Profile-procedure-de-basis-0.2.xml

<?xml version="1.0" encoding="utf-8"?>
<StructureDefinition xmlns="http://hl7.org/fhir">
  <meta>
    <lastUpdated value="2018-02-01T14:34:07.894-06:00" />
  </meta>
  <url value="http://fhir.de/StructureDefinition/procedure-de-basis/0.2" />
 <version value="0.2.4" />
  <name value="procedure-de-basis-0.2" />
  <title value="Procedure, Deutsches Basisprofil (Version 0.2)" />
  <status value="draft" />
  <experimental value="true" />
  <date value="2018-09-25" />
  <publisher value="HL7 Deutschland e.V. (Technisches Komitee FHIR)" />
  <contact>
    <telecom>
      <system value="other" />
      <value value="http://hl7.de/technische-komitees/fhir/" />
    </telecom>
  </contact>
  <copyright value="HL7 Deutschland e.V." />
  <fhirVersion value="3.0.1" />
  <kind value="resource" />
  <abstract value="false" />
  <type value="Procedure" />
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Procedure" />
  <derivation value="constraint" />
  <snapshot>
    <element id="Procedure">
      <path value="Procedure" />
      <short value="An action that is being or was performed on a patient" />
      <definition value="An action that is or was performed on a patient. This can be a physical intervention like an operation, or less invasive like counseling or hypnotherapy." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Resource" />
        <min value="0" />
        <max value="*" />
      </base>
      <constraint>
        <key value="dom-2" />
        <severity value="error" />
        <human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
        <expression value="contained.contained.empty()" />
        <xpath value="not(parent::f:contained and f:contained)" />
      </constraint>
      <constraint>
        <key value="dom-1" />
        <severity value="error" />
        <human value="If the resource is contained in another resource, it SHALL NOT contain any narrative" />
        <expression value="contained.text.empty()" />
        <xpath value="not(parent::f:contained and f:text)" />
      </constraint>
      <constraint>
        <key value="dom-4" />
        <severity value="error" />
        <human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
        <expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
        <xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
      </constraint>
      <constraint>
        <key value="dom-3" />
        <severity value="error" />
        <human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource" />
        <expression value="contained.where(('#'+id in %resource.descendants().reference).not()).empty()" />
        <xpath value="not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))" />
      </constraint>
      <constraint>
        <key value="pro-1" />
        <severity value="error" />
        <human value="Reason not done is only permitted if notDone indicator is true" />
        <expression value="notDoneReason.empty() or notDone = true" />
        <xpath value="not(exists(f:notDoneReason)) or f:notDone/@value=true()" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="Entity. Role, or Act" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Procedure[moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="clinical.general" />
      </mapping>
    </element>
    <element id="Procedure.id">
      <path value="Procedure.id" />
      <short value="Logical id of this artifact" />
      <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
      <comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="id" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.meta">
      <path value="Procedure.meta" />
      <short value="Metadata about the resource" />
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.meta" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Meta" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.implicitRules">
      <path value="Procedure.implicitRules" />
      <short value="A set of rules under which this content was created" />
      <definition value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content." />
      <comment value="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. &#xA;&#xA;This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.implicitRules" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="uri" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isModifier value="true" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.language">
      <path value="Procedure.language" />
      <short value="Language of the resource content" />
      <definition value="The base language in which the resource is written." />
      <comment value="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)." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Resource.language" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="code" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueReference>
            <reference value="http://hl7.org/fhir/ValueSet/all-languages" />
          </valueReference>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="Language" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
          <valueBoolean value="true" />
        </extension>
        <strength value="extensible" />
        <description value="A human language." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/languages" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.text">
      <path value="Procedure.text" />
      <short value="Text summary of the resource, for human interpretation" />
      <definition value="A human-readable narrative that contains a summary of the resource, and may 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 &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety." />
      <comment value="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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded in formation is added later." />
      <alias value="narrative" />
      <alias value="html" />
      <alias value="xhtml" />
      <alias value="display" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="DomainResource.text" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Narrative" />
      </type>
      <condition value="ele-1" />
      <condition value="dom-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Act.text?" />
      </mapping>
    </element>
    <element id="Procedure.contained">
      <path value="Procedure.contained" />
      <short value="Contained, inline Resources" />
      <definition value="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." />
      <comment value="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." />
      <alias value="inline resources" />
      <alias value="anonymous resources" />
      <alias value="contained resources" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="DomainResource.contained" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Resource" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="Entity. Role, or Act" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.extension">
      <path value="Procedure.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Additional Content defined by implementations" />
      <definition value="May be used to represent additional information that is not part of the basic definition of the resource. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="DomainResource.extension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.modifierExtension">
      <path value="Procedure.modifierExtension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Extensions that cannot be ignored" />
