HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1

HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU Ballot 1 - Local Development build (v0.9.1). See the Directory of published versions

Procedure


<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="obf-Procedure"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
  <p><b>Procedure Profile</b></p>
  <p>An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.</p>
  <p><b>Mapping Summary</b></p>
  <p><pre>obf.Procedure maps to http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure:
  Language maps to language
  ImplicitRules maps to implicitRules
  Metadata.VersionId maps to meta.versionId
  Metadata.SourceSystem maps to meta.source
  Metadata.Profile maps to meta.profile
  Metadata.LastUpdated maps to meta.lastUpdated
  Metadata.SecurityLabel maps to meta.security
  Metadata.Tag maps to meta.tag
  Narrative maps to text
  Identifier maps to identifier
  ProcedureBasedOn maps to basedOn
  ProcedurePartOf maps to partOf  // add Observation, MedicationAdministration
  Status maps to status
  StatusReason maps to statusReason
  Category maps to category
  Code maps to code
  SubjectOfRecord maps to subject
  CareContext maps to encounter
  OccurrenceTimeOrPeriod maps to performed[x]
  PersonAuthor maps to recorder
  PersonInformationSource maps to asserter
  Participation maps to performer
  Participation.Participant maps to performer.actor  // Added Target Type PractitionerRole -- not implemented
  Participation.ParticipationType maps to performer.function  // renamed role to function in R4
  Participation.OnBehalfOf maps to performer.onBehalfOf
  Location maps to location
  ReasonCode maps to reasonCode
  ProcedureReasonReference maps to reasonReference
  BodyLocation.Code maps to bodySite
  BodyLocation.Laterality maps to bodySite.extension
  BodyLocation.AnatomicalOrientation maps to bodySite.extension
  BodyLocation.RelationToLandmark maps to bodySite.extension
  Annotation maps to note
  Outcome maps to outcome
  DiagnosticReport maps to report
  ComplicationCode maps to complication
  ComplicationReference maps to complicationDetail
  FollowUp maps to followUp
  FocalDevice maps to focalDevice
  FocalDevice.Device maps to focalDevice.manipulated
  FocalDevice.FocalDeviceAction maps to focalDevice.action
  MaterialUsedReference maps to usedReference
  UsedCode maps to usedCode
</pre></p>
</div>
  </text>
  <url value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
  <version value="0.9.1"/>
  <name value="Procedure"/>
  <title value="obf-Procedure"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2019-08-01T00:00:00-04:00"/>
  <publisher value="HL7 International Clinical Interoperability Council"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cic"/>
    </telecom>
  </contact>
  <description
               value="An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <fhirVersion value="4.0.0"/>
  <mapping>
    <identity value="argonaut-dq-dstu2"/>
    <uri value="http://unknown.org/Argonaut-DQ-DSTU2"/>
    <name value="Argonaut-DQ-DSTU2"/>
  </mapping>
  <mapping>
    <identity value="workflow"/>
    <uri value="http://hl7.org/fhir/workflow"/>
    <name value="Workflow Pattern"/>
  </mapping>
  <mapping>
    <identity value="rim"/>
    <uri value="http://hl7.org/v3"/>
    <name value="RIM Mapping"/>
  </mapping>
  <mapping>
    <identity value="w5"/>
    <uri value="http://hl7.org/fhir/fivews"/>
    <name value="FiveWs Pattern Mapping"/>
  </mapping>
  <mapping>
    <identity value="v2"/>
    <uri value="http://hl7.org/v2"/>
    <name value="HL7 v2 Mapping"/>
  </mapping>
  <kind value="resource"/>
  <abstract value="false"/>
  <type value="Procedure"/>
  <baseDefinition
                  value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"/>
  <derivation value="constraint"/>
  <snapshot>
    <element id="Procedure">
      <path value="Procedure"/>
      <short value="obf-Procedure"/>
      <definition
                  value="An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure"/>
        <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)"/>
        <source value="DomainResource"/>
      </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))"/>
        <source value="DomainResource"/>
      </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 or SHALL refer to the containing resource"/>
        <expression
                    value="contained.where(((&#39;#&#39;+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists() or descendants().where(as(canonical) = &#39;#&#39;).exists()).not()).trace(&#39;unmatched&#39;, id).empty()"/>
        <xpath
               value="not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@value=concat(&#39;#&#39;, $contained/*/id/@value) or descendant::f:reference[@value=&#39;#&#39;])]))"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
          <valueBoolean value="true"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
          <valueMarkdown
                         value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
        </extension>
        <key value="dom-6"/>
        <severity value="warning"/>
        <human value="A resource should have narrative for robust management"/>
        <expression value="text.div.exists()"/>
        <xpath value="exists(f:text/h:div)"/>
        <source value="DomainResource"/>
      </constraint>
      <constraint>
        <key value="dom-5"/>
        <severity value="error"/>
        <human
               value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
        <expression value="contained.meta.security.empty()"/>
        <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
        <source value="DomainResource"/>
      </constraint>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="Entity. Role, or Act"/>
      </mapping>
      <mapping>
        <identity value="workflow"/>
        <map value="Event"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="Procedure[moodCode=EVN]"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="Procedure"/>
      </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>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </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 might 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>
      <isModifier value="false"/>
      <isSummary value="true"/>
    </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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc."/>
      <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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it&#39;s narrative along with other profiles, value sets, etc."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Resource.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation"/>
      <isSummary value="true"/>
    </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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
        </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="preferred"/>
        <description value="A human language."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
      </binding>
    </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 can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &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 information 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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels."/>
