1.9.1 - release

SHINNYHRSN - Local Development build (v1.9.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: SHINNYProcedureProfile - Detailed Descriptions

Active as of 2026-05-13

Definitions for the shinny-sdoh-procedure resource profile.

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

0. Procedure
Definition

For procedures that address SDOH conditions, SDOH observations, or SDOH goals.


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.

ShortAn action that addresses an SDOH condition, observation, or goal.An action that is being or was performed on a patient
Comments

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

Control0..*
Is Modifierfalse
Must Supportfalse
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.

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

Control10..1
Typeidstring
Is Modifierfalse
Must Supporttrue
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
Control10..1
TypeMeta(SHINNYMeta)
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Procedure.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

ShortWhen the resource version was created or last changedWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control10..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Procedure.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.


A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles this resource claims to conform to
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control10..1*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. 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()))
12. 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 SHINNYLanguageVShttp://hl7.org/fhir/ValueSet/languages
(preferred to http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS)
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()))
14. Procedure.extension:pertainsToGoal
Slice NamepertainsToGoal
Definition

Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to provide food vouchers pertainsToGoal of achieving food security.

ShortPertains to SDOH goal
Comments

This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

Control0..*
TypeExtension(Resource Pertains To Goal) (Extension Type: Reference(Goal))
Is Modifierfalse
Must Supporttrue
Requirements

Indicates that the procedure is related to the referenced SDOHCC Goal.

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())
16. Procedure.extension:pertainsToGoal.extension
Definition

An Extension


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.

ShortExtensionAdditional 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..0*
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())
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())
SlicingThis element introduces a set of slices on Procedure.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 18. Procedure.extension:pertainsToGoal.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
    20. Procedure.extension:pertainsToGoal.value[x]
    Definition

    Value of extension must reference a Goal resource.


    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control10..1
    This element is affected by the following invariants: ext-1
    TypeReference(SDOHCC Goal), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    Indicates that the procedure is related to the referenced SDOHCC Goal.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. 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())
    24. 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
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summarytrue
    Alternate Namesfulfills
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ resolve()
    • 26. Procedure.basedOn:SupportedBasedOn
      Slice NameSupportedBasedOn
      Definition

      A reference to an SDOHCC service request that contains details of the request for this procedure.


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

      ShortAn SDOH service request for this procedureA request for this procedure
      Control0..*
      TypeReference(SDOHCC ServiceRequest, CarePlan, ServiceRequest)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      When a procedure is based on an SDOH ServiceRequest, Procedure.basedOn should reference instances that comply with the SDOHCC ServiceRequest profile. However, references to other instance types are also possible.

      Alternate Namesfulfills
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. 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)
      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
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Procedure.category
      Definition

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


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

      ShortClassification of the procedure
      Control10..1
      BindingFor example codes, see ProcedureCategoryCodes(SNOMEDCT)http://hl7.org/fhir/ValueSet/procedure-category
      (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()))
      32. Procedure.category.coding
      Definition

      A reference to a code defined by a terminology system.

      ShortCode defined by a terminology system
      Comments

      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control10..*
      TypeCoding
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Procedure.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ $this
      • 34. Procedure.category.coding:SDOH
        Slice NameSDOH
        Definition

        An SDOH category assigned to the procedure.


        A reference to a code defined by a terminology system.

        Shorte.g., food-insecurity | transportation-insecurityCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..1*
        BindingThe codes SHALL be taken from For codes, see SDOHCC ValueSet SDOH Category
        (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

        Codes for high-level SDOH categories.

        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.
        Codes from this value set can be used to assign an SDOH category (e.g., food-insecurity, transportation-insecurity, etc.) to a procedure. It is recommended that SDOH category codes be used to facilitate searching for SDOH procedures that address SDOH conditions, observations, service requests, or goals.


        Allows for alternative encodings within a code system, and translations to other code systems.

        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.


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

        ShortProcedure codes from SNOMED CT, CPT, HCPCS II, ICD-10PC, or CDTIdentification of the procedure
        Control10..1
        BindingThe codes SHALL be taken from For example codes, see US Core Procedure Codeshttp://hl7.org/fhir/ValueSet/procedure-code
        (required to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

        Codes describing the type of Procedure


        A code to identify a specific procedure .

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        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(US Core Patient Profile, Patient, Group)
        Is Modifierfalse
        Must Supporttrue
        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.

        Control10..1
        TypeReference(Encounter)
        Is Modifierfalse
        Must Supporttrue
        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.

        Control10..1
        TypeChoice of: dateTime, Period, string, Range, Age
        [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
        Summarytrue
        Requirements

        NOTE: dateTime should be Must Support, but currenlty tooling does not support this.

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

        The justification of why the procedure was performed.

        ShortThe justification that the procedure was performed
        Comments

        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.

        Additionally, see Comments for reasonCode.


        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(Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Procedure.reasonReference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • profile @ resolve()
        • 46. Procedure.reasonReference:SupportedReasonReference
          Slice NameSupportedReasonReference
          Definition

          The justification of why the procedure was performed.

