We have removed the DateTime data type from this field as Period.start would provide identical data, and it reduced the complexity of processing multiple data types for the data consumer.

6. Body Site - Useful to populate if known.

7. Outcome - A short and simple list of “successful”, “unsuccessful”, “partially successful”. Must be populated when relevant and known. (Accepting that for some types of procedure then this may be impossible if there is no simple definition of “success”)

8. Focal Device - This is useful to provide if relevant. A device that is implanted, removed or otherwise manipulated (including The kind of change that happened to the device during the procedure such as calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.This may inform community teams with follow up care.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. For a Procedure there are many of these optional fields. This reflects the view expressed in the introduction that there is considerable richness which could be added, but which it is not necessarily realistic to insist on. Points of note include:

• Performer - Useful to provide if known, although it may be more relevant in some scenarios than others. For example some procedures are quite transactional and the person in overall charge of the care may be more useful as a contact.
  • Note: The “OnBehalfOf” reference is not essential and is removed – as this will also be covered by the Provenance tags

• Location - Generally speaking the exact location where the procedure was performed seems unlikely to be vital for a regional care record. The organisation involved (from the Provenance tags) is often likely to be sufficient, and further details can also be provided by the Context linking to an Encounter.

• Reason Code and Reason Reference - Could be useful to provide a code and/or a link to a Condition or Observation to explain the reason for the Procedure

• Report - Could be useful if relevant to provide additional background information

• Complication and Complication Detail - can be populated with a code and/or Condition reference for any complications if relevant and known

• Used Code and Used Reference - Relevant to stock control within an organisation, but less so for a regional record

• Note - Only to be used with caution. Any notes may be shared widely across the region, including being viewed by the patient themselves

• Follow Up - This is very useful to populate in a regional care record as, for example, it allows community teams to see that follow up care is needed. FHIR provides an "example" list which does not cover a great range of scenarios, and we are not aware of any better alternative list. Therefore categorised only as a "preferred" list for now - please get in touch if you intend to use and have further insights.

Discouraged or Removed fields

• Based On – Removed.

• Part Of – Removed.

• asserter - Removed. Not relevant to the shared care record.

• recorder - Removed. Not relevant to the shared care record.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from UKCoreProcedure

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	S	0..1	Identifier	External Identifiers for this procedure
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	S	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		0..0
partOf		0..0
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	S	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code		1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
id		0..0
extension		0..0
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT	S	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
system		0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
subject		1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
type		0..0
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
type		0..0
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
performed[x]		1..1	Period	When the procedure was performed.
id		0..0
extension		0..0
start	S	1..1	dateTime	Starting time with inclusive boundary
recorder		0..0
asserter		0..0
performer
id		0..0
extension		0..0
onBehalfOf		0..0
reasonCode		0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
bodySite	S	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
outcome	S	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
complication
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
id		0..0
extension		0..0
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..0
extension		0..0
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manipulated	S	1..1	Reference(Device)	Device that was changed
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	A code specifying the state of the procedure. Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
extension		0..0
code	SΣ	1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
extension		0..0
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
subject	SΣ	1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
performed[x]	SΣ	1..1	Period	When the procedure was performed.
extension		0..0
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
extension		0..0
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
extension		0..0
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
extension		0..0
text	Σ	1..1	markdown	The annotation - text content (as markdown)
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
extension		0..0
manipulated	S	1..1	Reference(Device)	Device that was changed
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Procedure.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:localIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the state of the procedure. Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
extension		0..0
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
performed[x]	SΣ	1..1	Period	When the procedure was performed.
extension		0..0
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	BackboneElement	The people who performed the procedure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
reasonReference	Σ	0..*	Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)	The justification that the procedure was performed
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: UK Core Condition Code (preferred): A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
extension		0..0
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	Σ	1..1	markdown	The annotation - text content (as markdown)
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
manipulated	S	1..1	Reference(Device)	Device that was changed
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Procedure.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.identifier:localIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:localIdentifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	preferred	UKCoreConditionCode https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode from this IG
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.focalDevice.manipulated.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from UKCoreProcedure