      <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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Procedure.extension">
      <path value="Procedure.extension"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <ordered value="false"/>
        <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. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Procedure.extension:statementdatetime">
      <path value="Procedure.extension"/>
      <sliceName value="statementdatetime"/>
      <definition value="The point in time when the statement was created."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-StatementDateTime-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.extension:treatmentintent">
      <path value="Procedure.extension"/>
      <sliceName value="treatmentintent"/>
      <definition value="The purpose of a treatment."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.modifierExtension">
      <path value="Procedure.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 resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
      <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>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
      <isSummary value="false"/>
      <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="Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server."/>
      <comment
               value="This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)).  It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types.  For example, multiple Patient and Person resource instances might share the same social insurance number."/>
      <requirements
                    value="Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.identifier"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.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>
    </element>
    <element id="Procedure.instantiatesCanonical">
      <path value="Procedure.instantiatesCanonical"/>
      <short value="Instantiates FHIR protocol or definition"/>
      <definition
                  value="The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.instantiatesCanonical"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="canonical"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/PlanDefinition"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ActivityDefinition"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Measure"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/OperationDefinition"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/Questionnaire"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.instantiatesCanonical"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".outboundRelationship[typeCode=DEFN].target"/>
      </mapping>
    </element>
    <element id="Procedure.instantiatesUri">
      <path value="Procedure.instantiatesUri"/>
      <short value="Instantiates external protocol or definition"/>
      <definition
                  value="The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure."/>
      <comment
               value="This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.instantiatesUri"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.instantiatesUri"/>
      </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 request for this procedure."/>
      <alias value="fulfills"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.basedOn"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.basedOn"/>
      </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 resource has a partOf reference to Procedure, but this is not a circular reference.   For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure).  For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration)."/>
      <alias value="container"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.partOf"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.partOf"/>
      </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 | not-done | suspended | aborted | completed | entered-in-error | unknown"/>
      <definition
                  value="A code specifying the state of the procedure. Generally, this will be the in-progress or completed state."/>
      <comment
               value="The &quot;unknown&quot; code is not to be used to convey other statuses.  The &quot;unknown&quot; code should be used when one of the statuses applies, but the authoring system doesn&#39;t know the current state of the procedure.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Procedure.status"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isModifierReason
                        value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <valueSet value="http://hl7.org/fhir/ValueSet/event-status"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.status"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.status"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value="statusCode"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="Procedure.status"/>
      </mapping>
    </element>
    <element id="Procedure.statusReason">
      <path value="Procedure.statusReason"/>
      <short value="Reason for current status"/>
      <definition
                  value="Captures the reason for the current state of the procedure."/>
      <comment
               value="This is generally only used for &quot;exception&quot; statuses such as &quot;not-done&quot;, &quot;suspended&quot; or &quot;aborted&quot;. The reason for performing the event at all is captured in reasonCode, not here."/>
      <alias value="Suspended Reason"/>
      <alias value="Cancelled Reason"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.statusReason"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <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."/>
        <valueSet
                  value="http://hl7.org/fhir/ValueSet/procedure-not-performed-reason"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.statusReason"/>
      </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;)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.category"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/procedure-category"/>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.class"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map
             value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quot;].code"/>
      </mapping>
    </element>
    <element id="Procedure.code">
      <path value="Procedure.code"/>
      <short value="SNOMED-CT | ICD-10 | CPT-4"/>
      <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;)."/>
      <requirements
                    value="0..1 to account for primarily narrative only resources."/>
      <alias value="type"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="Procedure.code"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
          <valueCanonical
                          value="http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code"/>
        </extension>
        <strength value="extensible"/>
        <description value="Codes describing the type of  Procedure"/>
        <valueSet