          ShortThe justification that the procedure was performed
          Comments

          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.


          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(SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Observation Assessment, Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
          Is Modifierfalse
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Summarytrue
          Requirements

          When a procedure is justified by one or more SDOH conditions or observations, Procedure.reasonReference should reference instances that comply with the SDOHCC Condition profile, or one of the SDOHCC Observation profiles. However, references to other instance types are also possible.

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

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

          0. Procedure
          2. Procedure.id
          ShortThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
          Control1..?
          Must Supporttrue
          4. Procedure.meta
          Control1..?
          TypeMeta(SHINNYMeta)
          Must Supporttrue
          6. Procedure.meta.profile
          Control0..1
          8. Procedure.language
          BindingThe codes SHOULD be taken from SHINNYLanguageVS
          (preferred to http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS)
          10. Procedure.category
          Control1..?
          12. Procedure.category.coding
          Control1..?
          14. Procedure.category.coding:SDOH
          Slice NameSDOH
          Control1..?
          16. Procedure.encounter
          Control1..?
          Must Supporttrue

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

          0. Procedure
          Definition

          For procedures that address SDOH conditions, SDOH observations, or SDOH goals.

          ShortAn action that addresses an SDOH condition, observation, or goal.
          Comments

          Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths are also possible.

          Control0..*
          Is Modifierfalse
          Must Supportfalse
          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.

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

          Control1..1
          Typeid
          Is Modifierfalse
          Must Supporttrue
          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
          Control1..1
          TypeMeta(SHINNYMeta)
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          6. Procedure.meta.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
          8. Procedure.meta.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())
          SlicingThis element introduces a set of slices on Procedure.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 10. Procedure.meta.versionId
            Definition

            The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

            ShortVersion specific identifier
            Comments

            The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

            Control0..1
            Typeid
            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()))
            12. Procedure.meta.lastUpdated
            Definition

            When the resource last changed - e.g. when the version changed.

            ShortWhen the resource version was created or last changed
            Comments

            This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

            Control1..1
            Typeinstant
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            14. Procedure.meta.source
            Definition

            A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

            ShortIdentifies where the resource comes from
            Comments

            In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

            This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

            Control0..1
            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()))
            16. Procedure.meta.profile
            Definition

            A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

            ShortProfiles this resource claims to conform to
            Comments

            It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

            Control1..1
            Typecanonical(StructureDefinition)
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. Procedure.meta.security
            Definition

            Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

            ShortSecurity Labels applied to this resource
            Comments

            The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

            Control0..*
            BindingUnless not suitable, these codes SHALL be taken from All Security Labels
            (extensible to http://hl7.org/fhir/ValueSet/security-labels)

            Security Labels from the Healthcare Privacy and Security Classification System.

            TypeCoding
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. Procedure.meta.tag
            Definition

            Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

            ShortTags applied to this resource
            Comments

            The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

            Control0..*
            BindingFor example codes, see CommonTags
            (example to http://hl7.org/fhir/ValueSet/common-tags)

            Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

            TypeCoding
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. 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()))
            24. 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 SHINNYLanguageVS
            (preferred to http://test.shinny.org/us/ny/hrsn/ValueSet/SHINNYLanguageVS)
            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()))
            26. 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()))
            28. 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
            30. 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
            • 32. Procedure.extension:pertainsToGoal
              Slice NamepertainsToGoal
              Definition

              Indicates that the resource is related to either the measurement, achievement or progress towards the referenced goal. For example, a Procedure to provide food vouchers pertainsToGoal of achieving food security.

              ShortPertains to SDOH goal
              Comments

              This extension is limited to subject-specific activity-related resources (events & intents). I.e. This can't be put on Goal or Patient. This association isn't for the purpose of goal management, but for things such as noting that a particular observation result, prescription or other activity is pertinent to the achievement (or possibly non-achievement) of the referenced goal.

              Control0..*
              TypeExtension(Resource Pertains To Goal) (Extension Type: Reference(Goal))
              Is Modifierfalse
              Must Supporttrue
              Requirements

              Indicates that the procedure is related to the referenced SDOHCC Goal.

              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())
              34. Procedure.extension:pertainsToGoal.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
              This element is affected by the following invariants: ele-1
              Typeid
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              36. Procedure.extension:pertainsToGoal.extension
              Definition

              An Extension

              ShortExtension
              Control0..0
              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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 38. Procedure.extension:pertainsToGoal.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal
                40. Procedure.extension:pertainsToGoal.value[x]
                Definition

                Value of extension must reference a Goal resource.

                ShortValue of extension
                Control1..1
                This element is affected by the following invariants: ext-1
                TypeReference(SDOHCC Goal)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Requirements

                Indicates that the procedure is related to the referenced SDOHCC Goal.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                42. 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())
                44. 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()))
                46. 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()))
                48. 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()))
                50. 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
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Alternate Namesfulfills
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Procedure.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • profile @ resolve()
                • 52. Procedure.basedOn:SupportedBasedOn
                  Slice NameSupportedBasedOn
                  Definition

                  A reference to an SDOHCC service request that contains details of the request for this procedure.

