MII IG Molekulares Tumorboard DE v2025

Behandlungsepisode: ClinicalImpression

Inhalt

Dieses Profil beschreibt die aktuelle Behandlungsepisode inkl. dem aktuellen Gesundheitszustand, Vortherapien, Molekular Pathologie Befund und NGS Bericht.

Verknüpfungen zu anderen Ressourcen

TODO:

Bezug zu Profil Diagnose Primaertumor (Vererbung Onko)
Bezug zu Profil NGS Bericht
Bezug zu Profil Molekular Pathologie Befund
Bezug zu Profil Systemische Therapie (Vererbung Onko)
Bezug zu Modul Onko Strahlentherapie, Operation
Bezug zu Modul Prozedu / Prozedur
Bezug zu Modul MolGen / Profil Familienanamnese
Bezug zu Modul Onko / Allgemeiner Leistungszustand ECOG

Zeitliche Zuordnung im Verlauf

Name	Status	Version	Canonical	Basis
MII_PR_MTB_Behandlungsepisode	draft	2024.0.0-ballot	https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-behandlungsepisode	http://hl7.org/fhir/StructureDefinition/ClinicalImpression

Inhalt

MII_PR_MTB_Behandlungsepisode (ClinicalImpression)	I		ClinicalImpression	There are no (further) constraints on this element Element id ClinicalImpression Short description A clinical assessment performed when planning treatments and management strategies for a patient Definition A record of a clinical assessment performed to determine what problem(s) may affect the patient and before planning the treatments or management strategies that are best to manage a patient's condition. Assessments are often 1:1 with a clinical consultation / encounter, but this varies greatly depending on the clinical workflow. This resource is called "ClinicalImpression" rather than "ClinicalAssessment" to avoid confusion with the recording of assessment tools such as Apgar score. Data type ClinicalImpression Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event v2: Partial mapping for problem evaluation
id	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	S Σ	0..1	Meta	There are no (further) constraints on this element Element id ClinicalImpression.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id ClinicalImpression.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id ClinicalImpression.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id ClinicalImpression.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id ClinicalImpression.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.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 resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. 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
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). 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
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id ClinicalImpression.identifier Short description Business identifier Definition Business identifiers assigned to this clinical impression by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Requirements Allows identification of the clinical impression as it is known by various participating systems and in a way that remains consistent across servers. Comments This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: PID-3
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id ClinicalImpression.status Short description in-progress \| completed \| entered-in-error Definition Identifies the workflow status of the assessment. Comments This element is labeled as a modifier because the status contains the code entered-in-error that marks the clinical impression as not currently valid. Data type code Binding The workflow state of a clinical impression. ClinicalImpressionStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status v2: PRB-14
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.statusReason Short description Reason for current status Alternate names Suspended Reason, Cancelled Reason Definition Captures the reason for the current state of the ClinicalImpression. Comments This is generally only used for "exception" statuses such as "not-done", "suspended" or "cancelled". [distinct reason codes for different statuses can be enforced using invariants if they are universal bindings]. Data type CodeableConcept Binding Codes identifying the reason for the current state of a clinical impression. (unbound) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.statusReason rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN].reasonCOde
code	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.code Short description Kind of assessment performed Alternate names type Definition Categorizes the type of clinical assessment performed. Comments This is present as a place-holder only and may be removed based on feedback/work group opinion. Data type CodeableConcept Binding Identifies categories of clinical impressions. This is a place-holder only. It may be removed. (unbound) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.what[x]
description	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.description Short description Why/how the assessment was performed Definition A summary of the context and/or cause of the assessment - why / where it was performed, and what patient events/status prompted it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
subject	Σ	1..1	Reference(https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert)	Element id ClinicalImpression.subject Short description Patient or group assessed Definition The patient or group of individuals assessed as part of this record. Requirements Group is typically for veterinary and/or public health purposes. Data type Reference(https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient \| https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 w5: FiveWs.subject
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id ClinicalImpression.encounter Short description Encounter created as part of Definition The Encounter during which this ClinicalImpression was created or to which the creation of this record is tightly associated. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context
effective[x]	Σ	1..1		Element id ClinicalImpression.effective[x] Short description Time of assessment Definition The point in time or period over which the subject was assessed. Comments This SHOULD be accurate to at least the minute, though some assessments only have a known date. Sliced: Unordered, Open, by $this(Type) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: PRB-2
(All Slices)				There are no (further) constraints on this element
effectiveDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
effectivePeriod	S Σ	1..1	Period	Element id ClinicalImpression.effective[x]:effectivePeriod Short description Zeitraum der Behandlungsepisode Definition Zeitraum von Einschluss bis Abschluss im Molekularen Tumorboard Comments This SHOULD be accurate to at least the minute, though some assessments only have a known date. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: PRB-2