                  value="http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.code"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.what[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBR-44/OBR-45"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".code"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="Procedure.code"/>
      </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."/>
      <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/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.subject"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.subject[x]"/>
      </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="FiveWs.subject"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="Procedure.subject"/>
      </mapping>
    </element>
    <element id="Procedure.encounter">
      <path value="Procedure.encounter"/>
      <short value="Encounter created as part of"/>
      <definition
                  value="The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated."/>
      <comment
               value="This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.encounter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.context"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.context"/>
      </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>
    </element>
    <element id="Procedure.performed[x]">
      <path value="Procedure.performed[x]"/>
      <short value="When the procedure was performed"/>
      <definition
                  value="Estimated or actual date, date-time, period, or age when the procedure was performed.  Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured."/>
      <comment
               value="Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old.  dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone."/>
      <min value="1"/>
      <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>
      <mustSupport value="true"/>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.occurrence[x]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.done[x]"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="OBR-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".effectiveTime"/>
      </mapping>
      <mapping>
        <identity value="argonaut-dq-dstu2"/>
        <map value="Procedure.performed[x]"/>
      </mapping>
    </element>
    <element id="Procedure.recorder">
      <path value="Procedure.recorder"/>
      <short
             value="A human author, patient, practitioner, or related person, as opposed to an organization or device"/>
      <definition
                  value="A human author, patient, practitioner, or related person, as opposed to an organization or device."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.recorder"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.author"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=AUT].role"/>
      </mapping>
    </element>
    <element id="Procedure.asserter">
      <path value="Procedure.asserter"/>
      <short
             value="The person who provided the information, not necessarily the patient"/>
      <definition
                  value="The person who provided the information, not necessarily the patient."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.asserter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.source"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=INF].role"/>
      </mapping>
    </element>
    <element id="Procedure.performer">
      <path value="Procedure.performer"/>
      <short value="The people who performed the procedure"/>
      <definition
                  value="Limited to &quot;real&quot; 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>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.performer"/>
      </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="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Procedure.performer.extension">
      <path value="Procedure.performer.extension"/>
      <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. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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 even if unrecognized"/>
      <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 in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
      <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>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element id="Procedure.performer.function">
      <path value="Procedure.performer.function"/>
      <short value="Type of performance"/>
      <definition
                  value="Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist."/>
      <requirements
                    value="Allows disambiguation of the types of involvement of different performers."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.performer.function"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/performer-role"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.performer.function"/>
      </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="Constrains participants to classes that are accepted by FHIR as actors in procedures in STU 3"/>
      <definition
                  value="Constrains participants to classes that are accepted by FHIR as actors in procedures in STU 3."/>
      <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://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.performer.actor"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.actor"/>
      </mapping>
      <mapping>
        <identity value="v2"/>
        <map value="ORC-19/PRT-5"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".role"/>
      </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."/>
      <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/us/core/StructureDefinition/us-core-organization"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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."/>
      <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/us/core/StructureDefinition/us-core-location"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.where[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=LOC].role[classCode=SDLOC]"/>
      </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 a coded entity of some type, or may simply be present as text."/>
      <comment
               value="Use Procedure.reasonCode when a code sufficiently describes the reason.  Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative.  For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used.  Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference.  Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.reasonCode"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/procedure-reason"/>
      </binding>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.reasonCode"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.why[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".reasonCode"/>
      </mapping>
    </element>
    <element id="Procedure.reasonReference">
      <path value="Procedure.reasonReference"/>
      <short value="The justification that the procedure was performed"/>
      <definition value="The justification that the procedure was performed."/>
      <comment
               value="It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). 
