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HdBe-BehandelAanwijzing2

CBB	Concept	Status
HdBe-TreatmentDirective2	Een behandelaanwijzing bevat een gezamenlijk besluit tussen een zorgverlener (bijvoorbeeld een huisarts) en een patiënt of diens vertegenwoordiger(s) over de wenselijkheid van het uitvoeren van een bepaalde behandeling, zoals een reanimatie, voordat deze behandeling (acuut) noodzakelijk wordt. Wanneer de noodzaak zich aandient en de behandeling niet kan worden besproken met de patiënt of vertegenwoordiger(s), is dat besluit een zwaarwegende aanwijzing voor de behandelend zorgverlener (bijvoorbeeld een SEH arts). De term Behandelgrens is een synoniem van de term BehandelAanwijzing. Purpose Een goed overzicht behandelaanwijzingen gebaseerd op de wensen van de patiënt of diens gevolmachtigde over (on)gewenste behandelingen is belangrijk bij de zorg voor de patiënt. Vooral in de acute situatie is een beknopte en overzichtelijke lijst van belang. Door de grote verscheidenheid van ziektebeelden gaat het niet alleen om een reanimatie setting maar ook om situaties waar ten gevolge van een bestaand ziektebeeld de conditie van de patiënt zeer snel achteruit gaat. Een zorgverlener die deze gegevens raadpleegt kan deze bestaande behandelaanwijzingen met de patiënt, zijn familie of gevolmachtigde bespreken en eventueel in het beleid opnemen. Evidence Base Toelichting bij BehandelingCodelijst: Bij het overleg over beperkingen in het therapeutisch beleid voor patiënten met chronische neurologische of longaandoeningen, wordt beademing soms als aparte restrictie opgenomen. Het item ‘Beademen’ dient los gezien te worden van de beslissingen rond reanimeren.	active

CBB

Concept

Status

HdBe-TreatmentDirective2

Een behandelaanwijzing bevat een gezamenlijk besluit tussen een zorgverlener (bijvoorbeeld een huisarts) en een patiënt of diens vertegenwoordiger(s) over de wenselijkheid van het uitvoeren van een bepaalde behandeling, zoals een reanimatie, voordat deze behandeling (acuut) noodzakelijk wordt. Wanneer de noodzaak zich aandient en de behandeling niet kan worden besproken met de patiënt of vertegenwoordiger(s), is dat besluit een zwaarwegende aanwijzing voor de behandelend zorgverlener (bijvoorbeeld een SEH arts). De term Behandelgrens is een synoniem van de term BehandelAanwijzing.

Purpose

Een goed overzicht behandelaanwijzingen gebaseerd op de wensen van de patiënt of diens gevolmachtigde over (on)gewenste behandelingen is belangrijk bij de zorg voor de patiënt. Vooral in de acute situatie is een beknopte en overzichtelijke lijst van belang. Door de grote verscheidenheid van ziektebeelden gaat het niet alleen om een reanimatie setting maar ook om situaties waar ten gevolge van een bestaand ziektebeeld de conditie van de patiënt zeer snel achteruit gaat. Een zorgverlener die deze gegevens raadpleegt kan deze bestaande behandelaanwijzingen met de patiënt, zijn familie of gevolmachtigde bespreken en eventueel in het beleid opnemen.

Evidence Base

Toelichting bij BehandelingCodelijst: Bij het overleg over beperkingen in het therapeutisch beleid voor patiënten met chronische neurologische of longaandoeningen, wordt beademing soms als aparte restrictie opgenomen. Het item ‘Beademen’ dient los gezien te worden van de beslissingen rond reanimeren.