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.effective[x]:effectivePeriod.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 ClinicalImpression.effective[x]:effectivePeriod.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
start	Σ I	0..1	dateTime	Element id ClinicalImpression.effective[x]:effectivePeriod.start Short description Einschlussdatum Definition Einschlussdatum Molekulares Tumorboard Comments If the low element is missing, the meaning is that the low boundary is not known. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: DR.1 rim: ./low
end	Σ I	0..1	dateTime	Element id ClinicalImpression.effective[x]:effectivePeriod.end Short description Abschlussdatum Definition Abschlussdatum Molekulares Tumorboard Comments The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03. Meaning when missing If the end of the period is missing, it means that the period is ongoing Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: DR.2 rim: ./high
date	Σ	0..1	dateTime	There are no (further) constraints on this element Element id ClinicalImpression.date Short description When the assessment was documented Definition Indicates when the documentation of the assessment was complete. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.recorded
assessor	Σ	0..1	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ClinicalImpression.assessor Short description The clinician performing the assessment Definition The clinician performing the assessment. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.author v2: ROL-4
previous		0..1	Reference(ClinicalImpression)	There are no (further) constraints on this element Element id ClinicalImpression.previous Short description Reference to last assessment Definition A reference to the last assessment that was conducted on this patient. Assessments are often/usually ongoing in nature; a care provider (practitioner or team) will make new assessments on an ongoing basis as new data arises or the patient's conditions changes. Comments It is always likely that multiple previous assessments exist for a patient. The point of quoting a previous assessment is that this assessment is relative to it (see resolved). Data type Reference(ClinicalImpression) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
problem	S Σ	0..*	Reference(Condition \| AllergyIntolerance)	Element id ClinicalImpression.problem Short description Relevant impressions of patient state Definition A list of the relevant problems/conditions for a patient. Comments e.g. The patient is a pregnant, has congestive heart failure, has an ‎Adenocarcinoma, and is allergic to penicillin. Data type Reference(Condition \| AllergyIntolerance) Sliced: Unordered, Open, by $this(Type) Slice für Diagnose Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.why[x] v2: PRB-3 / IAM-7
PrimaertumorDiagnose	S Σ	0..1	Reference(MII_PR_MTB_Diagnose_Primaertumor \| Condition)	Element id ClinicalImpression.problem:PrimaertumorDiagnose Short description Primärtumor Diagnose Definition Verweise auf Diagnose des Primärtumors Comments e.g. The patient is a pregnant, has congestive heart failure, has an ‎Adenocarcinoma, and is allergic to penicillin. Data type Reference(MII_PR_MTB_Diagnose_Primaertumor \| Condition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.why[x] v2: PRB-3 / IAM-7
investigation		0..*	BackboneElement	Element id ClinicalImpression.investigation Short description One or more sets of investigations (signs, symptoms, etc.) Definition One or more sets of investigations (signs, symptoms, etc.). The actual grouping of investigations varies greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes. Data type BackboneElement Sliced: Unordered, Open, by code.coding(Value) Slice für relevante Ermittlungen Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
(All Slices)				There are no (further) constraints on this element
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation.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 ClinicalImpression.investigation.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.investigation.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
code		1..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.investigation.code Short description A name/code for the set Definition A name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure\|family\|travel\|nutritional) history may be used. Data type CodeableConcept Binding A name/code for a set of investigations. InvestigationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
item		0..*	Reference(Observation \| QuestionnaireResponse \| FamilyMemberHistory \| DiagnosticReport \| RiskAssessment \| ImagingStudy \| Media)	There are no (further) constraints on this element Element id ClinicalImpression.investigation.item Short description Record of a specific investigation Definition A record of a specific investigation that was undertaken. Comments Most investigations are observations of one kind or another but some other specific types of data collection resources can also be used. Data type Reference(Observation \| QuestionnaireResponse \| FamilyMemberHistory \| DiagnosticReport \| RiskAssessment \| ImagingStudy \| Media) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-21
KrankengeschichteFamilie	S	0..1	BackboneElement	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie Short description One or more sets of investigations (signs, symptoms, etc.) Definition One or more sets of investigations (signs, symptoms, etc.). The actual grouping of investigations varies greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie.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 ClinicalImpression.investigation:KrankengeschichteFamilie.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie.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
code		1..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie.code Short description A name/code for the set Definition A name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure\|family\|travel\|nutritional) history may be used. Data type CodeableConcept Binding A name/code for a set of investigations. InvestigationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie.code.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 ClinicalImpression.investigation:KrankengeschichteFamilie.code.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
coding	Σ	1..*	CodingPattern	Element id ClinicalImpression.investigation:KrankengeschichteFamilie.code.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://snomed.info/sct", "code": "416471007", "display": "Family medical history" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:KrankengeschichteFamilie.code.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