      <definition value="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. Usually modifier elements provide negation or qualification. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="DomainResource.modifierExtension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <isModifier value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.identifier">
      <path value="Procedure.identifier" />
      <short value="External Identifiers for this procedure" />
      <definition value="This records identifiers associated with this procedure that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)." />
      <requirements value="Need to allow connection to a wider workflow." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.identifier" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Identifier" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CX / EI (occasionally, more often EI maps to a resource id or a URL)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]" />
      </mapping>
      <mapping>
        <identity value="servd" />
        <map value="Identifier" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".id" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="id" />
      </mapping>
    </element>
    <element id="Procedure.definition">
      <path value="Procedure.definition" />
      <short value="Instantiates protocol or definition" />
      <definition value="A protocol, guideline, orderset or other definition that was adhered to in whole or in part by this procedure." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.definition" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PlanDefinition" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ActivityDefinition" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/HealthcareService" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=DEFN].target" />
      </mapping>
    </element>
    <element id="Procedure.basedOn">
      <path value="Procedure.basedOn" />
      <short value="A request for this procedure" />
      <definition value="A reference to a resource that contains details of the request for this procedure." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <alias value="fulfills" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.basedOn" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/CarePlan" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ProcedureRequest" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/ReferralRequest" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT,  moodCode=RQO].code" />
      </mapping>
    </element>
    <element id="Procedure.partOf">
      <path value="Procedure.partOf" />
      <short value="Part of referenced event" />
      <definition value="A larger event of which this particular procedure is a component or step." />
      <comment value="The MedicationAdministration has a partOf reference to Procedure, but this is not a circular reference.  For a surgical procedure, the anesthesia related medicationAdministration is part of the procedure.  For an IV medication administration,  the procedure to insert the IV port is part of the medication administration." />
      <alias value="container" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.partOf" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/procedure-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/observation-de-basis/0.2" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]" />
      </mapping>
    </element>
    <element id="Procedure.status">
      <path value="Procedure.status" />
      <short value="preparation | in-progress | suspended | aborted | completed | entered-in-error | unknown" />
      <definition value="A code specifying the state of the procedure. Generally this will be in-progress or completed state." />
      <comment value="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.&#xA;&#xA;This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Procedure.status" />
        <min value="1" />
        <max value="1" />
      </base>
      <type>
        <code value="code" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isModifier value="true" />
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureStatus" />
        </extension>
        <strength value="required" />
        <description value="A code specifying the state of the procedure." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/event-status" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="statusCode" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="status" />
      </mapping>
    </element>
    <element id="Procedure.notDone">
      <path value="Procedure.notDone" />
      <short value="True if procedure was not performed as scheduled" />
      <definition value="Set this to true if the record is saying that the procedure was NOT performed." />
      <comment value="If true, it means the procedure did not occur as described.  Typically it would be accompanied by attributes describing the type of activity.  It might also be accompanied by body site information or time information (i.e. no procedure was done to the left arm or no procedure was done in this 2-year period).  Specifying additional information such as performer, outcome, etc. is generally inappropriate.  For example, it's not that useful to say &quot;There was no appendectomy done at 12:03pm June 6th by Dr. Smith with a successful outcome&quot; as it implies that there *could* have been an appendectomy done at any other time, by any other clinician or with any other outcome.&#xA;&#xA;This element is labeled as a modifier because it indicates that a procedure didn't happen." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.notDone" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="boolean" />
      </type>
      <defaultValueBoolean value="false" />
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isModifier value="true" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".actionNegationInd" />
      </mapping>
    </element>
    <element id="Procedure.notDoneReason">
      <path value="Procedure.notDoneReason" />
      <short value="Reason procedure was not performed" />
      <definition value="A code indicating why the procedure was not performed." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.notDoneReason" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <condition value="pro-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureNegationReason" />
        </extension>
        <strength value="example" />
        <description value="A code that identifies the reason a procedure was not performed." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-not-performed-reason" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".reason.Observation.value" />
      </mapping>
    </element>
    <element id="Procedure.category">
      <path value="Procedure.category" />
      <short value="Classification of the procedure" />
      <definition value="A code that classifies the procedure for searching, sorting and display purposes (e.g. &quot;Surgical Procedure&quot;)." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.category" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureCategory" />
        </extension>
        <strength value="example" />
        <description value="A code that classifies a procedure for searching, sorting and display purposes." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-category" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="class" />
      </mapping>
    </element>
    <element id="Procedure.code">
      <path value="Procedure.code" />