Use Procedure.reasonCode when a code sufficiently describes the reason.  Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative.  For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used.  Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference.  Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.reasonReference"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Condition"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.reasonReference"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="FiveWs.why[x]"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".reasonCode"/>
      </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="If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [procedure-targetbodystructure](http://hl7.org/fhir/R4/extension-procedure-targetbodystructure.html)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.bodySite"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-datatype-BodyLocationVS"/>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="OBX-20"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".targetSiteCode"/>
      </mapping>
    </element>
    <element id="Procedure.bodySite.id">
      <path value="Procedure.bodySite.id"/>
      <representation value="xmlAttr"/>
      <short value="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Procedure.bodySite.extension">
      <path value="Procedure.bodySite.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. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Procedure.bodySite.extension:laterality">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="laterality"/>
      <definition
                  value="Body side of the body location, if needed to distinguish from a similar location on the other side of the body.

The laterality element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-Laterality-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.bodySite.extension:anatomicalorientation">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="anatomicalorientation"/>
      <definition
                  value="AnatomicalOrientation of the body location, if needed to distinguish from a similar location in another orientation.
The orientation element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-AnatomicalOrientation-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.bodySite.extension:relationtolandmark">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="relationtolandmark"/>
      <definition
                  value="The relationship between a landmark that helps determine a body location and the body location itself. The location relative to a landmark is specified by:
* Specifying the location and type of landmark using a body site code and optional laterality/orientation,
* Specifying the direction from the landmark to the body location, and
* Specifying the distance from the landmark to the body location.

The RelationToLandmark element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-RelationToLandmark-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.bodySite.coding">
      <path value="Procedure.bodySite.coding"/>
      <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 alternative encodings within a code system, and translations to other code systems."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="CodeableConcept.coding"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Coding"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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.bodySite.text">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
        <valueBoolean value="true"/>
      </extension>
      <path value="Procedure.bodySite.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>
      <isModifier value="false"/>
      <isSummary value="true"/>
      <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.outcome">
      <path value="Procedure.outcome"/>
      <short value="The result of procedure"/>
      <definition
                  value="The outcome of the procedure - did it resolve the 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>
      <isModifier value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/procedure-outcome"/>
      </binding>
      <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/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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 &#39;post procedure&#39; 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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/condition-code"/>
      </binding>
      <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."/>
      <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/us/mcode/StructureDefinition/obf-Condition"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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 follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.followUp"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/procedure-followup"/>
      </binding>
      <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 and comments about the procedure."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Procedure.note"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="workflow"/>
        <map value="Event.note"/>
      </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="Manipulated, implanted, or removed device"/>
      <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>
      <constraint>
        <key value="ele-1"/>
        <severity value="error"/>
        <human value="All FHIR elements must have a @value or children"/>
        <expression value="hasValue() or (children().count() &gt; id.count())"/>
        <xpath value="@value|f:*|h:div"/>
        <source value="Element"/>
      </constraint>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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="Unique id for inter-element referencing"/>
      <definition
                  value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Element.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element id="Procedure.focalDevice.extension">
      <path value="Procedure.focalDevice.extension"/>
      <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. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
      <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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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 even if unrecognized"/>
      <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 in which it is contained and/or the understanding of the containing element&#39;s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)."/>
      <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."/>
      <requirements
