Implementierungsleitfaden ISiK-Basismodul (4.0.1)

ISiKDiagnose

Dieses Profil spezifiziert die Minimalanforderungen für die Bereitstellung von Informationen über die Diagnosen eines Patienten im Rahmen des Bestätigungsverfahrens der gematik.

Motivation

Die Möglichkeit, auf eine Übersicht der Diagnosen eines Patienten zuzugreifen, Patienten anhand ihrer Diagnose zu suchen oder zu prüfen, ob eine konkrete Diagnose bei einem Patienten vorliegt, sind wichtige Funktionen im klinischen Behandlungsablauf.

In FHIR werden Diagnosen mit der Condition-Ressource repräsentiert.

Da die Diagnosen in klinischen Primärsystemen in der Regel in ICD-10-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches. Falls eine Diagnose zwar dokumentiert, aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), ist alternativ eine Repräsentation als Freitext-Diagnose möglich.

Kompatibilität

Für das Profil ISiKDiagnose wird eine Kompatibilität mit folgenden Profilen angestrebt; allerdings kann nicht sichergestellt werden, dass Instanzen, die gegen ISiKDiagnose valide sind, auch valide sind gegen:

das Profil ProfileConditionDiagnose der Medizininformatik-Initative
das Profil KBV_PR_Base_Condition_Diagnosis der KBV]
Hinweise zu Inkompatibilitäten können über die Portalseite gemeldet werden.

Bestätigungsrelevanz

Verbindlichkeit	SHALL

Metadaten

Canonical	https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose
Status	active
Version	4.0.1
Basis	http://hl7.org/fhir/StructureDefinition/Condition