      <short value="Identification of the procedure" />
      <definition value="The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. &quot;Laparoscopic Appendectomy&quot;)." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <requirements value="0..1 to account for primarily narrative only resources." />
      <alias value="type" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.code" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureCode" />
        </extension>
        <strength value="example" />
        <description value="A code to identify a specific procedure ." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-code" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="OBR-44/OBR-45" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="what" />
      </mapping>
    </element>
    <element id="Procedure.code.id">
      <path value="Procedure.code.id" />
      <representation value="xmlAttr" />
      <short value="xml:id (or equivalent in JSON)" />
      <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Element.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.code.extension">
      <path value="Procedure.code.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Additional Content defined by implementations" />
      <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Element.extension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.code.coding">
      <path value="Procedure.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <rules value="open" />
      </slicing>
      <short value="Code defined by a terminology system" />
      <definition value="A reference to a code defined by a terminology system." />
      <comment value="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." />
      <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="CodeableConcept.coding" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Coding" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CV" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding rdfs:subClassOf dt:CDCoding" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.1-8, C*E.10-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="union(., ./translation)" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS">
      <path value="Procedure.code.coding" />
      <sliceName value="OPS" />
      <short value="Code defined by a terminology system" />
      <definition value="A reference to a code defined by a terminology system." />
      <comment value="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." />
      <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="CodeableConcept.coding" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Coding" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <strength value="required" />
        <valueSetUri value="http://fhir.de/ValueSet/dimdi/ops" />
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE subset one of the sets of component 1-3 or 4-6" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CV" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding rdfs:subClassOf dt:CDCoding" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.1-8, C*E.10-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="union(., ./translation)" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.id">
      <path value="Procedure.code.coding.id" />
      <representation value="xmlAttr" />
      <short value="xml:id (or equivalent in JSON)" />
      <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Element.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.extension">
      <path value="Procedure.code.coding.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Additional Content defined by implementations" />
      <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Element.extension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.system">
      <path value="Procedure.code.coding.system" />
      <short value="Identity of the terminology system" />
      <definition value="The identification of the code system that defines the meaning of the symbol in the code." />
      <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously." />
      <requirements value="Need to be unambiguous about the source of the definition of the symbol." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Coding.system" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="uri" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.3" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="./codeSystem" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.version">
      <path value="Procedure.code.coding.version" />
      <short value="Version of the system - if relevant" />
      <definition value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged." />
      <comment value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Coding.version" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.7" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="./codeSystemVersion" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.code">
      <path value="Procedure.code.coding.code" />
      <short value="Symbol in syntax defined by the system" />
      <definition value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <requirements value="Need to refer to a particular code in the system." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Coding.code" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="code" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.1" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="./code" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.display">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Procedure.code.coding.display" />
      <short value="Representation defined by the system" />
      <definition value="A representation of the meaning of the code in the system, following the rules of the system." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know  the system." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Coding.display" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.2 - but note this is not well followed" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CV.displayName" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName" />
      </mapping>
    </element>
    <element id="Procedure.code.coding:OPS.userSelected">
      <path value="Procedure.code.coding.userSelected" />
      <short value="If this coding was chosen directly by the user" />
      <definition value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)." />
      <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely." />
      <requirements value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Coding.userSelected" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="boolean" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="Sometimes implied by being first" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD.codingRationale" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [     fhir:source &quot;true&quot;;     fhir:target dt:CDCoding.codingRationale\#O   ]" />
      </mapping>
    </element>
    <element id="Procedure.code.text">
      <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true" />
      </extension>
      <path value="Procedure.code.text" />
      <short value="Plain text representation of the concept" />
      <definition value="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." />
      <comment value="Very often the text is the same as a displayName of one of the codings." />