item		1..1	Reference( \| FamilyMemberHistory)	Element id ClinicalImpression.investigation:KrankengeschichteFamilie.item Short description Krankengeschichte Familie Definition Verweis auf familiäre Krankengeschichte Comments Most investigations are observations of one kind or another but some other specific types of data collection resources can also be used. Data type Reference( \| FamilyMemberHistory) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-21
ECOG	S	0..1	BackboneElement	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG Short description One or more sets of investigations (signs, symptoms, etc.) Definition One or more sets of investigations (signs, symptoms, etc.). The actual grouping of investigations varies greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG.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 ClinicalImpression.investigation:ECOG.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG.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
code		1..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG.code Short description A name/code for the set Definition A name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure\|family\|travel\|nutritional) history may be used. Data type CodeableConcept Binding A name/code for a set of investigations. InvestigationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG.code.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 ClinicalImpression.investigation:ECOG.code.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
coding	Σ	1..*	CodingPattern	Element id ClinicalImpression.investigation:ECOG.code.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://snomed.info/sct", "code": "424122007", "display": "ECOG performance status finding" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:ECOG.code.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
item		1..1	Reference(https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog \| Observation)	Element id ClinicalImpression.investigation:ECOG.item Short description ECOG Definition ECOG Performance Status Comments Most investigations are observations of one kind or another but some other specific types of data collection resources can also be used. Data type Reference(https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog \| Observation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-21
NgsBericht	S	0..*	BackboneElement	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht Short description One or more sets of investigations (signs, symptoms, etc.) Definition One or more sets of investigations (signs, symptoms, etc.). The actual grouping of investigations varies greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht.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 ClinicalImpression.investigation:NgsBericht.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht.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
code		1..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht.code Short description A name/code for the set Definition A name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure\|family\|travel\|nutritional) history may be used. Data type CodeableConcept Binding A name/code for a set of investigations. InvestigationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht.code.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 ClinicalImpression.investigation:NgsBericht.code.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
coding	Σ	1..*	CodingPattern	Element id ClinicalImpression.investigation:NgsBericht.code.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://snomed.info/sct", "code": "106221001", "display": "Genetic finding" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:NgsBericht.code.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
item		1..1	Reference(MII_PR_MTB_NGS_Bericht \| DiagnosticReport)	Element id ClinicalImpression.investigation:NgsBericht.item Short description NGS Report Definition Für Molekulares Tumorboard bereitgestellter Next Generation Sequencing Bericht Comments Most investigations are observations of one kind or another but some other specific types of data collection resources can also be used. Data type Reference(MII_PR_MTB_NGS_Bericht \| DiagnosticReport) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-21
MolekularPathologieBefund	S	0..*	BackboneElement	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund Short description One or more sets of investigations (signs, symptoms, etc.) Definition One or more sets of investigations (signs, symptoms, etc.). The actual grouping of investigations varies greatly depending on the type and context of the assessment. These investigations may include data generated during the assessment process, or data previously generated and recorded that is pertinent to the outcomes. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund.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 ClinicalImpression.investigation:MolekularPathologieBefund.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund.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
code		1..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund.code Short description A name/code for the set Definition A name/code for the group ("set") of investigations. Typically, this will be something like "signs", "symptoms", "clinical", "diagnostic", but the list is not constrained, and others such groups such as (exposure\|family\|travel\|nutritional) history may be used. Data type CodeableConcept Binding A name/code for a set of investigations. InvestigationType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund.code.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 ClinicalImpression.investigation:MolekularPathologieBefund.code.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
coding	Σ	1..*	CodingPattern	Element id ClinicalImpression.investigation:MolekularPathologieBefund.code.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data type Coding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://snomed.info/sct", "code": "721967005", "display": "Tissue pathology biopsy report" } Mappings v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.investigation:MolekularPathologieBefund.code.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. Requirements The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source. Comments Very often the text is the same as a displayName of one of the codings. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CE.9. But note many systems use CE.2 for this rim: ./originalText[mediaType/code="text/plain"]/data orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