                    value="Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored.  This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
      <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>
      <isModifier value="true"/>
      <isModifierReason
                        value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
      <isSummary value="true"/>
      <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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="Procedure.focalDevice.action"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DeviceActionKind"/>
        </extension>
        <strength value="required"/>
        <description
                     value="A kind of change that happened to the device during the procedure."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/device-action"/>
      </binding>
      <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."/>
      <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/us/core/StructureDefinition/us-core-device"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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/us/core/StructureDefinition/us-core-device"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Substance"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <mapping>
        <identity value="rim"/>
        <map
             value=".participation[typeCode=DEV].role[classCode=MANU] or
.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>
      <isModifier value="false"/>
      <isSummary value="false"/>
      <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."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/device-kind"/>
      </binding>
      <mapping>
        <identity value="rim"/>
        <map value="participation[typeCode=Dev].role[classCode=MANU]"/>
      </mapping>
    </element>
  </snapshot>
  <differential>
    <element id="Procedure">
      <path value="Procedure"/>
      <short value="obf-Procedure"/>
      <definition
                  value="An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy."/>
      <mustSupport value="false"/>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.extension">
      <path value="Procedure.extension"/>
      <slicing id="1">
        <discriminator>
          <type value="value"/>
          <path value="url"/>
        </discriminator>
        <ordered value="false"/>
        <rules value="open"/>
      </slicing>
    </element>
    <element id="Procedure.extension:statementdatetime">
      <path value="Procedure.extension"/>
      <sliceName value="statementdatetime"/>
      <definition value="The point in time when the statement was created."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-StatementDateTime-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.extension:treatmentintent">
      <path value="Procedure.extension"/>
      <sliceName value="treatmentintent"/>
      <definition value="The purpose of a treatment."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="DomainResource.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-TreatmentIntent-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.basedOn">
      <path value="Procedure.basedOn"/>
      <definition value="A request for this procedure."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      </type>
    </element>
    <element id="Procedure.partOf">
      <path value="Procedure.partOf"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
      </type>
    </element>
    <element id="Procedure.subject">
      <path value="Procedure.subject"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
      </type>
    </element>
    <element id="Procedure.encounter">
      <path value="Procedure.encounter"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"/>
      </type>
    </element>
    <element id="Procedure.recorder">
      <path value="Procedure.recorder"/>
      <short
             value="A human author, patient, practitioner, or related person, as opposed to an organization or device"/>
      <definition
                  value="A human author, patient, practitioner, or related person, as opposed to an organization or device."/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
      </type>
    </element>
    <element id="Procedure.asserter">
      <path value="Procedure.asserter"/>
      <short
             value="The person who provided the information, not necessarily the patient"/>
      <definition
                  value="The person who provided the information, not necessarily the patient."/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
      </type>
    </element>
    <element id="Procedure.performer">
      <path value="Procedure.performer"/>
    </element>
    <element id="Procedure.performer.actor">
      <path value="Procedure.performer.actor"/>
      <short
             value="Constrains participants to classes that are accepted by FHIR as actors in procedures in STU 3"/>
      <definition
                  value="Constrains participants to classes that are accepted by FHIR as actors in procedures in STU 3."/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Patient"/>
        <targetProfile
                       value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
      </type>
    </element>
    <element id="Procedure.performer.onBehalfOf">
      <path value="Procedure.performer.onBehalfOf"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
      </type>
    </element>
    <element id="Procedure.location">
      <path value="Procedure.location"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-location"/>
      </type>
    </element>
    <element id="Procedure.reasonCode">
      <path value="Procedure.reasonCode"/>
      <min value="0"/>
      <max value="1"/>
    </element>
    <element id="Procedure.reasonReference">
      <path value="Procedure.reasonReference"/>
      <definition value="The justification that the procedure was performed."/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Condition"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Observation"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Procedure"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference"/>
      </type>
    </element>
    <element id="Procedure.bodySite">
      <path value="Procedure.bodySite"/>
      <binding>
        <strength value="preferred"/>
        <valueSet
                  value="http://hl7.org/fhir/us/mcode/ValueSet/obf-datatype-BodyLocationVS"/>
      </binding>
    </element>
    <element id="Procedure.bodySite.extension:laterality">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="laterality"/>
      <definition
                  value="Body side of the body location, if needed to distinguish from a similar location on the other side of the body.

