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HdBe-Wilsverklaring

CBB	Concept	Status
HdBe-AdvanceDirective	Een wilsverklaring is een mondelinge of schriftelijke omschrijving van de wens van de patiënt ten aanzien van toekomstig medisch handelen of het levenseinde. Een wilsverklaring is vooral voor situaties waarin de patiënt niet meer over deze beslissingen kan praten met de zorgverlener. Purpose Een goed overzicht van wensen van de patiënt is belangrijk. Een zorgverlener kan de wilsverklaring gebruiken om de bestaande wensen met de betrokkenen te bespreken en om deze wensen in het eigen beleid op te nemen. Vooral in de acute situatie is een beknopte en overzichtelijke lijst van belang. Evidence Base De lijst met type wilsverklaringen is tot stand gekomen in nauw overleg met de Nederlandse Patiënten en Consumenten Federatie (NPCF), de Nederlandse Vereniging voor een Vrijwillig Levenseinde (NVVE) en de Nederlandse Patiënten Vereniging (NPV). De lijst met types komt overeen met de wilsverklaringen waarvoor de verschillende verenigingen op hun websites voorbeelden voor aanbieden. References NPCF - Wilsverklaring [Online] Beschikbaar op: https://www.patientenfederatie.nl/themas/wilsverklaring/wat-hoe [Geraadpleegd: 15 juni 2020]. Wilsverklaringen van de NVVE [Online] Beschikbaar op: https://nvve.nl/index.php?cID=307 [Geraadpleegd: 15 juni 2020]. NPV - Levenswensverklaring [Online] Beschikbaar op: https://npvzorg.nl/levenswensverklaring/ [Geraadpleegd: 15 juni 2020].	active

CBB

Concept

Status

HdBe-AdvanceDirective

Een wilsverklaring is een mondelinge of schriftelijke omschrijving van de wens van de patiënt ten aanzien van toekomstig medisch handelen of het levenseinde. Een wilsverklaring is vooral voor situaties waarin de patiënt niet meer over deze beslissingen kan praten met de zorgverlener.

Purpose

Een goed overzicht van wensen van de patiënt is belangrijk. Een zorgverlener kan de wilsverklaring gebruiken om de bestaande wensen met de betrokkenen te bespreken en om deze wensen in het eigen beleid op te nemen. Vooral in de acute situatie is een beknopte en overzichtelijke lijst van belang.

Evidence Base

De lijst met type wilsverklaringen is tot stand gekomen in nauw overleg met de Nederlandse Patiënten en Consumenten Federatie (NPCF), de Nederlandse Vereniging voor een Vrijwillig Levenseinde (NVVE) en de Nederlandse Patiënten Vereniging (NPV).

De lijst met types komt overeen met de wilsverklaringen waarvoor de verschillende verenigingen op hun websites voorbeelden voor aanbieden.

References

NPCF - Wilsverklaring [Online] Beschikbaar op: https://www.patientenfederatie.nl/themas/wilsverklaring/wat-hoe [Geraadpleegd: 15 juni 2020].
Wilsverklaringen van de NVVE [Online] Beschikbaar op: https://nvve.nl/index.php?cID=307 [Geraadpleegd: 15 juni 2020].
NPV - Levenswensverklaring [Online] Beschikbaar op: https://npvzorg.nl/levenswensverklaring/ [Geraadpleegd: 15 juni 2020].

