{
  "resourceType": "StructureDefinition",
  "id": "zib-TreatmentDirective",
  "url": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective",
  "version": "2.1.0",
  "name": "Zib TreatmentDirective",
  "title": "HCIM TreatmentDirective",
  "status": "active",
  "publisher": "Nictiz",
  "contact": [
    {
      "name": "Nictiz",
      "telecom": [
        {
          "system": "email",
          "value": "info@nictiz.nl",
          "use": "work"
        }
      ]
    }
  ],
  "description": "TreatmentDirective as defined by the Dutch Health and Care Information models (Dutch: Zorginformatiebouwsteen or ZIB) version 3.1. A treatment instruction includes an agreed constraint in the treatment based on the oral or written living will of the patient.",
  "purpose": "A good overview of the patient’s wishes is important. A healthcare provider can use the living will to discuss the existing wishes with the persons involved and to incorporate these wishes in their own policy. A concise, orderly list is of particular importance in acute care situations.",
  "copyright": "CC0",
  "fhirVersion": "3.0.1",
  "mapping": [
    {
      "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
      "uri": "https://zibs.nl/wiki/TreatmentDirective-v1.0.1(2015EN)",
      "name": "HCIM TreatmentDirective-v1.0.1(2015EN)"
    },
    {
      "identity": "hcim-treatmentdirective-v3.0-2016EN",
      "uri": "https://zibs.nl/wiki/TreatmentDirective-v3.0(2016EN)",
      "name": "HCIM TreatmentDirective-v3.0(2016EN)"
    },
    {
      "identity": "hcim-treatmentdirective-v3.1-2017EN",
      "uri": "https://zibs.nl/wiki/TreatmentDirective-v3.1(2017EN)",
      "name": "HCIM TreatmentDirective-v3.1(2017EN)"
    },
    {
      "identity": "hcim-basicelements-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/BasicElements-v1.0(2017EN)",
      "name": "HCIM BasicElements-v1.0(2017EN)"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Consent",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Consent",
  "derivation": "constraint",
  "snapshot": {},
  "differential": {
    "element": [
      {
        "id": "Consent",
        "path": "Consent",
        "short": "TreatmentDirective",
        "alias": [
          "BehandelAanwijzing"
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.1",
            "comment": "TreatmentInstruction"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.1",
            "comment": "TreatmentInstruction"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.1",
            "comment": "TreatmentDirective"
          }
        ]
      },
      {
        "id": "Consent.extension",
        "path": "Consent.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.extension:verification",
        "path": "Consent.extension",
        "sliceName": "verification",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Verification"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.8",
            "comment": "Verification"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.8",
            "comment": "Verification"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.8",
            "comment": "Verification"
          }
        ]
      },
      {
        "id": "Consent.extension:verification.extension:Verified",
        "path": "Consent.extension.extension",
        "sliceName": "Verified",
        "short": "Verified",
        "alias": [
          "Geverifieerd"
        ],
        "min": 1,
        "max": "1",
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.9",
            "comment": "Verified"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.9",
            "comment": "Verified"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.9",
            "comment": "Verified"
          }
        ]
      },
      {
        "id": "Consent.extension:verification.extension:VerifiedWith",
        "path": "Consent.extension.extension",
        "sliceName": "VerifiedWith",
        "short": "VerifiedWith",
        "alias": [
          "GeverifieerdBij"
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.11",
            "comment": "VerifiedWith"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.11",
            "comment": "VerifiedWith"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.11",
            "comment": "VerifiedWith"
          }
        ]
      },
      {
        "id": "Consent.extension:verification.extension:VerifiedWith.valueCodeableConcept:valueCodeableConcept",
        "path": "Consent.extension.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "binding": {
          "strength": "extensible",
          "description": "The person with whom the treatment instruction was discussed and verified.",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.4--20171231000000",
            "display": "GeverifieerdBijCodelijst"
          }
        }
      },
      {
        "id": "Consent.extension:verification.extension:VerificationDate",
        "path": "Consent.extension.extension",
        "sliceName": "VerificationDate",
        "short": "VerificationDate",
        "alias": [
          "VerificatieDatum"
        ],
        "max": "1",
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.10",
            "comment": "VerificationDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.10",
            "comment": "VerificationDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.10",
            "comment": "VerificationDate"
          }
        ]
      },
      {
        "id": "Consent.extension:verification.url",
        "path": "Consent.extension.url",
        "fixedUri": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Verification"
      },
      {
        "id": "Consent.extension:comment",
        "path": "Consent.extension",
        "sliceName": "comment",
        "definition": "Comments on the treatment instruction such as a written description of an end date which can be indicated as a date (“until discharge from hospital”).",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/Comment"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.15",