item		1..1	Reference(MII_PR_MTB_MOLECULAR_PATHOLOGY_REPORT \| DiagnosticReport)	Element id ClinicalImpression.investigation:MolekularPathologieBefund.item Short description Molekular Pathologie Befund Definition Für Molekulares Tumorboard bereitgestellter Molekular Pathologie Befund Comments Most investigations are observations of one kind or another but some other specific types of data collection resources can also be used. Data type Reference(MII_PR_MTB_MOLECULAR_PATHOLOGY_REPORT \| DiagnosticReport) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-21
protocol		0..*	uri	There are no (further) constraints on this element Element id ClinicalImpression.protocol Short description Clinical Protocol followed Definition Reference to a specific published clinical protocol that was followed during this assessment, and/or that provides evidence in support of the diagnosis. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
summary		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.summary Short description Summary of the assessment Definition A text summary of the investigations and the diagnosis. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX
finding		0..*	BackboneElement	There are no (further) constraints on this element Element id ClinicalImpression.finding Short description Possible or likely findings and diagnoses Definition Specific findings or diagnoses that were considered likely or relevant to ongoing treatment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.finding.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 ClinicalImpression.finding.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 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
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id ClinicalImpression.finding.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
itemCodeableConcept		0..1	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.finding.itemCodeableConcept Short description What was found Definition Specific text or code for finding or diagnosis, which may include ruled-out or resolved conditions. Data type CodeableConcept Binding Identification of the Condition or diagnosis. Condition/Problem/DiagnosisCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX
itemReference		0..1	Reference(Condition \| Observation \| Media)	There are no (further) constraints on this element Element id ClinicalImpression.finding.itemReference Short description What was found Definition Specific reference for finding or diagnosis, which may include ruled-out or resolved conditions. Data type Reference(Condition \| Observation \| Media) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX
basis		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.finding.basis Short description Which investigations support finding Definition Which investigations support finding or diagnosis. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
prognosisCodeableConcept		0..*	CodeableConcept	There are no (further) constraints on this element Element id ClinicalImpression.prognosisCodeableConcept Short description Estimate of likely outcome Definition Estimate of likely outcome. Data type CodeableConcept Binding Prognosis or outlook findings. ClinicalImpressionPrognosis (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PRB-22
prognosisReference		0..*	Reference(RiskAssessment)	There are no (further) constraints on this element Element id ClinicalImpression.prognosisReference Short description RiskAssessment expressing likely outcome Definition RiskAssessment expressing likely outcome. Data type Reference(RiskAssessment) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
supportingInfo		0..*	Reference(Resource)	Element id ClinicalImpression.supportingInfo Short description Information supporting the clinical impression Definition Information supporting the clinical impression. Data type Reference(Resource) Sliced: Unordered, Open, by $this(Type) Slice für weitere Informationen Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Einwilligung	S	0..1	Reference(Consent)	Element id ClinicalImpression.supportingInfo:Einwilligung Short description Einwilligung Definition Einwilligung zum Molekularen Tumorboard Data type Reference(Consent) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Vortherapie	S	0..*	Reference(MII_PR_MTB_Systemische_Vortherapie \| MII_PR_Onko_Strahlentherapie \| MII_PR_Onko_Operation \| MII_PR_Prozedur_Procedure \| Procedure)	Element id ClinicalImpression.supportingInfo:Vortherapie Short description Vortherapie Definition Relevante Leitlinien-basierte Vortherapie Data type Reference(MII_PR_MTB_Systemische_Vortherapie \| MII_PR_Onko_Strahlentherapie \| MII_PR_Onko_Operation \| MII_PR_Prozedur_Procedure \| Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
id		0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.supportingInfo:Vortherapie.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 ClinicalImpression.supportingInfo:Vortherapie.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
LeitlinieDokumentation	S I	0..1	Extension(Complex)	Element id ClinicalImpression.supportingInfo:Vortherapie.extension:LeitlinieDokumentation Short description Leitlinie Dokumentation Alternate names extensions, user content Definition Dokumentation zur Leitlinien-konformen Umsetzung der Prozedur 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(Complex) Extension URL https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation 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
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.supportingInfo:Vortherapie.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. 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
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id ClinicalImpression.supportingInfo:Vortherapie.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id ClinicalImpression.supportingInfo:Vortherapie.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id ClinicalImpression.supportingInfo:Vortherapie.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. 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
Vorbefund	S	0..*	Reference(DiagnosticReport \| Observation)	Element id ClinicalImpression.supportingInfo:Vorbefund Short description Vorbefund Definition Relevanter Vorbefund Data type Reference(DiagnosticReport \| Observation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
note		0..*	Annotation	There are no (further) constraints on this element Element id ClinicalImpression.note Short description Comments made about the ClinicalImpression Definition Commentary about the impression, typically recorded after the impression itself was made, though supplemental notes by the original author could also appear. Comments Don't use this element for content that should more properly appear as one of the specific elements of the impression. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.note