active

AdvanceDirective			AdvanceDirective	Element id AdvanceDirective Short description Wilsverklaring Definition Rootconcept van de bouwsteen Wilsverklaring. Dit concept bevat alle gegevenselementen van de bouwsteen Wilsverklaring. Data type AdvanceDirective 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 AdvanceDirective.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 AdvanceDirective.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
LivingWillType		1..1	CodeableConceptBinding	Element id AdvanceDirective.LivingWillType Short description WilsverklaringType Definition Aanduiding van de verschillende soorten wilsverklaringen. 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 LivingWillType codes TypeOfLivingWill (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
LivingWillDate		1..1	dateTime	Element id AdvanceDirective.LivingWillDate Short description WilsverklaringDatum Definition De datum waarop de wilsverklaring is vastgelegd. 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
Disorder	I	0..*	Reference(HdBe-Problem)	Element id AdvanceDirective.Disorder Short description Aandoening Definition Het probleem of aandoening waar de wilsverklaring betrekking op heeft. 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-Problem) 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..*	Reference(HdBe-ContactPerson)	Element id AdvanceDirective.Representative Short description Vertegenwoordiger Definition De persoon die wettelijke vertegerwoordiger is of in de ondertekende volmacht als gevolmachtigde wordt benoemd. 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)
LivingWillDocument		0..1	base64Binary	Element id AdvanceDirective.LivingWillDocument Short description WilsverklaringDocument Definition Ingescand brondocument met de wilsverklaring en handtekening van de patiënt, bijv. een PDF. Comments A stream of bytes, base64 encoded Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Comment		0..1	string	Element id AdvanceDirective.Comment Short description Toelichting Definition Toelichting bij de wilsverklaring, bijvoorbeeld de vorm, zoals een penning, een tattoo etc. of waar de wilsverklaring te vinden 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		0..*
AdvanceDirective.LivingWillType	CodeableConcept	1..1
AdvanceDirective.LivingWillDate	dateTime	1..1
AdvanceDirective.Disorder	Reference(HdBe-Problem)	0..*
AdvanceDirective.Representative	Reference(HdBe-ContactPerson)	0..*
AdvanceDirective.LivingWillDocument	base64Binary	0..1
AdvanceDirective.Comment	string	0..1

AdvanceDirective
Definition	Root concept of the AdvanceDirective information model. This concept contains all data elements of the AdvanceDirective 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
AdvanceDirective.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
AdvanceDirective.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
AdvanceDirective.LivingWillType
Definition	List of the different types of living wills.
Cardinality	1...1
Type	CodeableConcept
Binding	LivingWillType codes TypeOfLivingWill (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
AdvanceDirective.LivingWillDate
Definition	The date on which the living will was recorded.
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
AdvanceDirective.Disorder
Definition	The problem or disorder to which the living will applies.
Cardinality	0...*
Type	Reference(HdBe-Problem)
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)
AdvanceDirective.Representative
Definition	The person who is the legal representative or is appointed as the authorized representative in the signed authorization.
Cardinality	0...*
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)
AdvanceDirective.LivingWillDocument
Definition	Scanned source document with the living will and the patient's signature, such as a PDF.
Cardinality	0...1
Type	base64Binary
Comments	A stream of bytes, base64 encoded
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AdvanceDirective.Comment
Definition	Comment on the living will: the form, such as a medallion, tattoo, etc., or where the living will can be found.
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

AdvanceDirective
LivingWillType	186065003 - Power of attorney medical report (code by SNOMED CT)
LivingWillDate	2010-05-06
disorder	Reference to Problem (Listeriosis)
representative	Reference to ContactPerson (Berend Ulijn)
LivingWillDocument	Power of attorney medical report.Pdf
Comment	Power of attorney granted to partner

zib AdvanceDirective-v3.1.1 difference

Concept	Category	Description
description	textual	Replaced LivingWill with AdvanceDirective where appopriate (zib-1597).
`AdvanceDirective` (root)	textual	Improved text (zib-1587).
`LivingWillType`	terminology	Included NL SNOMED codes based on the codes found in the AdvanceDirective-v4.1(2022EN) LivingWillTypeSnomedCodelist. This needs to become International codes or codes available in the BE edition. Also made the ValueSet binding strenght Extensible instead of Required which is inline with the future version of the zib as well (zib-1683)).
`LivingWillType`	textual	Improved text (zib-1587).
`Representative`	cardinality	Loosened the cardinality from 0..1 to 0..* (zib-1557).
`Representative.ContactPerson`	naming	Renamed contact to contactPerson to be consistent with the contactPerson zib (zib-1587).

Terminology Bindings

Path	Name	Strength	URL
LivingWillType	TypeOfLivingWill	extensible	https://fhir.healthdata.be/ValueSet/TypeOfLivingWill