active

TreatmentDirective2			TreatmentDirective2	Element id TreatmentDirective2 Short description BehandelAanwijzing Definition Rootconcept van de bouwsteen BehandelAanwijzing2. Dit concept bevat alle gegevenselementen van de bouwsteen BehandelAanwijzing2. Data type TreatmentDirective2 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TreatmentDirective2.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TreatmentDirective2.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
TreatmentDecision		1..1	CodeableConceptBinding	Element id TreatmentDirective2.TreatmentDecision Short description BehandelBesluit Definition Het gezamenlijk genomen besluit ten aanzien van de wenselijkheid van het uitvoeren van de aangegeven behandeling. Bij een besluit 'Anders' moet 'SpecificatieAnders' de aanwijzingen bevatten voor het al of niet uitvoeren van de behandeling. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding TreatmentDecision codes TreatmentDecision (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Treatment		1..1	CodeableConceptBinding	Element id TreatmentDirective2.Treatment Short description Behandeling Definition De medische behandeling waarop de behandelaanwijzing betrekking heeft. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Treatment codes Treatment (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
SpecificationOther		0..1	string	Element id TreatmentDirective2.SpecificationOther Short description SpecificatieAnders Definition Specificatie van het behandelbesluit indien het behandelbesluit 'Anders' is. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
MostRecentReviewDate		1..1	dateTime	Element id TreatmentDirective2.MostRecentReviewDate Short description MeestRecenteBespreekdatum Definition De datum waarop de behandelaanwijzing is afgesproken is met de patiënt en/of zijn vertegenwoordiger(s). Dit kan de eerste keer zijn dat de behandelaanwijzing is besproken, maar ook kan de reeds bestaande behandelaanwijzing opnieuw besproken zijn. De inhoud van de behandelaanwijzing kan hierbij gewijzigd zijn of hetzelfde gebleven. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
DateExpired		0..1	dateTime	Element id TreatmentDirective2.DateExpired Short description DatumBeeindigd Definition De datum waarop de de behandelaanwijzing ingetrokken en dus niet meer van kracht is. Over de 'datum beëindigd' moet een expliciet besluit genomen worden in een overleg tussen verantwoordelijk zorgverlener en patiënt of diens vertegenwoordiger(s). Een eventuele beëindiging in de toekomst kan alleen worden ingevoerd als een voorwaarde. Vaak zal dit gekoppeld zijn aan 1 of meer gebeurtenissen. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
ReasonForEnding		0..1	string	Element id TreatmentDirective2.ReasonForEnding Short description RedenBeeindigd Definition Reden waarom de afspraak over een behandel aanwijzing niet meer van toepassing is. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
AdvanceDirective	I	0..*	Reference(HdBe-AdvanceDirective)	Element id TreatmentDirective2.AdvanceDirective Short description Wilsverklaring Definition Een (schriftelijke) verklaring waarin een persoon wensen aangeeft met betrekking tot toekomstig medisch handelen, voor het geval deze persoon op dat moment niet meer in staat is (of wordt geacht) hierover beslissingen te nemen. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-AdvanceDirective) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
AgreementParty	I	2..*	BackboneElement	Element id TreatmentDirective2.AgreementParty Short description AfspraakPartij Definition Container van het concept AfspraakPartij. Deze container bevat alle gegevenselementen van het concept AfspraakPartij. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` HdBe-TreatmentDirective2-1: Exactly one of Patient, Representative, or HealthProfessional must be selected. `Patient.exists() xor Representative.exists() xor HealthProfessional.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TreatmentDirective2.AgreementParty.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TreatmentDirective2.AgreementParty.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id TreatmentDirective2.AgreementParty.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition 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'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). Requirements 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Patient	I	0..1	Reference(HdBe-Patient)	Element id TreatmentDirective2.AgreementParty.Patient Short description Patient Definition Patiënt als de persoon met wie de afspraak gemaakt is. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Representative	I	0..1	Reference(HdBe-ContactPerson)	Element id TreatmentDirective2.AgreementParty.Representative Short description Vertegenwoordiger Definition Persoon die de patiënt in gezondheidszorg zaken vertegenwoordigt en met wie de afspraak (mede) gemaakt is. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-ContactPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
HealthProfessional	I	0..1	Reference(HdBe-HealthProfessional)	Element id TreatmentDirective2.AgreementParty.HealthProfessional Short description Zorgverlener Definition Zorgverlener die de afspraak ten aanzien van de behandelaanwijzing heeft gemaakt Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-HealthProfessional) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Comment		0..1	string	Element id TreatmentDirective2.Comment Short description Toelichting Definition In de toelichting kan nadere informatie worden opgenomen zoals de reden waarom een behandelaanwijzing is opgesteld, personen die de patiënt hebben bijgestaan bij het afspreken van de behandelaanwijzing maar verder niet als vertegenwoordiger bij de afspraak zijn betrokken, enzovoort. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a

TreatmentDirective2		0..*
TreatmentDirective2.TreatmentDecision	CodeableConcept	1..1
TreatmentDirective2.Treatment	CodeableConcept	1..1
TreatmentDirective2.SpecificationOther	string	0..1
TreatmentDirective2.MostRecentReviewDate	dateTime	1..1
TreatmentDirective2.DateExpired	dateTime	0..1
TreatmentDirective2.ReasonForEnding	string	0..1
TreatmentDirective2.AdvanceDirective	Reference(HdBe-AdvanceDirective)	0..*
TreatmentDirective2.AgreementParty	BackboneElement	2..*
TreatmentDirective2.AgreementParty.Patient	Reference(HdBe-Patient)	0..1
TreatmentDirective2.AgreementParty.Representative	Reference(HdBe-ContactPerson)	0..1
TreatmentDirective2.AgreementParty.HealthProfessional	Reference(HdBe-HealthProfessional)	0..1
TreatmentDirective2.Comment	string	0..1