      <requirements value="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." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="CodeableConcept.text" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="C*E.9. But note many systems use C*E.2 for this" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" />
      </mapping>
    </element>
    <element id="Procedure.subject">
      <path value="Procedure.subject" />
      <short value="Who the procedure was performed on" />
      <definition value="The person, animal or group on which the procedure was performed." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <alias value="patient" />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Procedure.subject" />
        <min value="1" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/patient-de-basis/0.2" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mustSupport value="true" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="PID-3" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=SBJ].role" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.focus" />
      </mapping>
    </element>
    <element id="Procedure.context">
      <path value="Procedure.context" />
      <short value="Encounter or episode associated with the procedure" />
      <definition value="The encounter during which the procedure was performed." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <alias value="encounter" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.context" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/EpisodeOfCare" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="PV1-19" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="context" />
      </mapping>
    </element>
    <element id="Procedure.performed[x]">
      <path value="Procedure.performed[x]" />
      <short value="Date/Period the procedure was performed" />
      <definition value="The date(time)/period over which 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." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.performed[x]" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="dateTime" />
      </type>
      <type>
        <code value="Period" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="OBR-7" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".effectiveTime" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="when.done" />
      </mapping>
    </element>
    <element id="Procedure.performer">
      <path value="Procedure.performer" />
      <short value="The people who performed the procedure" />
      <definition value="Limited to 'real' people rather than equipment." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.performer" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="BackboneElement" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=PRF]" />
      </mapping>
    </element>
    <element id="Procedure.performer.id">
      <path value="Procedure.performer.id" />
      <representation value="xmlAttr" />
      <short value="xml:id (or equivalent in JSON)" />
      <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Element.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.performer.extension">
      <path value="Procedure.performer.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Additional Content defined by implementations" />
      <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Element.extension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.performer.modifierExtension">
      <path value="Procedure.performer.modifierExtension" />
      <short value="Extensions that cannot be ignored" />
      <definition value="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 that contains it. Usually modifier elements provide negation or qualification. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <alias value="modifiers" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="BackboneElement.modifierExtension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <isModifier value="true" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.performer.role">
      <path value="Procedure.performer.role" />
      <short value="The role the actor was in" />
      <definition value="For example: surgeon, anaethetist, endoscopist." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.performer.role" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedurePerformerRole" />
        </extension>
        <strength value="example" />
        <description value="A code that identifies the role of a performer of the procedure." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/performer-role" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".functionCode" />
      </mapping>
    </element>
    <element id="Procedure.performer.actor">
      <path value="Procedure.performer.actor" />
      <short value="The reference to the practitioner" />
      <definition value="The practitioner who was involved in the procedure." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <requirements value="A reference to Device supports use cases, such as pacemakers." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Procedure.performer.actor" />
        <min value="1" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/organization-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/patient-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/practitioner-de-basis/0.2" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="ORC-19/PRT-5" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".role" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.actor" />
      </mapping>
    </element>
    <element id="Procedure.performer.onBehalfOf">
      <path value="Procedure.performer.onBehalfOf" />
      <short value="Organization the device or practitioner was acting for" />
      <definition value="The organization the device or practitioner was acting on behalf of." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <requirements value="Practitioners and Devices can be associated with multiple organizations.  This element indicates which organization they were acting on behalf of when performing the action." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.performer.onBehalfOf" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".scoper" />
      </mapping>
    </element>
    <element id="Procedure.location">
      <path value="Procedure.location" />
      <short value="Where the procedure happened" />
      <definition value="The location where the procedure actually happened.  E.g. a newborn at home, a tracheostomy at a restaurant." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <requirements value="Ties a procedure to where the records are likely kept." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.location" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=LOC].role[classCode=SDLOC]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="where" />
      </mapping>
    </element>
    <element id="Procedure.reasonCode">
      <path value="Procedure.reasonCode" />
      <short value="Coded reason procedure performed" />
      <definition value="The coded reason why the procedure was performed. This may be coded entity of some type, or may simply be present as text." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.reasonCode" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureReason" />
        </extension>
        <strength value="example" />
        <description value="A code that identifies the reason a procedure is  required." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-reason" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".reasonCode" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="why" />
      </mapping>
    </element>
    <element id="Procedure.reasonReference">