                  ShortAn SDOH service request for this procedure
                  Control0..*
                  TypeReference(SDOHCC ServiceRequest)
                  Is Modifierfalse
                  Must Supporttrue
                  Summarytrue
                  Requirements

                  When a procedure is based on an SDOH ServiceRequest, Procedure.basedOn should reference instances that comply with the SDOHCC ServiceRequest profile. However, references to other instance types are also possible.

                  Alternate Namesfulfills
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  54. 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()))
                  56. 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)
                  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
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  58. 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()))
                  60. Procedure.category
                  Definition

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

                  ShortClassification of the procedure
                  Control1..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()))
                  62. Procedure.category.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
                  64. Procedure.category.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())
                  SlicingThis element introduces a set of slices on Procedure.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 66. Procedure.category.coding
                    Definition

                    A reference to a code defined by a terminology system.

                    ShortCode defined by a terminology system
                    Comments

                    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                    Control1..*
                    TypeCoding
                    Is Modifierfalse
                    Must Supporttrue
                    Summarytrue
                    Requirements

                    Allows for alternative encodings within a code system, and translations to other code systems.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Procedure.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ $this
                    • 68. Procedure.category.coding:SDOH
                      Slice NameSDOH
                      Definition

                      An SDOH category assigned to the procedure.

                      Shorte.g., food-insecurity | transportation-insecurity
                      Comments

                      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                      Control1..1
                      BindingThe codes SHALL be taken from SDOHCC ValueSet SDOH Category
                      (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

                      Codes for high-level SDOH categories.

                      TypeCoding
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Allows for alternative encodings within a code system, and translations to other code systems.
                      Codes from this value set can be used to assign an SDOH category (e.g., food-insecurity, transportation-insecurity, etc.) to a procedure. It is recommended that SDOH category codes be used to facilitate searching for SDOH procedures that address SDOH conditions, observations, service requests, or goals.

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

                      A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                      ShortPlain text representation of the concept
                      Comments

                      Very often the text is the same as a displayName of one of the codings.

                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summarytrue
                      Requirements

                      The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

                      The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded.

                      ShortProcedure codes from SNOMED CT, CPT, HCPCS II, ICD-10PC, or CDT
                      Control1..1
                      BindingThe codes SHALL be taken from US Core Procedure Codes
                      (required to http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code)

                      Codes describing the type of Procedure

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      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()))
                      74. Procedure.subject
                      Definition

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

                      ShortWho the procedure was performed on
                      Control1..1
                      TypeReference(US Core Patient Profile)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Alternate Namespatient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. 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.

                      Control1..1
                      TypeReference(Encounter)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      78. 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.

                      Control1..1
                      TypeChoice of: dateTime, Period
                      [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
                      Summarytrue
                      Requirements

                      NOTE: dateTime should be Must Support, but currenlty tooling does not support this.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      80. 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()))
                      82. 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()))
                      84. 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()))
                      86. 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
                      88. 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())
                      90. 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())
                      92. 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()))
                      94. 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()))
                      96. 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()))
                      98. 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()))
                      100. 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

                      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.

                      Information represented by Procedure.reasonCode may overlap significantly with information represented by Procedure.reasonReference. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar information could be provided by either Procedure.reasonCode or Procedure.reasonReference, it is recommended that Procedure.reasonReference be used to provide a reason for why a procedure was performed.

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

                      The justification of why the procedure was performed.

                      ShortThe justification that the procedure was performed
                      Comments

                      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.

                      Additionally, see Comments for reasonCode.

                      Control0..*
                      TypeReference(Condition, Observation, Procedure, DiagnosticReport, DocumentReference)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Procedure.reasonReference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • profile @ resolve()
                      • 104. Procedure.reasonReference:SupportedReasonReference
                        Slice NameSupportedReasonReference
                        Definition

                        The justification of why the procedure was performed.

                        ShortThe justification that the procedure was performed
                        Comments

                        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(SDOHCC Condition, SDOHCC Observation Screening Response, SDOHCC Observation Assessment)
                        Is Modifierfalse
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Summarytrue
                        Requirements

                        When a procedure is justified by one or more SDOH conditions or observations, Procedure.reasonReference should reference instances that comply with the SDOHCC Condition profile, or one of the SDOHCC Observation profiles. However, references to other instance types are also possible.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        106. 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..*
                        BindingFor example codes, see SNOMEDCTBodyStructures
                        (example to http://hl7.org/fhir/ValueSet/body-site)

                        Codes describing anatomical locations. May include laterality.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        108. 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()))
                        110. 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()))
                        112. 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()))
                        114. 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()))
                        116. 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()))
                        118. 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()))
                        120. 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()))
                        122. 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
                        124. 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())
                        126. 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())
                        128. 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()))
                        130. 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()))
                        132. 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()))
                        134. 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()))