            "comment": "Explanation"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.15",
            "comment": "Explanation"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.15",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "Consent.extension:treatment",
        "path": "Consent.extension",
        "sliceName": "treatment",
        "short": "Treatment",
        "definition": "The medical treatment to which the treatment instruction applies.",
        "alias": [
          "Behandeling"
        ],
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Treatment"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.3",
            "comment": "Treatment"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.3",
            "comment": "Treatment"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.3",
            "comment": "Treatment"
          }
        ]
      },
      {
        "id": "Consent.extension:treatment.valueCodeableConcept:valueCodeableConcept",
        "path": "Consent.extension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "binding": {
          "strength": "extensible",
          "description": "The medical treatment to which the treatment instruction applies.",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.1--20171231000000",
            "display": "TreatmentCodelist"
          }
        }
      },
      {
        "id": "Consent.modifierExtension",
        "path": "Consent.modifierExtension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.modifierExtension:treatmentPermitted",
        "path": "Consent.modifierExtension",
        "sliceName": "treatmentPermitted",
        "short": "TreatmentPermitted",
        "definition": "Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.",
        "comment": "If the value of the element NL-CM:2.1.4 TreatmentPermitted is YES_BUT/JA_MAAR, then the value of NL-CM:2.1.5 Restrictions is expected under Consent.except.",
        "alias": [
          "BehandelingToegestaan"
        ],
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-TreatmentPermitted"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.4",
            "comment": "TreatmentPermitted"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.4",
            "comment": "TreatmentPermitted"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.4",
            "comment": "TreatmentPermitted"
          }
        ]
      },
      {
        "id": "Consent.modifierExtension:treatmentPermitted.valueCodeableConcept:valueCodeableConcept",
        "path": "Consent.modifierExtension.valueCodeableConcept",
        "sliceName": "valueCodeableConcept",
        "binding": {
          "strength": "extensible",
          "description": "Indication of permission for the treatment, no permission for the treatment, or permission for the treatment with constraints.",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.2.1.2--20171231000000",
            "display": "TreatmentPermittedCodelist"
          }
        }
      },
      {
        "id": "Consent.identifier",
        "path": "Consent.identifier",
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.6",
            "comment": "IdentificationNumber"
          }
        ]
      },
      {
        "id": "Consent.status",
        "path": "Consent.status",
        "comment": "The HCIM treatmentDirective is not explicit on its intention. The expectation however is that any instantation of a TreatmentDirective is \"active\" unless stated otherwise."
      },
      {
        "id": "Consent.category",
        "path": "Consent.category",
        "min": 1
      },
      {
        "id": "Consent.category.coding",
        "path": "Consent.category.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Consent.category.coding:treatmentDirective",
        "path": "Consent.category.coding",
        "sliceName": "treatmentDirective",
        "definition": "Category snomed code used for indexing/retrieval of TreatmentDirective.",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Consent.category.coding:treatmentDirective.system",
        "path": "Consent.category.coding.system",
        "min": 1,
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "Consent.category.coding:treatmentDirective.code",
        "path": "Consent.category.coding.code",
        "min": 1,
        "fixedCode": "11291000146105"
      },
      {
        "id": "Consent.category.coding:treatmentDirective.display",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
            "valueBoolean": true
          }
        ],
        "path": "Consent.category.coding.display",
        "defaultValueString": "Treatment instructions (record artifact)"
      },
      {
        "id": "Consent.patient",
        "path": "Consent.patient",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.11",
            "comment": "Subject"
          }
        ]
      },
      {
        "id": "Consent.period.start",
        "path": "Consent.period.start",
        "short": "StartDate",
        "definition": "Date on which the treatment instruction went into effect. A ‘vague’ date, such as only the year, is permitted.",
        "alias": [
          "BeginDatum"
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.6",
            "comment": "StartDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.6",
            "comment": "StartDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.6",
            "comment": "StartDate"
          }
        ]
      },
      {
        "id": "Consent.period.end",
        "path": "Consent.period.end",
        "short": "EndDate",
        "definition": "Date on which the treatment instruction ends. A ‘vague’ date, such as only the year, is permitted.",
        "alias": [
          "EindDatum"
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.7",
            "comment": "EndDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.7",