Inhalt

ISiKDiagnose (Condition)	I		Condition	Element id Condition Short description Detailed information about conditions, problems or diagnoses Definition A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern. Data type Condition Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.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-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-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error `verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()` con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission `abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()` con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item `clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()` isik-con1: Falls eine kodierte Diagnose vorliegt muss angegeben werden durch welchen Kontakt diese Dokumentation erfolgte. `code.coding.exists() implies encounter.exists()` Mappings rim: Entity. Role, or Act workflow: Event sct-concept: < 243796009 \|Situation with explicit context\| : 246090004 \|Associated finding\| = ( ( < 404684003 \|Clinical finding\| MINUS ( << 420134006 \|Propensity to adverse reactions\| OR << 473010000 \|Hypersensitivity condition\| OR << 79899007 \|Drug interaction\| OR << 69449002 \|Drug action\| OR << 441742003 \|Evaluation finding\| OR << 307824009 \|Administrative status\| OR << 385356007 \|Tumor stage finding\|)) OR < 272379006 \|Event\|) v2: PPR message rim: Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
id	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.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	Σ	0..1	Meta	There are no (further) constraints on this element Element id Condition.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())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Condition.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())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id Condition.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())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id Condition.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: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Condition.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: Entity. Role, or Act rim: N/A
extension	S I	0..*	Extension	There are no (further) constraints on this element Element id Condition.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 Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
related	S I	0..1	Extension(Reference(Condition))	Element id Condition.extension:related Short description Verknüpfte Diagnose Alternate names extensions, user content Definition This condition has an unspecified relationship with another condition. Comments Die Deutschen Kodierrichtlinien und die 'German Modification' ermöglichen es teilweise, ICD-10-Codierte Diagnosen miteinander zu verknüpfen ("Kreuz-Stern-Ausrufezeichen-Notation"), diese aber dennoch wie eigenständige Diagnosen (mit jeweils eigener Diagnosesicherheit oder -Lokalisation) zu kommunizieren. Daher ist es in Deutschland nicht möglich, dem internationalen Usus zu folgen und verknüpfte Diagnosen als postkoordinierten Code einer Condition-Ressource aufzufassen. Statt dessen müssen sie zwei eigenständige Condition-Ressourcen abgebildet werden, die mit Hilfe der `related`-Extension miteinander verknüpft werden. Die Sekundärdiagnose verweist jeweils auf die Primärdiagnose. Data type Extension(Reference(Condition)) Extension URL http://hl7.org/fhir/StructureDefinition/condition-related Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Condition.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 Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Condition.identifier Short description External Ids for this condition Definition Business identifiers assigned to this condition 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 condition 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 rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id
clinicalStatus	S Σ ?! I	0..1	CodeableConceptBinding	Element id Condition.clinicalStatus Short description klinischer Status Definition The clinical status of the condition. Comments Begründung MS: Auch in Stufe 4 sind keine (client-seitigen) schreibenden Operationen für das Erstellen einer Condition-Ressource vorgesehen (siehe CapabilityStatement). Das heißt, entweder führen KISe entsprechende Informationen und exponieren diese, oder es gibt keinen pragmatischen Mechanismus (im ISIK-Kontext), um den Use Case einer zusätzlichen Annotation mittels Client zu erfüllen. Da alle KIS-Hersteller, die sich zu Wort gemeldet haben, eine Befüllung von Condition.clinicalStatus NICHT unterstützen, erscheint das MS nach übergreifender Definition und ein verpflichtender Testfall nicht angemessen. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Status einer Diagnose, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch `clinicalStatus` befüllen, sofern die entsprechende Information verfügbar ist. Hinweis: Für Diagnosen aus der ambulanten Versorgung können die Werte für `clinicalStatus` und `verificationStatus` aus dem ICD-10-Zusatzkennzeichen für die Diagnosesicherheit abgeleitet werden. Das entsprechende Mapping kann den Deutschen Basisprofilen entnommen werden. Data type CodeableConcept Binding The clinical status of the condition or diagnosis. ConditionClinicalStatusCodes (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.status w5: FiveWs.status sct-concept: < 303105007 \|Disease phases\| v2: PRB-14 rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
verificationStatus	Σ ?! I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Condition.verificationStatus Short description unconfirmed \| provisional \| differential \| confirmed \| refuted \| entered-in-error Definition The verification status to support the clinical status of the condition. Comments verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity. Data type CodeableConcept Binding The verification status to support or decline the clinical status of the condition or diagnosis. ConditionVerificationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.status w5: FiveWs.status sct-concept: < 410514004 \|Finding context value\| v2: PRB-13 rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value sct-attr: 408729009
category		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Condition.category Short description problem-list-item \| encounter-diagnosis Definition A category assigned to the condition. Comments The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts. Data type CodeableConcept Binding A category assigned to the condition. ConditionCategoryCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class sct-concept: < 404684003 \|Clinical finding\| v2: 'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message rim: .code
severity		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Condition.severity Short description Subjective severity of condition Definition A subjective assessment of the severity of the condition as evaluated by the clinician. Comments Coding of the severity with a terminology is preferred, where possible. Data type CodeableConcept Binding A subjective assessment of the severity of the condition as evaluated by the clinician. Condition/DiagnosisSeverity (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.grade sct-concept: < 272141005 \|Severities\| v2: PRB-26 / ABS-3 rim: Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value sct-attr: 246112005