The laterality element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-Laterality-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.bodySite.extension:anatomicalorientation">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="anatomicalorientation"/>
      <definition
                  value="AnatomicalOrientation of the body location, if needed to distinguish from a similar location in another orientation.
The orientation element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-AnatomicalOrientation-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.bodySite.extension:relationtolandmark">
      <path value="Procedure.bodySite.extension"/>
      <sliceName value="relationtolandmark"/>
      <definition
                  value="The relationship between a landmark that helps determine a body location and the body location itself. The location relative to a landmark is specified by:
* Specifying the location and type of landmark using a body site code and optional laterality/orientation,
* Specifying the direction from the landmark to the body location, and
* Specifying the distance from the landmark to the body location.

The RelationToLandmark element is part of BodyLocation, a flexible structure that allows the location to be determined by a single code, or a code plus laterality and/or orientation. The body location can also be specified in relation to one or more body landmarks. SNOMED CT is used in all cases.

* Code only: The code should include (precoordinate) laterality and/orientation to the degree necessary to completely specify the body location.
* Code plus laterality and/or orientation: The basic code augmented by codes specifying the body side and/or anatomical orientation.
* Relation to landmark: The location relative to a landmark is specified by:
1. Establishing the location and type of landmark using a body site code and optional laterality/orientation, and
2. Specifying the direction and distance from the landmark to the body location.

Note that BodyLocation is a data type (a reusable structure), not a stand-alone entity. The concept is similar to how a postal address can apply to a person, location, or organization. This contrasts with FHIR&#39;s stand-alone BodySite (aka BodyStructure in r4) which &#39;is not ... intended for describing the type of anatomical location but rather a specific body site on a specific patient&#39; (FHIR 3.5)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="Element.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
        <profile
                 value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-datatype-RelationToLandmark-extension"/>
      </type>
      <isModifier value="false"/>
      <isSummary value="false"/>
    </element>
    <element id="Procedure.report">
      <path value="Procedure.report"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-DiagnosticReport"/>
      </type>
    </element>
    <element id="Procedure.complicationDetail">
      <path value="Procedure.complicationDetail"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/mcode/StructureDefinition/obf-Condition"/>
      </type>
    </element>
    <element id="Procedure.focalDevice">
      <path value="Procedure.focalDevice"/>
    </element>
    <element id="Procedure.focalDevice.action">
      <path value="Procedure.focalDevice.action"/>
      <binding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DeviceActionKind"/>
        </extension>
        <strength value="required"/>
        <description
                     value="A kind of change that happened to the device during the procedure."/>
        <valueSet value="http://hl7.org/fhir/ValueSet/device-action"/>
      </binding>
    </element>
    <element id="Procedure.focalDevice.manipulated">
      <path value="Procedure.focalDevice.manipulated"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
      </type>
    </element>
    <element id="Procedure.usedReference">
      <path value="Procedure.usedReference"/>
      <type>
        <code value="Reference"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication"/>
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Substance"/>
      </type>
    </element>
  </differential>
</StructureDefinition>