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for identifier		0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	S	0..1	Identifier	External Identifiers for this procedure
system	S	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	S	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
period		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		0..0
partOf		0..0
statusReason	S	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	S	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
code		1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
id		0..0
extension		0..0
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
coding:snomedCT	S	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
system		0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
subject		1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
type		0..0
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
type		0..0
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
performed[x]		1..1	Period	When the procedure was performed.
id		0..0
extension		0..0
start	S	1..1	dateTime	Starting time with inclusive boundary
recorder		0..0
asserter		0..0
performer
id		0..0
extension		0..0
onBehalfOf		0..0
reasonCode		0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
bodySite	S	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
outcome	S	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
complication
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
id		0..0
extension		0..0
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..0
extension		0..0
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
id		0..0
extension		0..0
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manipulated	S	1..1	Reference(Device)	Device that was changed
id		0..0
extension		0..0
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
status	?!SΣ	1..1	code	A code specifying the state of the procedure. Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
extension		0..0
code	SΣ	1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
extension		0..0
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
subject	SΣ	1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
performed[x]	SΣ	1..1	Period	When the procedure was performed.
extension		0..0
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
extension		0..0
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
extension		0..0
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
extension		0..0
text	Σ	1..1	markdown	The annotation - text content (as markdown)
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
extension		0..0
manipulated	S	1..1	Reference(Device)	Device that was changed
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Procedure.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:localIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	UKCoreProcedure	An action that is being or was performed on a patient
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:system
identifier:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	0..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
identifier:localIdentifier	SΣ	0..1	Identifier	External Identifiers for this procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	SΣ	1..1	uri	The namespace for the identifier value Fixed Value: https://fhir.interweavedigital.nhs.uk/Id/local-procedure-identifier
value	SΣ	1..1	string	The Local procedure Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique Example General: 123456
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!SΣ	1..1	code	A code specifying the state of the procedure. Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (preferred)
category	SΣ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (required): A code that classifies a procedure for searching, sorting and display purposes.
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	A code identifying the procedure performed. Binding: UK Core Procedure Code (required): A code from the SNOMED Clinical Terminology UK.
extension		0..0
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:coding.system
coding:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	SΣ	1..1	Coding	Code defined by a terminology system Binding: UK Core Procedure Code (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(InterweavePatient)	Who the procedure was performed on. (A patient, NOT group)
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
performed[x]	SΣ	1..1	Period	When the procedure was performed.
extension		0..0
start	SΣC	1..1	dateTime	Starting time with inclusive boundary
end	ΣC	0..1	dateTime	End time with inclusive boundary, if not ongoing
performer	Σ	0..*	BackboneElement	The people who performed the procedure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (preferred)
reasonReference	Σ	0..*	Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)	The justification that the procedure was performed
bodySite	SΣ	0..1	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
outcome	SΣ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (required)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: UK Core Condition Code (preferred): A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (preferred)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
note		0..*	Annotation	Additional information about the Procedure. NB: Any notes may be shared widely across the region, including being viewed by the patient themselves
extension		0..0
author[x]	Σ	0..1		Individual responsible for the annotation
authorReference			Reference(Practitioner | Patient | RelatedPerson | Organization)
authorString			string
time	Σ	0..1	dateTime	When the annotation was made
text	Σ	1..1	markdown	The annotation - text content (as markdown)
focalDevice	S	0..*	BackboneElement	Manipulated, implanted, or removed device
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred)
extension		0..0
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
manipulated	S	1..1	Reference(Device)	Device that was changed
extension		0..0
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
Procedure.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.identifier:localIdentifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:localIdentifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	preferred	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	required	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.code.coding:snomedCT	required	UKCoreProcedureCode https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode from this IG
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.reasonCode	preferred	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	required	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	required	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	preferred	UKCoreConditionCode https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode from this IG
Procedure.followUp	preferred	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.focalDevice.manipulated.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	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	error	Procedure	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	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from UKCoreProcedure

Summary

Mandatory: 10 elements(28 nested mandatory elements)
Must-Support: 22 elements
Fixed: 4 elements
Prohibited: 41 elements

Structures

This structure refers to these other structures:

• InterweaveOrganization (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Organization)
• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Procedure.meta.tag
• The element 1 is sliced based on the value of Procedure.identifier
• The element 1 is sliced based on the value of Procedure.code.coding