Aktueller Krankheitszustand und bisherige Behandlungsmaßnahmen

Feldname	Kurzbeschreibung
ClinicalImpression.meta
ClinicalImpression.effective[x]:effectivePeriod	Zeitraum der Behandlungsepisode
ClinicalImpression.problem
ClinicalImpression.problem:PrimaertumorDiagnose	Primärtumor Diagnose
ClinicalImpression.investigation:KrankengeschichteFamilie
ClinicalImpression.investigation:ECOG
ClinicalImpression.investigation:NgsBericht
ClinicalImpression.investigation:MolekularPathologieBefund
ClinicalImpression.supportingInfo:Einwilligung	Einwilligung
ClinicalImpression.supportingInfo:Vortherapie	Vortherapie
ClinicalImpression.supportingInfo:Vortherapie.extension:LeitlinieDokumentation	Leitlinie Dokumentation
ClinicalImpression.supportingInfo:Vorbefund	Vorbefund

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="mii-pr-mtb-behandlungsepisode" />
    <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-behandlungsepisode" />
    <version value="2024.0.0-ballot" />
    <name value="MII_PR_MTB_Behandlungsepisode" />
    <title value="MII PR MTB Behandlungsepisode" />
    <status value="draft" />
    <publisher value="Medizininformatik Initiative" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="https://www.medizininformatik-initiative.de" />
        </telecom>
    </contact>
    <description value="Aktueller Krankheitszustand und bisherige Behandlungsma&#223;nahmen" />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="ClinicalImpression" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/ClinicalImpression" />
    <derivation value="constraint" />
    <differential>
        <element id="ClinicalImpression.meta">
            <path value="ClinicalImpression.meta" />
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.subject">
            <path value="ClinicalImpression.subject" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert" />
            </type>
        </element>
        <element id="ClinicalImpression.effective[x]">
            <path value="ClinicalImpression.effective[x]" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <min value="1" />
        </element>
        <element id="ClinicalImpression.effective[x]:effectivePeriod">
            <path value="ClinicalImpression.effective[x]" />
            <sliceName value="effectivePeriod" />
            <short value="Zeitraum der Behandlungsepisode" />
            <definition value="Zeitraum von Einschluss bis Abschluss im Molekularen Tumorboard" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Period" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.effective[x]:effectivePeriod.start">
            <path value="ClinicalImpression.effective[x].start" />
            <short value="Einschlussdatum" />
            <definition value="Einschlussdatum Molekulares Tumorboard" />
        </element>
        <element id="ClinicalImpression.effective[x]:effectivePeriod.end">
            <path value="ClinicalImpression.effective[x].end" />
            <short value="Abschlussdatum" />
            <definition value="Abschlussdatum Molekulares Tumorboard" />
        </element>
        <element id="ClinicalImpression.problem">
            <path value="ClinicalImpression.problem" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <description value="Slice f&#252;r Diagnose" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.problem:PrimaertumorDiagnose">
            <path value="ClinicalImpression.problem" />
            <sliceName value="PrimaertumorDiagnose" />
            <short value="Prim&#228;rtumor Diagnose" />
            <definition value="Verweise auf Diagnose des Prim&#228;rtumors" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-diagnose-primaertumor" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Condition" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.investigation">
            <path value="ClinicalImpression.investigation" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="code.coding" />
                </discriminator>
                <description value="Slice f&#252;r relevante Ermittlungen" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="ClinicalImpression.investigation:KrankengeschichteFamilie">
            <path value="ClinicalImpression.investigation" />
            <sliceName value="KrankengeschichteFamilie" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.investigation:KrankengeschichteFamilie.code.coding">
            <path value="ClinicalImpression.investigation.code.coding" />
            <min value="1" />
            <patternCoding>
                <system value="http://snomed.info/sct" />
                <code value="416471007" />
                <display value="Family medical history" />
            </patternCoding>
        </element>
        <element id="ClinicalImpression.investigation:KrankengeschichteFamilie.item">
            <path value="ClinicalImpression.investigation.item" />
            <short value="Krankengeschichte Familie" />
            <definition value="Verweis auf famili&#228;re Krankengeschichte" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-molgen/StructureDefinition/familienanamnese" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory" />
            </type>
        </element>
        <element id="ClinicalImpression.investigation:ECOG">
            <path value="ClinicalImpression.investigation" />
            <sliceName value="ECOG" />
            <min value="0" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.investigation:ECOG.code.coding">
            <path value="ClinicalImpression.investigation.code.coding" />
            <min value="1" />
            <patternCoding>
                <system value="http://snomed.info/sct" />
                <code value="424122007" />
                <display value="ECOG performance status finding" />
            </patternCoding>
        </element>
        <element id="ClinicalImpression.investigation:ECOG.item">
            <path value="ClinicalImpression.investigation.item" />
            <short value="ECOG" />
            <definition value="ECOG Performance Status" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
            </type>
        </element>
        <element id="ClinicalImpression.investigation:NgsBericht">
            <path value="ClinicalImpression.investigation" />
            <sliceName value="NgsBericht" />
            <min value="0" />
            <max value="*" />
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.investigation:NgsBericht.code.coding">
            <path value="ClinicalImpression.investigation.code.coding" />
            <min value="1" />
            <patternCoding>
                <system value="http://snomed.info/sct" />
                <code value="106221001" />
                <display value="Genetic finding" />
            </patternCoding>
        </element>
        <element id="ClinicalImpression.investigation:NgsBericht.item">
            <path value="ClinicalImpression.investigation.item" />
            <short value="NGS Report" />
            <definition value="F&#252;r Molekulares Tumorboard bereitgestellter Next Generation Sequencing Bericht" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-ngs-bericht" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
            </type>
        </element>
        <element id="ClinicalImpression.investigation:MolekularPathologieBefund">