code	S Σ I	1..1	CodeableConcept	Element id Condition.code Short description Diagnose-Code Alternate names type Definition Identification of the condition, problem or diagnosis. Requirements 0..1 to account for primarily narrative only resources. Comments Diagnosen SOLLEN mindestens entweder mit einem der angebenen standardisierten Codier-Verfahren codiert werden. Ist keine Codierung möglich, MUSS statt dessen eine textuelle Beschreibung der Prozedur angegeben werden. Begründung Pflichtfeld: Ist weder eine Codierung noch eine textuelle Beschreibung vorhanden, besitzt diese Ressource keine medizinische Aussagefähigkeit. 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())` icd-text-1: Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt. `coding.exists().not() implies text.exists()` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.code w5: FiveWs.what[x] sct-concept: code 246090004 \|Associated finding\| (< 404684003 \|Clinical finding\| MINUS << 420134006 \|Propensity to adverse reactions\| MINUS << 473010000 \|Hypersensitivity condition\| MINUS << 79899007 \|Drug interaction\| MINUS << 69449002 \|Drug action\| MINUS << 441742003 \|Evaluation finding\| MINUS << 307824009 \|Administrative status\| MINUS << 385356007 \|Tumor stage finding\|) OR < 413350009 \|Finding with explicit context\| OR < 272379006 \|Event\| v2: PRB-3 rim: .value sct-attr: 246090004
id		0..1	string	There are no (further) constraints on this element Element id Condition.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 Condition.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 rim: N/A
coding	S Σ	0..*	Coding	Element id Condition.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 Sliced: Unordered, Open, by $this(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
ICD-10-GM	S Σ	0..1	ISiKICD10GMCodingPattern	Element id Condition.code.coding:ICD-10-GM Short description A reference to a 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. Data type ISiKICD10GMCoding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm" } Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.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 Condition.code.coding:ICD-10-GM.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Mehrfachcodierungs-Kennzeichen	S I	0..1	Extension(Coding)	Element id Condition.code.coding:ICD-10-GM.extension:Mehrfachcodierungs-Kennzeichen Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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(Coding) Extension URL http://fhir.de/StructureDefinition/icd-10-gm-mehrfachcodierungs-kennzeichen 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
Seitenlokalisation	S I	0..1	Extension(Coding)	Element id Condition.code.coding:ICD-10-GM.extension:Seitenlokalisation Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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(Coding) Extension URL http://fhir.de/StructureDefinition/seitenlokalisation 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
Diagnosesicherheit	S I	0..1	Extension(Coding)	Element id Condition.code.coding:ICD-10-GM.extension:Diagnosesicherheit Short description Optional Extensions Element Alternate names extensions, user content Definition Optional Extension Element - found in all resources. 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(Coding) Extension URL http://fhir.de/StructureDefinition/icd-10-gm-diagnosesicherheit 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
system	S Σ	1..1	uriFixed ValuePattern	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.system Short description Canonische CodeSystem URL für ICD-10-GM Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value http://fhir.de/CodeSystem/bfarm/icd-10-gm Mappings rim: n/a v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	S Σ	1..1	string	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.version Short description Die Jahresversion von ICD-10-GM. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017") Definition Bie Verwendung von ICD-10-GM ist die Angabe der Version zwingend erforderlich. Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von ICD-10-GM ein neues Codesystem darstellt. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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 v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ I	1..1	code	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.code Short description Der ICD-10-Code Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` icd-regex: In code sind nur gültige ICD-10-Codes ohne Zusätze erlaubt `matches('^[A-Z][0-9][A-Z0-9](\\.?[A-Z0-9]{0,4})?$')` Examples Einfacher ICD-Code F17.4 Mappings rim: n/a v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	S Σ	0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id Condition.code.coding:ICD-10-GM.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Alpha-ID	S Σ	0..1	CodingAlphaIDPattern	Element id Condition.code.coding:Alpha-ID Short description A reference to a 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. Data type CodingAlphaID Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://fhir.de/CodeSystem/alpha-id" } Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.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 Condition.code.coding:Alpha-ID.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
system	S Σ	1..1	uriFixed ValuePattern	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.system Short description Canonische CodeSystem URL für Alpha-ID Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value http://fhir.de/CodeSystem/bfarm/alpha-id Mappings rim: n/a v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	1..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.version Short description Die Jahresversion von Alpha-ID. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017") Definition Bie Verwendung von Alpha-ID ist die Angabe der Version zwingend erforderlich. Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von Alpha-ID ein neues Codesystem darstellt. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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 v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	S Σ	1..1	code	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.code Short description Der Alpha-ID-Code Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id Condition.code.coding:Alpha-ID.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
SNOMED-CT	S Σ	0..1	ISiKSnomedCTCodingBindingPattern	Element id Condition.code.coding:SNOMED-CT Short description A reference to a 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. Data type ISiKSnomedCTCoding Binding DiagnosesSCT (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern { "system": "http://snomed.info/sct" } Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Orphanet	S Σ	0..1	CodingPattern	Element id Condition.code.coding:Orphanet 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://www.orpha.net" } Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
id		0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.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 Condition.code.coding:Orphanet.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
system	S Σ	1..1	uriPattern	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.system Short description Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code. Requirements Need to be unambiguous about the source of the definition of the symbol. Comments The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern http://www.orpha.net Mappings rim: n/a v2: CE.3 rim:* ./codeSystem orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
version	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.version Short description Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged. Comments Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date. 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 v2: CE.7 rim:* ./codeSystemVersion orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