      <path value="Procedure.reasonReference" />
      <short value="Condition that is the reason the procedure performed" />
      <definition value="The condition that is the reason why the procedure was performed." />
      <comment value="e.g. endoscopy for dilatation and biopsy, combination diagnosis and therapeutic." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.reasonReference" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/observation-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/condition-de-basis/0.2" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".reasonCode" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="why" />
      </mapping>
    </element>
    <element id="Procedure.bodySite">
      <path value="Procedure.bodySite" />
      <short value="Target body sites" />
      <definition value="Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.bodySite" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="BodySite" />
        </extension>
        <strength value="example" />
        <description value="Codes describing anatomical locations. May include laterality." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/body-site" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="OBX-20" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".targetSiteCode" />
      </mapping>
    </element>
    <element id="Procedure.outcome">
      <path value="Procedure.outcome" />
      <short value="The result of procedure" />
      <definition value="The outcome of the procedure - did it resolve reasons for the procedure being performed?" />
      <comment value="If outcome contains narrative text only, it can be captured using the CodeableConcept.text." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.outcome" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <isSummary value="true" />
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureOutcome" />
        </extension>
        <strength value="example" />
        <description value="An outcome of a procedure - whether it was resolved or otherwise." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-outcome" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=OUT].target.text" />
      </mapping>
    </element>
    <element id="Procedure.report">
      <path value="Procedure.report" />
      <short value="Any report resulting from the procedure" />
      <definition value="This could be a histology result, pathology report, surgical report, etc.." />
      <comment value="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." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.report" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]" />
      </mapping>
    </element>
    <element id="Procedure.complication">
      <path value="Procedure.complication" />
      <short value="Complication following the procedure" />
      <definition value="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." />
      <comment value="If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.complication" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureComplication" />
        </extension>
        <strength value="example" />
        <description value="Codes describing complications that resulted from a procedure." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/condition-code" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=OUTC].target[classCode=OBS, code=&quot;complication&quot;, moodCode=EVN].value" />
      </mapping>
    </element>
    <element id="Procedure.complicationDetail">
      <path value="Procedure.complicationDetail" />
      <short value="A condition that is a result of the procedure" />
      <definition value="Any complications that occurred during the procedure, or in the immediate post-performance period." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <requirements value="This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.complicationDetail" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=OUTC].target[classCode=OBS, code=&quot;complication&quot;, moodCode=EVN].value" />
      </mapping>
    </element>
    <element id="Procedure.followUp">
      <path value="Procedure.followUp" />
      <short value="Instructions for follow up" />
      <definition value="If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note, or could potentially be more complex in which case the CarePlan resource can be used." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.followUp" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureFollowUp" />
        </extension>
        <strength value="example" />
        <description value="Specific follow up required for a procedure e.g. removal of sutures." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/procedure-followup" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code" />
      </mapping>
    </element>
    <element id="Procedure.note">
      <path value="Procedure.note" />
      <short value="Additional information about the procedure" />
      <definition value="Any other notes about the procedure.  E.g. the operative notes." />
      <comment value="For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time.  This element may need to be included in narrative because of the potential for modifying information.  *Annotations SHOULD NOT* be used to communicate &quot;modifying&quot; information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible)." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.note" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Annotation" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="N/A" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Act" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="NTE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=&quot;annotation&quot;].value" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice">
      <path value="Procedure.focalDevice" />
      <short value="Device changed in procedure" />
      <definition value="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." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.focalDevice" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="BackboneElement" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=DEV].role[classCode=MANU]" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice.id">
      <path value="Procedure.focalDevice.id" />
      <representation value="xmlAttr" />
      <short value="xml:id (or equivalent in JSON)" />
      <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
      <comment value="Note that FHIR strings may not exceed 1MB in size" />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Element.id" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="string" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice.extension">
      <path value="Procedure.focalDevice.extension" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="url" />
        </discriminator>
        <description value="Extensions are always sliced by (at least) url" />
        <rules value="open" />
      </slicing>
      <short value="Additional Content defined by implementations" />
      <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Element.extension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice.modifierExtension">
      <path value="Procedure.focalDevice.modifierExtension" />
      <short value="Extensions that cannot be ignored" />
      <definition value="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 that contains it. Usually modifier elements provide negation or qualification. In order 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." />