            <path value="ClinicalImpression.investigation" />
            <sliceName value="MolekularPathologieBefund" />
            <min value="0" />
            <max value="*" />
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.investigation:MolekularPathologieBefund.code.coding">
            <path value="ClinicalImpression.investigation.code.coding" />
            <min value="1" />
            <patternCoding>
                <system value="http://snomed.info/sct" />
                <code value="721967005" />
                <display value="Tissue pathology biopsy report" />
            </patternCoding>
        </element>
        <element id="ClinicalImpression.investigation:MolekularPathologieBefund.item">
            <path value="ClinicalImpression.investigation.item" />
            <short value="Molekular Pathologie Befund" />
            <definition value="F&#252;r Molekulares Tumorboard bereitgestellter Molekular Pathologie Befund" />
            <min value="1" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-molecular-pathology-report" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
            </type>
        </element>
        <element id="ClinicalImpression.supportingInfo">
            <path value="ClinicalImpression.supportingInfo" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <description value="Slice f&#252;r weitere Informationen" />
                <ordered value="false" />
                <rules value="open" />
            </slicing>
        </element>
        <element id="ClinicalImpression.supportingInfo:Einwilligung">
            <path value="ClinicalImpression.supportingInfo" />
            <sliceName value="Einwilligung" />
            <short value="Einwilligung" />
            <definition value="Einwilligung zum Molekularen Tumorboard" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Consent" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.supportingInfo:Vortherapie">
            <path value="ClinicalImpression.supportingInfo" />
            <sliceName value="Vortherapie" />
            <short value="Vortherapie" />
            <definition value="Relevante Leitlinien-basierte Vortherapie" />
            <min value="0" />
            <max value="*" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-systemische-vortherapie" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-strahlentherapie" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-operation" />
                <targetProfile value="https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Procedure" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Procedure" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.supportingInfo:Vortherapie.extension:LeitlinieDokumentation">
            <path value="ClinicalImpression.supportingInfo.extension" />
            <sliceName value="LeitlinieDokumentation" />
            <short value="Leitlinie Dokumentation" />
            <definition value="Dokumentation zur Leitlinien-konformen Umsetzung der Prozedur" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="ClinicalImpression.supportingInfo:Vorbefund">
            <path value="ClinicalImpression.supportingInfo" />
            <sliceName value="Vorbefund" />
            <short value="Vorbefund" />
            <definition value="Relevanter Vorbefund" />
            <min value="0" />
            <max value="*" />
            <type>
                <code value="Reference" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
                <targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
            </type>
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "mii-pr-mtb-behandlungsepisode",
    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-behandlungsepisode",
    "version": "2024.0.0-ballot",
    "name": "MII_PR_MTB_Behandlungsepisode",
    "title": "MII PR MTB Behandlungsepisode",
    "status": "draft",
    "publisher": "Medizininformatik Initiative",
    "contact":  [
        {
            "telecom":  [
                {
                    "system": "url",
                    "value": "https://www.medizininformatik-initiative.de"
                }
            ]
        }
    ],
    "description": "Aktueller Krankheitszustand und bisherige Behandlungsmaßnahmen",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "ClinicalImpression",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/ClinicalImpression",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "ClinicalImpression.meta",
                "path": "ClinicalImpression.meta",
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.subject",
                "path": "ClinicalImpression.subject",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/Patient",
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-person/StructureDefinition/PatientPseudonymisiert"
                        ]
                    }
                ]
            },
            {
                "id": "ClinicalImpression.effective[x]",
                "path": "ClinicalImpression.effective[x]",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                },
                "min": 1
            },
            {
                "id": "ClinicalImpression.effective[x]:effectivePeriod",
                "path": "ClinicalImpression.effective[x]",
                "sliceName": "effectivePeriod",
                "short": "Zeitraum der Behandlungsepisode",
                "definition": "Zeitraum von Einschluss bis Abschluss im Molekularen Tumorboard",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Period"
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.effective[x]:effectivePeriod.start",
                "path": "ClinicalImpression.effective[x].start",
                "short": "Einschlussdatum",
                "definition": "Einschlussdatum Molekulares Tumorboard"
            },
            {
                "id": "ClinicalImpression.effective[x]:effectivePeriod.end",
                "path": "ClinicalImpression.effective[x].end",
                "short": "Abschlussdatum",
                "definition": "Abschlussdatum Molekulares Tumorboard"
            },
            {
                "id": "ClinicalImpression.problem",
                "path": "ClinicalImpression.problem",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für Diagnose",
                    "ordered": false
                },
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.problem:PrimaertumorDiagnose",
                "path": "ClinicalImpression.problem",
                "sliceName": "PrimaertumorDiagnose",
                "short": "Primärtumor Diagnose",
                "definition": "Verweise auf Diagnose des Primärtumors",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-diagnose-primaertumor",
                            "http://hl7.org/fhir/StructureDefinition/Condition"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.investigation",
                "path": "ClinicalImpression.investigation",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "code.coding"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für relevante Ermittlungen",
                    "ordered": false
                }
            },
            {
                "id": "ClinicalImpression.investigation:KrankengeschichteFamilie",
                "path": "ClinicalImpression.investigation",