code	Σ	1..1	code	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.code Short description Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination). Requirements Need to refer to a particular code in the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE.1 rim:* ./code orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
display	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.display Short description Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system. Requirements Need to be able to carry a human-readable meaning of the code for readers that do not know the system. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE.2 - but note this is not well followed rim:* CV.displayName orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
userSelected	Σ	0..1	boolean	There are no (further) constraints on this element Element id Condition.code.coding:Orphanet.userSelected Short description If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays). Requirements This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing. Comments Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: Sometimes implied by being first rim: CD.codingRationale orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
text	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.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 rim: n/a 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
bodySite	S Σ	0..*	CodeableConcept	Element id Condition.bodySite Short description Anatomical location, if relevant Definition The anatomical location where this condition manifests itself. Comments Begründung MS: Harmonisierung mit KBV-Profil (KBV_PR_Base_Condition_Diagnosis) Data type CodeableConcept Binding Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept: < 442083009 \|Anatomical or acquired body structure\| rim: .targetBodySiteCode sct-attr: 363698007
id		0..1	string	There are no (further) constraints on this element Element id Condition.bodySite.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 Condition.bodySite.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
coding	S Σ	0..*	Coding	Element id Condition.bodySite.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 Sliced: Unordered, Open, by system(Pattern) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding v2: CE.1-8, CE.10-22 rim: union(., ./translation) orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
snomed-ct	S Σ	0..1	ISiKSnomedCTCoding	Element id Condition.bodySite.coding:snomed-ct Short description A reference to a 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. Data type ISiKSnomedCTCoding Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding 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 Condition.bodySite.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 rim: n/a 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
subject	S Σ I	1..1	Reference(Patient \| Group)	Element id Condition.subject Short description Patientenbezug Alternate names patient Definition Indicates the patient or group who the condition record is associated with. Requirements Group is typically used for veterinary or public health use cases. Comments Begründung Must-Support: Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen. Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=SBJ].role[classCode=PAT] w5: FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id Condition.subject.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 Condition.subject.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
reference	S Σ I	1..1	string	Element id Condition.subject.reference Short description Patienten-Link 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 Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. 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 rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id Condition.subject.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 rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id Condition.subject.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: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.subject.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 rim: N/A
encounter	S Σ I	0..1	Reference(Encounter)	Element id Condition.encounter Short description Aufenthaltsbezug Definition The Encounter during which this Condition was created or to which the creation of this record is tightly associated. Comments Begründung Must-Support: Ein Aufenthaltsbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.context w5: FiveWs.context v2: PV1-19 (+PV1-54) rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id Condition.encounter.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 Condition.encounter.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
reference	S Σ I	1..1	string	Element id Condition.encounter.reference Short description Encounter-Link 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 Begründung Pflichtfeld: Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. WICHTIGER Hinweis für Implementierer: Die Zuordnung MUSS auf auf einen Encounter der Ebene "Abteilungskontakt" (siehe hierzu {{pagelink:Fall}}) erfolgen. Bei der Auswahl des Encounters ist zu beachten, dass unter einer (Abrechnungs-)"Fallnummer" (hier: `Encounter.account`) unter Umständen mehrere Encounter gruppiert sein können (z.B. stationärer Besuch mit mehreren vor- und nachstationären Aufenthalten.) 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 rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id Condition.encounter.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 rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id Condition.encounter.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: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.encounter.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 rim: N/A
onset[x]	S Σ	0..1		Element id Condition.onset[x] Short description Erkrankungsbeginn Definition Estimated or actual date or date-time the condition began, in the opinion of the clinician. Comments Datum oder Alter/Lebensphase des Erkrankungsbeginns Begründung MS: Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist. 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 rim: n/a workflow: Event.occurrence[x] w5: FiveWs.init v2: PRB-16 rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
(All Slices)				There are no (further) constraints on this element
onsetDateTime			dateTime	Data type dateTime
onsetAge	Σ	0..1	Age	Element id Condition.onset[x]:onsetAge Short description Estimated or actual date, date-time, or age Definition Estimated or actual date or date-time the condition began, in the opinion of the clinician. Comments Age is generally used when the patient reports an age at which the Condition began to occur. Data type Age Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.occurrence[x] w5: FiveWs.init v2: PRB-16 rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
id		0..1	string	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.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 Condition.onset[x]:onsetAge.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Lebensphase-Beginn	I	0..1	Extension(CodeableConcept)	Element id Condition.onset[x]:onsetAge.extension:Lebensphase-Beginn Short description Lebensphase des Erkrankungsbeginns Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht möglich sind, insbesondere im Kontext anamnestischer Diagnosen Data type Extension(CodeableConcept) Extension URL http://fhir.de/StructureDefinition/lebensphase 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
value	Σ	0..1	decimal	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.value Short description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value. Requirements Precision is handled implicitly in almost all cases of measurement. Comments The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.2 / CQ - N/A rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