            "comment": "EndDate"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.7",
            "comment": "EndDate"
          }
        ]
      },
      {
        "id": "Consent.dateTime",
        "path": "Consent.dateTime",
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.14",
            "comment": "DateTime"
          }
        ]
      },
      {
        "id": "Consent.consentingParty",
        "path": "Consent.consentingParty",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-basicelements-v1.0-2017EN",
            "map": "NL-CM:0.0.7",
            "comment": "Author"
          }
        ]
      },
      {
        "id": "Consent.consentingParty.extension",
        "path": "Consent.consentingParty.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.consentingParty.extension:practitionerRole",
        "path": "Consent.consentingParty.extension",
        "sliceName": "practitionerRole",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"
          }
        ]
      },
      {
        "id": "Consent.actor.reference",
        "path": "Consent.actor.reference",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Group"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/CareTeam"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson"
          }
        ]
      },
      {
        "id": "Consent.actor.reference.extension",
        "path": "Consent.actor.reference.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.actor.reference.extension:practitionerRole",
        "path": "Consent.actor.reference.extension",
        "sliceName": "practitionerRole",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"
          }
        ]
      },
      {
        "id": "Consent.organization",
        "path": "Consent.organization",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          }
        ]
      },
      {
        "id": "Consent.source[x]",
        "path": "Consent.source[x]",
        "short": "AdvanceDirective",
        "definition": "A (written) statement in which a person indicates wishes concerning future medical action, in the event that this person is at that point no longer (deemed) capable of taking decisions on the matter.",
        "alias": [
          "Wilsverklaring"
        ],
        "type": [
          {
            "code": "Attachment"
          },
          {
            "code": "Identifier"
          },
          {
            "code": "Reference",
            "targetProfile": "http://nictiz.nl/fhir/StructureDefinition/zib-AdvanceDirective"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/DocumentReference"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.14",
            "comment": "LivingWill"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.14",
            "comment": "LivingWill"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.14",
            "comment": "AdvanceDirective"
          }
        ]
      },
      {
        "id": "Consent.policy.uri",
        "path": "Consent.policy.uri",
        "example": [
          {
            "label": "General Dutch Law",
            "valueUri": "http://wetten.overheid.nl/"
          }
        ]
      },
      {
        "id": "Consent.except",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
            "valueString": "Except"
          }
        ],
        "path": "Consent.except",
        "comment": "If a Consent.except is used in accordance with the HCIM TreatmentDirective, then the only time an except is in order, is when the value of the element NL-CM:2.1.4 TreatmentPermitted is YES_BUT/JA_MAAR."
      },
      {
        "id": "Consent.except.extension",
        "path": "Consent.except.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.except.extension:restrictions",
        "path": "Consent.except.extension",
        "sliceName": "restrictions",
        "short": "Restrictions",
        "definition": "The restrictions or specific circumstances that apply to a certain treatment.",
        "alias": [
          "Beperkingen"
        ],
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/zib-TreatmentDirective-Restrictions"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-treatmentdirective-v1.0.1-2015EN",
            "map": "NL-CM:2.1.5",
            "comment": "Constraints"
          },
          {
            "identity": "hcim-treatmentdirective-v3.0-2016EN",
            "map": "NL-CM:2.1.5",
            "comment": "Constraints"
          },
          {
            "identity": "hcim-treatmentdirective-v3.1-2017EN",
            "map": "NL-CM:2.1.5",
            "comment": "Restrictions"
          }
        ]
      },
      {
        "id": "Consent.except.type",
        "path": "Consent.except.type",
        "comment": "If a Consent.except is used in accordance with the HCIM TreatmentDirective and the value of the element NL-CM:2.1.4 TreatmentPermitted is YES_BUT/JA_MAAR, then the value of this element SHALL be \"deny\""
      },
      {
        "id": "Consent.except.actor.reference",
        "path": "Consent.except.actor.reference",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Device"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Group"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/CareTeam"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-organization"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-practitioner"
          },
          {
            "code": "Reference",
            "targetProfile": "http://fhir.nl/fhir/StructureDefinition/nl-core-relatedperson"
          }
        ]
      },
      {
        "id": "Consent.except.actor.reference.extension",
        "path": "Consent.except.actor.reference.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Consent.except.actor.reference.extension:practitionerRole",
        "path": "Consent.except.actor.reference.extension",
        "sliceName": "practitionerRole",
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": "http://nictiz.nl/fhir/StructureDefinition/practitionerrole-reference"
          }
        ]
      }
    ]
  }
}