      <comment value="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." />
      <alias value="extensions" />
      <alias value="user content" />
      <alias value="modifiers" />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="BackboneElement.modifierExtension" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Extension" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ext-1" />
        <severity value="error" />
        <human value="Must have either extensions or value[x], not both" />
        <expression value="extension.exists() != value.exists()" />
        <xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])" />
      </constraint>
      <isModifier value="true" />
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice.action">
      <path value="Procedure.focalDevice.action" />
      <short value="Kind of change to device" />
      <definition value="The kind of change that happened to the device during the procedure." />
      <comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
      <min value="0" />
      <max value="1" />
      <base>
        <path value="Procedure.focalDevice.action" />
        <min value="0" />
        <max value="1" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DeviceActionKind" />
        </extension>
        <strength value="preferred" />
        <description value="A kind of change that happened to the device during the procedure." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/device-action" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=&quot;procedure device action&quot;].value=:procedure device action codes" />
      </mapping>
    </element>
    <element id="Procedure.focalDevice.manipulated">
      <path value="Procedure.focalDevice.manipulated" />
      <short value="Device that was changed" />
      <definition value="The device that was manipulated (changed) during the procedure." />
      <comment value="References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository." />
      <min value="1" />
      <max value="1" />
      <base>
        <path value="Procedure.focalDevice.manipulated" />
        <min value="1" />
        <max value="1" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=DEV].role[classCode=SDLOC]" />
      </mapping>
    </element>
    <element id="Procedure.usedReference">
      <path value="Procedure.usedReference" />
      <short value="Items used during procedure" />
      <definition value="Identifies medications, devices and any other substance used as part of the procedure." />
      <comment value="For devices actually implanted or removed, use Procedure.device." />
      <requirements value="Used for tracking contamination, etc." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.usedReference" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Substance" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/medication-de-basis/0.2" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <constraint>
        <key value="ref-1" />
        <severity value="error" />
        <human value="SHALL have a contained resource if a local reference is provided" />
        <expression value="reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))" />
        <xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
      </constraint>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="The target of a resource reference is a RIM entry point (Act, Role, or Entity)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value=".participation[typeCode=DEV].role[classCode=MANU] or&#xA;.participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)" />
      </mapping>
    </element>
    <element id="Procedure.usedCode">
      <path value="Procedure.usedCode" />
      <short value="Coded items used during the procedure" />
      <definition value="Identifies coded items that were used as part of the procedure." />
      <comment value="For devices actually implanted or removed, use Procedure.device." />
      <min value="0" />
      <max value="*" />
      <base>
        <path value="Procedure.usedCode" />
        <min value="0" />
        <max value="*" />
      </base>
      <type>
        <code value="CodeableConcept" />
      </type>
      <condition value="ele-1" />
      <constraint>
        <key value="ele-1" />
        <severity value="error" />
        <human value="All FHIR elements must have a @value or children" />
        <expression value="hasValue() | (children().count() &gt; id.count())" />
        <xpath value="@value|f:*|h:div" />
      </constraint>
      <binding>
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="ProcedureUsed" />
        </extension>
        <strength value="example" />
        <description value="Codes describing items used during a procedure" />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/device-kind" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="rim" />
        <map value="n/a" />
      </mapping>
      <mapping>
        <identity value="v2" />
        <map value="CE/CNE/CWE" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="CD" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=Dev].role[classCode=MANU]" />
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element id="Procedure.partOf">
      <path value="Procedure.partOf" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/procedure-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/observation-de-basis/0.2" />
      </type>
    </element>
    <element id="Procedure.code.coding">
      <path value="Procedure.code.coding" />
      <slicing>
        <discriminator>
          <type value="value" />
          <path value="system" />
        </discriminator>
        <rules value="open" />
      </slicing>
    </element>
    <element id="Procedure.code.coding:OPS">
      <path value="Procedure.code.coding" />
      <sliceName value="OPS" />
      <binding>
        <strength value="required" />
        <valueSetUri value="http://fhir.de/ValueSet/dimdi/ops" />
      </binding>
    </element>
    <element id="Procedure.code.coding:OPS.system">
      <path value="Procedure.code.coding.system" />
      <min value="1" />
    </element>
    <element id="Procedure.code.coding:OPS.version">
      <path value="Procedure.code.coding.version" />
      <min value="1" />
    </element>
    <element id="Procedure.code.coding:OPS.code">
      <path value="Procedure.code.coding.code" />
      <min value="1" />
    </element>
    <element id="Procedure.subject">
      <path value="Procedure.subject" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/patient-de-basis/0.2" />
      </type>
      <mustSupport value="true" />
    </element>
    <element id="Procedure.performer.actor">
      <path value="Procedure.performer.actor" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/organization-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/patient-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/practitioner-de-basis/0.2" />
      </type>
    </element>
    <element id="Procedure.reasonReference">
      <path value="Procedure.reasonReference" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/observation-de-basis/0.2" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/condition-de-basis/0.2" />
      </type>
    </element>
    <element id="Procedure.usedReference">
      <path value="Procedure.usedReference" />
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Substance" />
      </type>
      <type>
        <code value="Reference" />
        <targetProfile value="http://fhir.de/StructureDefinition/medication-de-basis/0.2" />
      </type>
    </element>
  </differential>
</StructureDefinition>