comparator	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.comparator Short description < \| <= \| >= \| > - how to understand the value Definition How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Requirements Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Meaning when missing If there is no comparator, then there is no modification of the value Data type code Binding How the Quantity should be understood and represented. QuantityComparator (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.1 / CQ.1 rim: IVL properties
unit	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.unit Short description Unit representation Definition A human-readable form of the unit. Requirements There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.unit
system	Σ I	0..1	uri	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.system Short description System that defines coded unit form Definition The identification of the system that provides the coded form of the unit. Requirements Need to know the system that defines the coded form of the unit. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: CO.codeSystem, PQ.translation.codeSystem
code	Σ	0..1	code	There are no (further) constraints on this element Element id Condition.onset[x]:onsetAge.code Short description Coded form of the unit Definition A computer processable form of the unit in some unit representation system. Requirements Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Comments The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.code, MO.currency, PQ.translation.code
abatement[x]	S I	0..1		Element id Condition.abatement[x] Short description Erkrankungsende Definition The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate. Comments Datum oder Alter/Lebensphase des Erkrankungsendes Begründung MS: Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist. 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 rim: n/a w5: FiveWs.done[x] rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
(All Slices)				There are no (further) constraints on this element
abatementDateTime			dateTime	Data type dateTime
abatementAge	I	0..1	Age	Element id Condition.abatement[x]:abatementAge Short description When in resolution/remission Definition The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate. Comments There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated. Data type Age Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.done[x] rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
id		0..1	string	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.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 Condition.abatement[x]:abatementAge.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Lebensphase-Ende	I	0..1	Extension(CodeableConcept)	Element id Condition.abatement[x]:abatementAge.extension:Lebensphase-Ende Short description Lebensphase des Erkrankungsendes Alternate names extensions, user content Definition Optional Extension Element - found in all resources. Comments Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht möglich sind, insbesondere im Kontext anamnestischer Diagnosen Data type Extension(CodeableConcept) Extension URL http://fhir.de/StructureDefinition/lebensphase 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
value	Σ	0..1	decimal	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.value Short description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value. Requirements Precision is handled implicitly in almost all cases of measurement. Comments The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). Data type decimal Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.2 / CQ - N/A rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
comparator	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.comparator Short description < \| <= \| >= \| > - how to understand the value Definition How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value. Requirements Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Meaning when missing If there is no comparator, then there is no modification of the value Data type code Binding How the Quantity should be understood and represented. QuantityComparator (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.1 / CQ.1 rim: IVL properties
unit	Σ	0..1	string	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.unit Short description Unit representation Definition A human-readable form of the unit. Requirements There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.unit
system	Σ I	0..1	uri	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.system Short description System that defines coded unit form Definition The identification of the system that provides the coded form of the unit. Requirements Need to know the system that defines the coded form of the unit. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: CO.codeSystem, PQ.translation.codeSystem
code	Σ	0..1	code	There are no (further) constraints on this element Element id Condition.abatement[x]:abatementAge.code Short description Coded form of the unit Definition A computer processable form of the unit in some unit representation system. Requirements Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Comments The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.code, MO.currency, PQ.translation.code
recordedDate	S Σ	1..1	dateTime	Element id Condition.recordedDate Short description Dokumentationsdatum Definition The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date. Comments Datum, an dem die Diagnose dokumentiert wurde. Begründung Pflichtfeld: Das Dokumentationsdatum der Diagnose MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein. Hinweis: Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a w5: FiveWs.recorded v2: REL-11 rim: .participation[typeCode=AUT].time
recorder	Σ I	0..1	Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Condition.recorder Short description Who recorded the condition Definition Individual who recorded the record and takes responsibility for its content. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.author rim: .participation[typeCode=AUT].role
asserter	Σ I	0..1	Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Condition.asserter Short description Person who asserts this condition Definition Individual who is making the condition statement. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.source v2: REL-7.1 identifier + REL-7.12 type code rim: .participation[typeCode=INF].role
stage	I	0..*	BackboneElement	There are no (further) constraints on this element Element id Condition.stage Short description Stage/grade, usually assessed formally Definition Clinical stage or grade of a condition. May include formal severity assessments. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` con-1: Stage SHALL have summary or assessment `summary.exists() or assessment.exists()` Mappings rim: n/a rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
id		0..1	string	There are no (further) constraints on this element Element id Condition.stage.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 Condition.stage.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Condition.stage.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
summary	I	0..1	CodeableConcept	There are no (further) constraints on this element Element id Condition.stage.summary Short description Simple summary (disease specific) Definition A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Codes describing condition stages (e.g. Cancer stages). ConditionStage (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD sct-concept: < 254291000 \|Staging and scales\| v2: PRB-14 rim: .value
