Introduction

This profile is used to represent de-identified Procedure information. The de-identification process has to remove all data elements not explicitly identified as "SUPPORTED" in the profile.

The HHS De-identification Guidance is to be followed to ensure appropriate level of de-identification is performed.

According to the HHS guidance, dates should not have a precision of more than the year. This means month and day cannot be included. This includes Procedure.occurenceDateTime.

In FHIR Resources, text elements and reference.display elements which provide human readable information to the providers may be generated using programs and tools from the data present within the resource. For e.g a Procedure resource text element may contain information such as the Procedure date, patient information. This type of information will enable identification of the individuals. In order to avoid inadvertent revealing of PII/PHI, text elements cannot be included in the De-identified FHIR resource and the submission will be rejected when text elements are present by the validation process.

Ids and References

The original Procedure resource id should not be included in the De-identified Procedure instance. Instead a new id should be created and provided as part of the FHIR resource. The Data Submitter should be capable of using the generated id to relink the data to the original Procedure. All resource references to the Procedure submitted as part of the UDS+ report should refer to newly generated id.

Resource references cannot contain text element as it may contain PHI/PII. The text element for following references are not allowed

• subject
• encounter

Date Truncation

The Data Submitter has to truncate the following dates to only have a precision of year

• performedDateTime
• extension.recordedDate

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

This structure is derived from Procedure

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	S	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
status	S	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
statusReason	S	0..1	CodeableConcept	Reason for current status
code	S	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	S	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
display		0..0
encounter	S	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
display		0..0
performed[x]	SC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime S
performedPeriod			Period
performedAge			Age
performedString			string
performedRange			Range
recorder
display		0..0
asserter
display		0..0
performer	S	0..*	BackboneElement	The people who performed the procedure
actor
display		0..0
bodySite	S	0..*	CodeableConcept	Target body sites
note		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	SΣ	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
encounter	SΣ	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
performed[x]	SΣC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime
performer	SΣ	0..*	BackboneElement	The people who performed the procedure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
bodySite	SΣ	0..*	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	example	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	SΣ	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Identifiers for this procedure
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest)	A request for this procedure
partOf	Σ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	Σ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
encounter	SΣ	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
performed[x]	SΣC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime S
performedPeriod			Period
performedAge			Age
performedString			string
performedRange			Range
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
performer	SΣ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
reasonReference	Σ	0..*	Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome	Σ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	example	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	example	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.encounter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.recorder.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.asserter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.performer.actor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.reasonCode	example	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	example	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Procedure.followUp	example	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Differential View

This structure is derived from Procedure

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	S	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
text		0..0
contained		0..0
Slices for extension				Content/Rules for all slices
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
status	S	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
statusReason	S	0..1	CodeableConcept	Reason for current status
code	S	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	S	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
display		0..0
encounter	S	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
display		0..0
performed[x]	SC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime S
performedPeriod			Period
performedAge			Age
performedString			string
performedRange			Range
recorder
display		0..0
asserter
display		0..0
performer	S	0..*	BackboneElement	The people who performed the procedure
actor
display		0..0
bodySite	S	0..*	CodeableConcept	Target body sites
note		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code

Constraints

Id	Grade	Path(s)	Details	Requirements
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	SΣ	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
encounter	SΣ	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
performed[x]	SΣC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime
performer	SΣ	0..*	BackboneElement	The people who performed the procedure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
bodySite	SΣ	0..*	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	example	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Procedure		0..*	Procedure	De-Identified UDS Plus Procedure
id	SΣ	0..1	id	The de-identified Procedure identifier created by the health center to send data to UDS+ Data Receiver
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
recordedDate	S	0..1	dateTime	Indicates the recorded date of a clinical event URL: http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External Identifiers for this procedure
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest)	A request for this procedure
partOf	Σ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣ	1..1	code	preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required): A code specifying the state of the procedure.
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: ProcedureNotPerformedReason(SNOMED-CT) (example): A code that identifies the reason a procedure was not performed.
category	Σ	0..1	CodeableConcept	Classification of the procedure Binding: ProcedureCategoryCodes(SNOMEDCT) (example): A code that classifies a procedure for searching, sorting and display purposes.
code	SΣ	1..1	CodeableConcept	Identification of the procedure Binding: US Core Procedure Codes (extensible): The set of codes indicating the procedures
subject	SΣ	1..1	Reference(De-Identified UDS Plus Patient)	Who the procedure was performed on
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
encounter	SΣ	0..1	Reference(De-Identified UDS Plus Encounter)	Encounter created as part of
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
performed[x]	SΣC	0..1		When the procedure was performed uds-plus-proc-1: All dateTime data elements should be truncated to a year only for de-identified resources. uds-plus-proc-2: All Period.start data elements should be truncated to a year only for de-identified resources. uds-plus-proc-3: All Period.emd data elements should be truncated to a year only for de-identified resources.
performedDateTime			dateTime S
performedPeriod			Period
performedAge			Age
performedString			string
performedRange			Range
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
performer	SΣ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	0..1	string	Literal reference, Relative, internal or absolute URL
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	Logical reference, when literal reference is not known
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	Σ	0..1	Reference(Location)	Where the procedure happened
reasonCode	Σ	0..*	CodeableConcept	Coded reason procedure performed Binding: ProcedureReasonCodes (example): A code that identifies the reason a procedure is required.
reasonReference	Σ	0..*	Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	Target body sites Binding: SNOMEDCTBodyStructures (example): Codes describing anatomical locations. May include laterality.
outcome	Σ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
usedReference		0..*	Reference(Device | Medication | Substance)	Items used during procedure
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Procedure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status|4.0.1 from the FHIR Standard
Procedure.statusReason	example	ProcedureNotPerformedReason(SNOMED-CT) http://hl7.org/fhir/ValueSet/procedure-not-performed-reason from the FHIR Standard
Procedure.category	example	ProcedureCategoryCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-category from the FHIR Standard
Procedure.code	extensible	USCoreProcedureCodes http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.encounter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.recorder.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.asserter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.performer.actor.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
Procedure.reasonCode	example	ProcedureReasonCodes http://hl7.org/fhir/ValueSet/procedure-reason from the FHIR Standard
Procedure.bodySite	example	SNOMEDCTBodyStructures http://hl7.org/fhir/ValueSet/body-site from the FHIR Standard
Procedure.outcome	example	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Procedure.followUp	example	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Procedure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Procedure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Procedure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Procedure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
uds-plus-proc-1	error	Procedure.performed[x]	All dateTime data elements should be truncated to a year only for de-identified resources. : $this is DateTime implies $this.toString().length() = 4
uds-plus-proc-2	error	Procedure.performed[x]	All Period.start data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.start.exists() implies $this.start.toString().length() = 4
uds-plus-proc-3	error	Procedure.performed[x]	All Period.emd data elements should be truncated to a year only for de-identified resources. : $this is Period and Period.end.exists() implies $this.end.toString().length() = 4

This structure is derived from Procedure

Summary

Mandatory: 3 elements
Must-Support: 10 elements
Prohibited: 8 elements

Structures

This structure refers to these other structures:

• De-Identified UDS Plus Patient (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/de-identified-uds-plus-patient)
• De-Identified UDS Plus Encounter (http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-encounter)

Extensions

This structure refers to these extensions:

• http://fhir.org/guides/hrsa/uds-plus/StructureDefinition/uds-plus-recordedDate-extension

Maturity: 2