                "sliceName": "KrankengeschichteFamilie",
                "min": 0,
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.investigation:KrankengeschichteFamilie.code.coding",
                "path": "ClinicalImpression.investigation.code.coding",
                "min": 1,
                "patternCoding": {
                    "code": "416471007",
                    "system": "http://snomed.info/sct",
                    "display": "Family medical history"
                }
            },
            {
                "id": "ClinicalImpression.investigation:KrankengeschichteFamilie.item",
                "path": "ClinicalImpression.investigation.item",
                "short": "Krankengeschichte Familie",
                "definition": "Verweis auf familiäre Krankengeschichte",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-molgen/StructureDefinition/familienanamnese",
                            "http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory"
                        ]
                    }
                ]
            },
            {
                "id": "ClinicalImpression.investigation:ECOG",
                "path": "ClinicalImpression.investigation",
                "sliceName": "ECOG",
                "min": 0,
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.investigation:ECOG.code.coding",
                "path": "ClinicalImpression.investigation.code.coding",
                "min": 1,
                "patternCoding": {
                    "code": "424122007",
                    "system": "http://snomed.info/sct",
                    "display": "ECOG performance status finding"
                }
            },
            {
                "id": "ClinicalImpression.investigation:ECOG.item",
                "path": "ClinicalImpression.investigation.item",
                "short": "ECOG",
                "definition": "ECOG Performance Status",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-allgemeiner-leistungszustand-ecog",
                            "http://hl7.org/fhir/StructureDefinition/Observation"
                        ]
                    }
                ]
            },
            {
                "id": "ClinicalImpression.investigation:NgsBericht",
                "path": "ClinicalImpression.investigation",
                "sliceName": "NgsBericht",
                "min": 0,
                "max": "*",
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.investigation:NgsBericht.code.coding",
                "path": "ClinicalImpression.investigation.code.coding",
                "min": 1,
                "patternCoding": {
                    "code": "106221001",
                    "system": "http://snomed.info/sct",
                    "display": "Genetic finding"
                }
            },
            {
                "id": "ClinicalImpression.investigation:NgsBericht.item",
                "path": "ClinicalImpression.investigation.item",
                "short": "NGS Report",
                "definition": "Für Molekulares Tumorboard bereitgestellter Next Generation Sequencing Bericht",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-ngs-bericht",
                            "http://hl7.org/fhir/StructureDefinition/DiagnosticReport"
                        ]
                    }
                ]
            },
            {
                "id": "ClinicalImpression.investigation:MolekularPathologieBefund",
                "path": "ClinicalImpression.investigation",
                "sliceName": "MolekularPathologieBefund",
                "min": 0,
                "max": "*",
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.investigation:MolekularPathologieBefund.code.coding",
                "path": "ClinicalImpression.investigation.code.coding",
                "min": 1,
                "patternCoding": {
                    "code": "721967005",
                    "system": "http://snomed.info/sct",
                    "display": "Tissue pathology biopsy report"
                }
            },
            {
                "id": "ClinicalImpression.investigation:MolekularPathologieBefund.item",
                "path": "ClinicalImpression.investigation.item",
                "short": "Molekular Pathologie Befund",
                "definition": "Für Molekulares Tumorboard bereitgestellter Molekular Pathologie Befund",
                "min": 1,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-molecular-pathology-report",
                            "http://hl7.org/fhir/StructureDefinition/DiagnosticReport"
                        ]
                    }
                ]
            },
            {
                "id": "ClinicalImpression.supportingInfo",
                "path": "ClinicalImpression.supportingInfo",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "rules": "open",
                    "description": "Slice für weitere Informationen",
                    "ordered": false
                }
            },
            {
                "id": "ClinicalImpression.supportingInfo:Einwilligung",
                "path": "ClinicalImpression.supportingInfo",
                "sliceName": "Einwilligung",
                "short": "Einwilligung",
                "definition": "Einwilligung zum Molekularen Tumorboard",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/Consent"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.supportingInfo:Vortherapie",
                "path": "ClinicalImpression.supportingInfo",
                "sliceName": "Vortherapie",
                "short": "Vortherapie",
                "definition": "Relevante Leitlinien-basierte Vortherapie",
                "min": 0,
                "max": "*",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-pr-mtb-systemische-vortherapie",
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-strahlentherapie",
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/StructureDefinition/mii-pr-onko-operation",
                            "https://www.medizininformatik-initiative.de/fhir/core/modul-prozedur/StructureDefinition/Procedure",
                            "http://hl7.org/fhir/StructureDefinition/Procedure"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.supportingInfo:Vortherapie.extension:LeitlinieDokumentation",
                "path": "ClinicalImpression.supportingInfo.extension",
                "sliceName": "LeitlinieDokumentation",
                "short": "Leitlinie Dokumentation",
                "definition": "Dokumentation zur Leitlinien-konformen Umsetzung der Prozedur",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://www.medizininformatik-initiative.de/fhir/ext/modul-mtb/StructureDefinition/mii-ex-mtb-leitlinie-dokumentation"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "ClinicalImpression.supportingInfo:Vorbefund",
                "path": "ClinicalImpression.supportingInfo",
                "sliceName": "Vorbefund",
                "short": "Vorbefund",
                "definition": "Relevanter Vorbefund",
                "min": 0,
                "max": "*",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
                            "http://hl7.org/fhir/StructureDefinition/Observation"
                        ]
                    }
                ],
                "mustSupport": true
            }
        ]
    }
}