assessment	I	0..*	Reference(ClinicalImpression \| DiagnosticReport \| Observation)	There are no (further) constraints on this element Element id Condition.stage.assessment Short description Formal record of assessment Definition Reference to a formal record of the evidence on which the staging assessment is based. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(ClinicalImpression \| DiagnosticReport \| Observation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: .self
type		0..1	CodeableConcept	There are no (further) constraints on this element Element id Condition.stage.type Short description Kind of staging Definition The kind of staging, such as pathological or clinical staging. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Codes describing the kind of condition staging (e.g. clinical or pathological). ConditionStageType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]
evidence	I	0..*	BackboneElement	There are no (further) constraints on this element Element id Condition.evidence Short description Supporting evidence Definition Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition. Comments The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` con-2: evidence SHALL have code or details `code.exists() or detail.exists()` Mappings rim: n/a rim: .outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id Condition.evidence.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 Condition.evidence.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Condition.evidence.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
code	Σ I	0..*	CodeableConcept	There are no (further) constraints on this element Element id Condition.evidence.code Short description Manifestation/symptom Definition A manifestation or symptom that led to the recording of this condition. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Codes that describe the manifestation or symptoms of a condition. ManifestationAndSymptomCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.reasonCode w5: FiveWs.why[x] sct-concept: < 404684003 \|Clinical finding\| rim: [code="diagnosis"].value
detail	Σ I	0..*	Reference(Resource)	There are no (further) constraints on this element Element id Condition.evidence.detail Short description Supporting information found elsewhere Definition Links to other relevant information, including pathology reports. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.why[x] rim: .self
note	S	0..*	Annotation	Element id Condition.note Short description Notizen Definition Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis. Comments Ergänzende Hinweise und Anmerkungen zur Diagnose Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Event.note v2: NTE child of PRB rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="ISiKDiagnose" />
    <url value="https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose" />
    <version value="4.0.1" />
    <name value="ISiKDiagnose" />
    <status value="active" />
    <experimental value="false" />
    <date value="2024-11-25" />
    <publisher value="gematik GmbH" />
    <description value="Dieses Profil spezifiziert die Minimalanforderungen f&#252;r die Bereitstellung von Informationen \n&#252;ber die Diagnosen eines Patienten im Rahmen des Best&#228;tigungsverfahrens der gematik.  \n### Motivation\nDie M&#246;glichkeit, auf eine &#220;bersicht der Diagnosen eines Patienten zuzugreifen, Patienten anhand ihrer Diagnose zu suchen oder zu pr&#252;fen, \nob eine konkrete Diagnose bei einem Patienten vorliegt, sind wichtige Funktionen im klinischen Behandlungsablauf.  \n\nIn FHIR werden Diagnosen mit der Condition-Ressource repr&#228;sentiert.  \n\nDa die Diagnosen in klinischen Prim&#228;rsystemen in der Regel in ICD-10-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches. \nFalls eine Diagnose zwar dokumentiert, aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), \nist alternativ eine Repr&#228;sentation als Freitext-Diagnose m&#246;glich.\n\n### Kompatibilit&#228;t\nF&#252;r das Profil ISiKDiagnose wird eine Kompatibilit&#228;t mit folgenden Profilen angestrebt; allerdings kann nicht sichergestellt werden, dass Instanzen, die gegen ISiKDiagnose valide sind, auch valide sind gegen:\n* das [Profil ProfileConditionDiagnose der Medizininformatik-Initative](https://www.medizininformatik-initiative.de/fhir/core/modul-diagnose/StructureDefinition/Diagnose)\n* das [Profil KBV_PR_Base_Condition_Diagnosis der KBV](https://fhir.kbv.de/StructureDefinition/KBV_PR_Base_Condition_Diagnosis)]  \nHinweise zu Inkompatibilit&#228;ten k&#246;nnen &#252;ber die [Portalseite](https://service.gematik.de/servicedesk/customer/portal/16) gemeldet werden." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Condition" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Condition" />
    <derivation value="constraint" />
    <differential>
        <element id="Condition">
            <path value="Condition" />
            <constraint>
                <key value="isik-con1" />
                <severity value="error" />
                <human value="Falls eine kodierte Diagnose vorliegt muss angegeben werden durch welchen Kontakt diese Dokumentation erfolgte." />
                <expression value="code.coding.exists() implies encounter.exists()" />
                <source value="https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose" />
            </constraint>
        </element>
        <element id="Condition.extension">
            <path value="Condition.extension" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.extension:related">
            <path value="Condition.extension" />
            <sliceName value="related" />
            <short value="Verkn&#252;pfte Diagnose" />
            <comment value="Die Deutschen Kodierrichtlinien und die &#39;German Modification&#39; erm&#246;glichen es teilweise, \n  ICD-10-Codierte Diagnosen miteinander zu verkn&#252;pfen (&amp;quot;Kreuz-Stern-Ausrufezeichen-Notation&amp;quot;), \n  diese aber dennoch wie eigenst&#228;ndige Diagnosen (mit jeweils eigener Diagnosesicherheit oder -Lokalisation) zu kommunizieren.\n  Daher ist es in Deutschland nicht m&#246;glich, dem internationalen Usus zu folgen und verkn&#252;pfte Diagnosen als postkoordinierten Code *einer* Condition-Ressource aufzufassen.\n  Statt dessen m&#252;ssen sie zwei eigenst&#228;ndige Condition-Ressourcen abgebildet werden, die mit Hilfe der `related`-Extension miteinander verkn&#252;pft werden.  \n  Die Sekund&#228;rdiagnose verweist jeweils auf die Prim&#228;rdiagnose." />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/condition-related" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Condition.clinicalStatus">
            <path value="Condition.clinicalStatus" />
            <short value="klinischer Status" />
            <comment value="**Begr&#252;ndung MS:** Auch in Stufe 4 sind keine (client-seitigen) schreibenden Operationen f&#252;r das Erstellen einer Condition-Ressource vorgesehen \n  (siehe CapabilityStatement). Das hei&#223;t, entweder f&#252;hren KISe entsprechende Informationen und exponieren diese, \n  oder es gibt keinen pragmatischen Mechanismus (im ISIK-Kontext), um den Use Case einer zus&#228;tzlichen Annotation mittels Client zu erf&#252;llen. \n  Da alle KIS-Hersteller, die sich zu Wort gemeldet haben, eine Bef&#252;llung von Condition.clinicalStatus NICHT unterst&#252;tzen, \n  erscheint das MS nach &#252;bergreifender Definition und ein verpflichtender Testfall nicht angemessen.  \n  **Einschr&#228;nkung der &#252;bergreifenden MS-Definition:** Verf&#252;gt ein best&#228;tigungsrelevantes System nicht &#252;ber die Datenstruktur \n  zur Hinterlegung des Status einer Diagnose, so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch `clinicalStatus` bef&#252;llen, sofern die entsprechende Information verf&#252;gbar ist.  \n  **Hinweis:** F&#252;r Diagnosen aus der *ambulanten* Versorgung k&#246;nnen die Werte f&#252;r `clinicalStatus` und `verificationStatus` aus dem \n  [ICD-10-Zusatzkennzeichen f&#252;r die Diagnosesicherheit](https://www.bfarm.de/DE/Kodiersysteme/Services/Kodierfragen/ICD-10-GM/Allgemeine-Kodierfragen/icd-10-gm-1010.html) abgeleitet werden.\n  Das entsprechende Mapping kann den [Deutschen Basisprofilen](https://simplifier.net/guide/leitfaden-de-basis-r4/ig-markdown-Ressourcen-DiagnosenCondition?version=current) entnommen werden." />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code">
