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Template Procedure Activity Procedure 2019‑03‑06 11:55:46

Id2.16.840.1.113883.3.1937.99.61.26.10.52Effective Date2019‑03‑06 11:55:46
Statusdraft DraftVersion Label1.1
NameProcedureActivityProcedureDisplay NameProcedure Activity Procedure
Description
The common notion of ""procedure"" is broader than that specified by the HL7 Version 3 Reference Information Model (RIM). Therefore procedure templates can be represented with various RIM classes: act (e.g., dressing change), observation (e.g., EEG), procedure (e.g. splenectomy). This clinical statement represents procedures whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the patient. Examples of these procedures are an appendectomy, hip replacement and a creation of a gastrostomy.
ContextParent nodes of template element with id 2.16.840.1.113883.3.1937.99.61.26.10.52
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 0 templates, Uses 5 templates
Uses as NameVersion
2.16.840.1.113883.10.20.22.4.16Containmentdraft Medication Activity (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.4.19Containmentdraft Indication (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.4.20Containmentdraft Instructions (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.4.32Containmentdraft Service Delivery Location (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.4.37Containmentdraft Product Instance (1.1)2013‑01‑31
RelationshipSpecialization: template 2.16.840.1.113883.10.20.22.4.14 Procedure Activity Procedure (2013‑01‑31)
ref
ccda-
ItemDTCardConfDescriptionLabel
cda:procedure
Procdotsdure
@classCode
cs1 … 1FPROCconf‑7652
@moodCode
cs1 … 1Rconf‑7653
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.11.20.9.18 MoodCodeEvnInt (DYNAMIC)
hl7:templateId
II1 … 1MProcdotsdure
@root
uid1 … 1F2.16.840.1.113883.3.1937.99.61.26.10.52
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:7654) such that itconf‑7654
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.14confdots0521
cda:id
II1 … *RSHALL contain at least one [1..*] id (CONF:7655).conf‑7655
cda:code
1 … 1RSHALL contain exactly one [1..1] code (CONF:7656).conf‑7656
cda:originalText
0 … 1RThis code SHOULD contain zero or one [0..1] originalText (CONF:19203).confdots9203
cda:reference
0 … 1RThe originalText, if present, SHOULD contain zero or one [0..1] reference (CONF:19204).

This reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1).

confdots9204
@value
0 … 1 confdots9205
 Schematron assertrolered error 
 testnot(@value) or starts-with(@value, '#') 
 MessageThis reference/@value SHALL begin with a '#' and SHALL point to its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1). 
cda:statusCode
CS1 … 1RSHALL contain exactly one [1..1] statusCode, which SHALL be selected from ValueSet ProcedureAct statusCode 2.16.840.1.113883.11.20.9.22 DYNAMIC (CONF:7661).conf‑7661
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.20.9.22 ProcedureAct statusCode (DYNAMIC)
cda:effectiveTime
0 … 1RSHOULD contain zero or one [0..1] effectiveTime (CONF:7662).conf‑7662
cda:priorityCode
0 … 1MAY contain zero or one [0..1] priorityCode, which SHALL be selected from ValueSet Act Priority 2.16.840.1.113883.1.11.16866 DYNAMIC (CONF:7668).conf‑7668
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16866 ActPriority (DYNAMIC)
cda:methodCode
CE0 … 1MAY contain zero or one [0..1] methodCode (CONF:7670).

methodCode SHALL NOT conflict with the method inherent in Procedure / code.

conf‑7670
cda:targetSiteCode
0 … *RSHOULD contain zero or more [0..*] targetSiteCode (CONF:7683).conf‑7683
@code
1 … 1Rconfdots6082
cda:specimen
0 … *MAY contain zero or more [0..*] specimen (CONF:7697).

This specimen is for representing specimens obtained from a procedure.

conf‑7697
cda:specimenRole
1 … 1MThe specimen, if present, SHALL contain exactly one [1..1] specimenRole (CONF:7704).conf‑7704
cda:id
II0 … *RThis specimenRole SHOULD contain zero or more [0..*] id (CONF:7716).

If you want to indicate that the Procedure and the Results are referring to the same specimen, the Procedure/specimen/specimenRole/id SHOULD be set to equal an Organizer/specimen/ specimenRole/id

conf‑7716
cda:performer
0 … *RSHOULD contain zero or more [0..*] performer (CONF:7718) such that itconf‑7718
cda:assignedEntity
1 … 1MSHALL contain exactly one [1..1] assignedEntity (CONF:7720).conf‑7720
cda:id
II1 … *RThis assignedEntity SHALL contain at least one [1..*] id (CONF:7722).conf‑7722
cda:addr
AD1 … 1RThis assignedEntity SHALL contain exactly one [1..1] addr (CONF:7731).conf‑7731
cda:telecom
TEL1 … 1RThis assignedEntity SHALL contain exactly one [1..1] telecom (CONF:7732).conf‑7732
cda:representedOrganization
0 … 1RThis assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:7733).conf‑7733
cda:id
II0 … *RThe representedOrganization, if present, SHOULD contain zero or more [0..*] id (CONF:7734).conf‑7734
cda:name
0 … *The representedOrganization, if present, MAY contain zero or more [0..*] name (CONF:7735).conf‑7735
cda:telecom
TEL1 … 1RThe representedOrganization, if present, SHALL contain exactly one [1..1] telecom (CONF:7737).conf‑7737
cda:addr
AD1 … 1RThe representedOrganization, if present, SHALL contain exactly one [1..1] addr (CONF:7736).conf‑7736
cda:participant
0 … *Contains 2.16.840.1.113883.10.20.22.4.37 Product Instance (2013‑01‑31)conf‑7751
@typeCode
cs1 … 1FDEVconf‑7752
cda:participant
0 … *Contains 2.16.840.1.113883.10.20.22.4.32 Service Delivery Location (2013‑01‑31)conf‑7765
@typeCode
cs1 … 1FLOCconf‑7766
cda:entryRelationship
0 … *MAY contain zero or more [0..*] entryRelationship (CONF:7768) such that itconf‑7768
@typeCode
cs1 … 1FCOMPconf‑7769
@inversionInd
bl1 … 1Ftrueconf‑8009
cda:encounter
1 … 1MSHALL contain exactly one [1..1] encounter (CONF:7770).conf‑7770
@classCode
cs1 … 1FENCconf‑7771
@moodCode
cs1 … 1FEVNconf‑7772
cda:id
II1 … 1RThis encounter SHALL contain exactly one [1..1] id (CONF:7773).

Set the encounter ID to the ID of an encounter in another section to signify they are the same encounter.

conf‑7773
cda:entryRelationship
0 … 1Contains 2.16.840.1.113883.10.20.22.4.20 Instructions (2013‑01‑31)conf‑7775
@typeCode
cs1 … 1FSUBJconf‑7776
@inversionInd
bl1 … 1Ftrueconf‑7777
cda:entryRelationship
0 … *Contains 2.16.840.1.113883.10.20.22.4.19 Indication (2013‑01‑31)conf‑7779
@typeCode
cs1 … 1FRSONconf‑7780
cda:entryRelationship
0 … *Contains 2.16.840.1.113883.10.20.22.4.16 Medication Activity (2013‑01‑31)conf‑7886
@typeCode
cs1 … 1FCOMPconf‑7887