TreatmentDirective2
Definition	Root concept of the TreatmentDirective2 information model. This concept contains all data elements of the TreatmentDirective2 information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TreatmentDirective2.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TreatmentDirective2.extension
Definition	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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TreatmentDirective2.TreatmentDecision
Definition	The joint decision taken with regard to the desirability of performing the indicated treatment. If the agreement is 'Other', 'Specification Other' shall contain the instructions for whether or not to carry out the treatment.
Cardinality	1...1
Type	CodeableConcept
Binding	TreatmentDecision codes TreatmentDecision (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TreatmentDirective2.Treatment
Definition	The medical treatment to which the treatment instruction applies.
Cardinality	1...1
Type	CodeableConcept
Binding	Treatment codes Treatment (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TreatmentDirective2.SpecificationOther
Definition	Specification of the treatment decision when the decision is 'Other'.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TreatmentDirective2.MostRecentReviewDate
Definition	The date on which the treatment directive has been agreed is with the patient and / or his representative(s). This can be the first time that the treatment directive has been discussed, but an existing treatment directive may also have been discussed again. The content of the treatment directive may have changed or remained the same.
Cardinality	1...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TreatmentDirective2.DateExpired
Definition	The date on which the treatment directive has been withdrawn and therefore no longer applies. An explicit decision must be taken about the 'date expired', in consultation between the responsible care professional and the patient or his representative(s). Any future termination can only be entered as a condition. Often this will be linked to 1 or more events.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TreatmentDirective2.ReasonForEnding
Definition	Reason why the agreement on a treatment directive no longer applies.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TreatmentDirective2.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.
Cardinality	0...*
Type	Reference(HdBe-AdvanceDirective)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TreatmentDirective2.AgreementParty
Definition	Container of the Agreement concept. This container contains all data elements of the Agreement concept.
Cardinality	2...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` HdBe-TreatmentDirective2-1: Exactly one of Patient, Representative, or HealthProfessional must be selected. `Patient.exists() xor Representative.exists() xor HealthProfessional.exists()`
Mappings	rim: n/a
TreatmentDirective2.AgreementParty.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TreatmentDirective2.AgreementParty.extension
Definition	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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TreatmentDirective2.AgreementParty.modifierExtension
Definition	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'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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	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.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TreatmentDirective2.AgreementParty.Patient
Definition	Patient as the person with whom the agreement was made.
Cardinality	0...1
Type	Reference(HdBe-Patient)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TreatmentDirective2.AgreementParty.Representative
Definition	Person who represents the patient in health care matters and with whom the agreement has been made (too).
Cardinality	0...1
Type	Reference(HdBe-ContactPerson)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TreatmentDirective2.AgreementParty.HealthProfessional
Definition	HealthProfessional who has made the agreement regarding the treatment directive.
Cardinality	0...1
Type	Reference(HdBe-HealthProfessional)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TreatmentDirective2.Comment
Definition	The comment may include further information such as the reason why a treatment directive has been drawn up, persons who assisted the patient in agreeing the treatment directive but who are not otherwise involved in the agreement as a representative, etc.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a

Example instances

TreatmentDirective2
TreatmentDecision	385643006 - To be done (code by SNOMED CT)
Treatment	305351004 - Admission to intensive care unit (code by SNOMED CT)
SpecificationOther
MostRecentReviewDate	2012-09-11
DateExpired	2012-10-15
ReasonForEnding	Recovered and released from the hospital.
AdvanceDirective	Reference to AdvanceDirective (Power of attorney granted)
AgreementParty	---
AgreementParty.Patient
AgreementParty.Representative	Reference to ContactPerson (Jan Pieter Mark (Piet) van Putten)
AgreementParty.HealthProfessional	Reference to HealthProfessional (J.H.R. Peters, Doctor)
Comment

TreatmentDirective2
TreatmentDecision	74964007 - Other (code by SNOMED CT)
Treatment	89666000 - Cardiopulmonary resuscitation (code by SNOMED CT)
SpecificationOther	First consult with husband
MostRecentReviewDate	2012-09-11
DateExpired
ReasonForEnding
AdvanceDirective
AgreementParty	---
AgreementParty.Patient
AgreementParty.Representative	Reference to ContactPerson (Jan Pieter Mark (Piet) van Putten)
AgreementParty.HealthProfessional
Comment

zib TreatmentDirective2-v1.0 difference

Concept	Category	Description
`TreatmentDirective2` (root)	naming	Renamed the root concept name TreatmentDirective to TreatmentDirective2 to align with the sdf-8 constraint. (zib ticket #1875)
`Treatment`	terminology	Changed binding strenght from Required to Extensible because it is very likely other codes may be relevant in the future. This is already the case with the zibs in release 2020 versus the pre-release of 2022 where new codes have been added.
`Treatment`	terminology	Changed codes to the one found in TreatmentDirective2-v2.0(2022EN).
`TreatmentDecision`	terminology	Replaced zib codes to SNOMED codes.
description.concept	textual	Replaced 'patient or representative (s)' with 'patient or representative(s)'.
`MostRecentReviewDate`	textual	Replaced 'his representative (s)' with 'his representative(s)'.
`MostRecentReviewDate`	textual	Replaced 'treatment directive have' with 'treatment directive has'.
`AgreementParty`	textual	Replaced 'concept.This' with 'concept. This'.

Terminology Bindings

Path	Name	Strength	URL
TreatmentDecision	TreatmentDecision	required	https://fhir.healthdata.be/ValueSet/TreatmentDecision
Treatment	Treatment	extensible	https://fhir.healthdata.be/ValueSet/Treatment