            <path value="Condition.code" />
            <short value="Diagnose-Code" />
            <comment value="Diagnosen SOLLEN mindestens entweder mit einem der angebenen standardisierten Codier-Verfahren codiert werden. \n  Ist keine Codierung m&#246;glich, MUSS statt dessen eine textuelle Beschreibung der Prozedur angegeben werden.  \n   **Begr&#252;ndung Pflichtfeld:** Ist *weder* eine Codierung *noch* eine textuelle Beschreibung vorhanden, besitzt diese Ressource keine medizinische Aussagef&#228;higkeit." />
            <min value="1" />
            <constraint>
                <key value="icd-text-1" />
                <severity value="error" />
                <human value="Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzuf&#252;gen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt." />
                <expression value="coding.exists().not() implies text.exists()" />
                <source value="https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose" />
            </constraint>
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding">
            <path value="Condition.code.coding" />
            <slicing>
                <discriminator>
                    <type value="pattern" />
                    <path value="$this" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:ICD-10-GM">
            <path value="Condition.code.coding" />
            <sliceName value="ICD-10-GM" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Coding" />
                <profile value="https://gematik.de/fhir/isik/StructureDefinition/ISiKICD10GMCoding" />
            </type>
            <patternCoding>
                <system value="http://fhir.de/CodeSystem/bfarm/icd-10-gm" />
            </patternCoding>
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:ICD-10-GM.extension:Mehrfachcodierungs-Kennzeichen">
            <path value="Condition.code.coding.extension" />
            <sliceName value="Mehrfachcodierungs-Kennzeichen" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:ICD-10-GM.extension:Seitenlokalisation">
            <path value="Condition.code.coding.extension" />
            <sliceName value="Seitenlokalisation" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:ICD-10-GM.extension:Diagnosesicherheit">
            <path value="Condition.code.coding.extension" />
            <sliceName value="Diagnosesicherheit" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:Alpha-ID">
            <path value="Condition.code.coding" />
            <sliceName value="Alpha-ID" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Coding" />
                <profile value="http://fhir.de/StructureDefinition/CodingAlphaID" />
            </type>
            <patternCoding>
                <system value="http://fhir.de/CodeSystem/alpha-id" />
            </patternCoding>
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:Alpha-ID.system">
            <path value="Condition.code.coding.system" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:Alpha-ID.code">
            <path value="Condition.code.coding.code" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:SNOMED-CT">
            <path value="Condition.code.coding" />
            <sliceName value="SNOMED-CT" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Coding" />
                <profile value="https://gematik.de/fhir/isik/StructureDefinition/ISiKSnomedCTCoding" />
            </type>
            <patternCoding>
                <system value="http://snomed.info/sct" />
            </patternCoding>
            <mustSupport value="true" />
            <binding>
                <strength value="required" />
                <valueSet value="https://gematik.de/fhir/isik/ValueSet/DiagnosesSCT" />
            </binding>
        </element>
        <element id="Condition.code.coding:Orphanet">
            <path value="Condition.code.coding" />
            <sliceName value="Orphanet" />
            <min value="0" />
            <max value="1" />
            <patternCoding>
                <system value="http://www.orpha.net" />
            </patternCoding>
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:Orphanet.system">
            <path value="Condition.code.coding.system" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.code.coding:Orphanet.code">
            <path value="Condition.code.coding.code" />
            <min value="1" />
        </element>
        <element id="Condition.bodySite">
            <path value="Condition.bodySite" />
            <comment value="**Begr&#252;ndung MS:** Harmonisierung mit KBV-Profil (KBV_PR_Base_Condition_Diagnosis)" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.bodySite.coding">
            <path value="Condition.bodySite.coding" />
            <slicing>
                <discriminator>
                    <type value="pattern" />
                    <path value="system" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <mustSupport value="true" />
        </element>
        <element id="Condition.bodySite.coding:snomed-ct">
            <path value="Condition.bodySite.coding" />
            <sliceName value="snomed-ct" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Coding" />
                <profile value="https://gematik.de/fhir/isik/StructureDefinition/ISiKSnomedCTCoding" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Condition.subject">
            <path value="Condition.subject" />
            <short value="Patientenbezug" />
            <comment value="**Begr&#252;ndung Must-Support:** Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrit&#228;t vorliegen." />
            <mustSupport value="true" />
        </element>
        <element id="Condition.subject.reference">
            <path value="Condition.subject.reference" />
            <short value="Patienten-Link" />
            <comment value="Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation \n    zu einem Patienten und erm&#246;glicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc." />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.encounter">
            <path value="Condition.encounter" />
            <short value="Aufenthaltsbezug" />
            <comment value="**Begr&#252;ndung Must-Support:** Ein Aufenthaltsbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrit&#228;t vorliegen." />
            <mustSupport value="true" />
        </element>
        <element id="Condition.encounter.reference">
            <path value="Condition.encounter.reference" />
            <short value="Encounter-Link" />
            <comment value="**Begr&#252;ndung Pflichtfeld:** Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt \n    und erm&#246;glicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.    \n    **WICHTIGER Hinweis f&#252;r Implementierer:** Die Zuordnung MUSS auf auf einen Encounter der Ebene &amp;quot;Abteilungskontakt&amp;quot; (siehe hierzu {{pagelink:Fall}}) erfolgen. \n    Bei der Auswahl des Encounters ist zu beachten, dass unter einer (Abrechnungs-)&amp;quot;Fallnummer&amp;quot; (hier: `Encounter.account`) \n    unter Umst&#228;nden mehrere Encounter gruppiert sein k&#246;nnen (z.B. station&#228;rer Besuch mit mehreren vor- und nachstation&#228;ren Aufenthalten.)" />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.onset[x]">