MII PR MTB Behandlungsepisode

Mapping Datensatz zu FHIR

Datensatz	Erklaerung	FHIR
Behandlungsepisode	Behandlungsepisode	ClinicalImpression
Anmeldedatum	Anmeldedatum für das Molekulare Tumorboard	ClinicalImpression.effectiveDateTime
Verweis auf Krankengeschichte Familie	Verweis auf die familiäre Krankengeschichte	ClinicalImpression.investigation.item:Reference(FamilyMemberHistory)
Verweis auf NGS Bericht	Verweis auf Next Generation Sequencing Bericht	ClinicalImpression.investigation.item:Reference(DiagnosticReport)
Verweis auf Molekular Pathologie Befund	Verweis auf Molekular Pathologie Befund	ClinicalImpression.investigation.item:Reference(DiagnosticReport)
Zulassungsstatus	Zulassungsstatus der Vortherapie	ClinicalImpression.extension.extension(Zulassungsstatus)
Therapielinie	Therapielinie der Vortherapie (0 bis 9)	ClinicalImpression.extension.extension(Therapielinie)

Suchparameter

Folgende Suchparameter sind für das Modul Onkologie relevant, auch in Kombination:

Der Suchparameter "_id" MUSS unterstützt werden:

Beispiele:

GET [base]/ClinicalImpression?_id=12345

Anwendungshinweise: Weitere Informationen zur Suche nach "_id" finden sich in der FHIR-Basisspezifikation - Abschnitt "Parameters for all resources".

Beispiele