            <path value="Condition.onset[x]" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <short value="Erkrankungsbeginn" />
            <comment value="Datum oder Alter/Lebensphase des Erkrankungsbeginns\n  **Begr&#252;ndung MS:** Die Kenntnis des Erkrankungszeitraumes ist wichtig f&#252;r die korrekte Einsch&#228;tzung der medizinischen Relevanz einer Erkraknung.  \n  **Einschr&#228;nkung der &#252;bergreifenden MS-Definition:** Verf&#252;gt ein best&#228;tigungsrelevantes System nicht &#252;ber die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes,\n  so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verf&#252;gbar ist." />
            <type>
                <code value="dateTime" />
            </type>
            <type>
                <code value="Age" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Condition.onset[x]:onsetAge">
            <path value="Condition.onset[x]" />
            <sliceName value="onsetAge" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Age" />
            </type>
        </element>
        <element id="Condition.onset[x]:onsetAge.extension:Lebensphase-Beginn">
            <path value="Condition.onset[x].extension" />
            <sliceName value="Lebensphase-Beginn" />
            <short value="Lebensphase des Erkrankungsbeginns" />
            <comment value="Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht m&#246;glich sind, insbesondere im Kontext anamnestischer Diagnosen" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="http://fhir.de/StructureDefinition/lebensphase" />
            </type>
        </element>
        <element id="Condition.abatement[x]">
            <path value="Condition.abatement[x]" />
            <slicing>
                <discriminator>
                    <type value="type" />
                    <path value="$this" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <short value="Erkrankungsende" />
            <comment value="Datum oder Alter/Lebensphase des Erkrankungsendes  \n  **Begr&#252;ndung MS:** Die Kenntnis des Erkrankungszeitraumes ist wichtig f&#252;r die korrekte Einsch&#228;tzung der medizinischen Relevanz einer Erkraknung.  \n  **Einschr&#228;nkung der &#252;bergreifenden MS-Definition:** Verf&#252;gt ein best&#228;tigungsrelevantes System nicht &#252;ber die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes,\n  so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verf&#252;gbar ist." />
            <type>
                <code value="dateTime" />
            </type>
            <type>
                <code value="Age" />
            </type>
            <mustSupport value="true" />
        </element>
        <element id="Condition.abatement[x]:abatementAge">
            <path value="Condition.abatement[x]" />
            <sliceName value="abatementAge" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Age" />
            </type>
        </element>
        <element id="Condition.abatement[x]:abatementAge.extension:Lebensphase-Ende">
            <path value="Condition.abatement[x].extension" />
            <sliceName value="Lebensphase-Ende" />
            <short value="Lebensphase des Erkrankungsendes" />
            <comment value="Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht m&#246;glich sind, insbesondere im Kontext anamnestischer Diagnosen" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="http://fhir.de/StructureDefinition/lebensphase" />
            </type>
        </element>
        <element id="Condition.recordedDate">
            <path value="Condition.recordedDate" />
            <short value="Dokumentationsdatum" />
            <comment value="Datum, an dem die Diagnose dokumentiert wurde.   \n  **Begr&#252;ndung Pflichtfeld:** Das Dokumentationsdatum der Diagnose MUSS zu Qualit&#228;tssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, \n  nicht zu verwechseln mit der technischen Anlage des Datensatzes im Prim&#228;rsystem. Diese beiden Daten k&#246;nnen jedoch identisch sein.  \n  **Hinweis:** Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden." />
            <min value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Condition.note">
            <path value="Condition.note" />
            <short value="Notizen" />
            <comment value="Erg&#228;nzende Hinweise und Anmerkungen zur Diagnose" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "ISiKDiagnose",
    "url": "https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose",
    "version": "4.0.1",
    "name": "ISiKDiagnose",
    "status": "active",
    "experimental": false,
    "date": "2024-11-25",
    "publisher": "gematik GmbH",
    "description": "Dieses Profil spezifiziert die Minimalanforderungen für die Bereitstellung von Informationen \nüber die Diagnosen eines Patienten im Rahmen des Bestätigungsverfahrens der gematik.  \n### Motivation\nDie Möglichkeit, auf eine Übersicht der Diagnosen eines Patienten zuzugreifen, Patienten anhand ihrer Diagnose zu suchen oder zu prüfen, \nob eine konkrete Diagnose bei einem Patienten vorliegt, sind wichtige Funktionen im klinischen Behandlungsablauf.  \n\nIn FHIR werden Diagnosen mit der Condition-Ressource repräsentiert.  \n\nDa die Diagnosen in klinischen Primärsystemen in der Regel in ICD-10-codierter Form vorliegen, fordert ISiK in erster Linie diese Form des Austausches. \nFalls eine Diagnose zwar dokumentiert, aber noch nicht codiert wurde (z.B. wenn die Kodierung erst nach der Entlassung erfolgt), \nist alternativ eine Repräsentation als Freitext-Diagnose möglich.\n\n### Kompatibilität\nFür das Profil ISiKDiagnose wird eine Kompatibilität mit folgenden Profilen angestrebt; allerdings kann nicht sichergestellt werden, dass Instanzen, die gegen ISiKDiagnose valide sind, auch valide sind gegen:\n* das [Profil ProfileConditionDiagnose der Medizininformatik-Initative](https://www.medizininformatik-initiative.de/fhir/core/modul-diagnose/StructureDefinition/Diagnose)\n* das [Profil KBV_PR_Base_Condition_Diagnosis der KBV](https://fhir.kbv.de/StructureDefinition/KBV_PR_Base_Condition_Diagnosis)]  \nHinweise zu Inkompatibilitäten können über die [Portalseite](https://service.gematik.de/servicedesk/customer/portal/16) gemeldet werden.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Condition",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Condition",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Condition",
                "path": "Condition",
                "constraint":  [
                    {
                        "key": "isik-con1",
                        "severity": "error",
                        "human": "Falls eine kodierte Diagnose vorliegt muss angegeben werden durch welchen Kontakt diese Dokumentation erfolgte.",
                        "expression": "code.coding.exists() implies encounter.exists()",
                        "source": "https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose"
                    }
                ]
            },
            {
                "id": "Condition.extension",
                "path": "Condition.extension",
                "mustSupport": true
            },
            {
                "id": "Condition.extension:related",
                "path": "Condition.extension",
                "sliceName": "related",
                "short": "Verknüpfte Diagnose",
                "comment": " Die Deutschen Kodierrichtlinien und die 'German Modification' ermöglichen es teilweise, \n  ICD-10-Codierte Diagnosen miteinander zu verknüpfen (&quot;Kreuz-Stern-Ausrufezeichen-Notation&quot;), \n  diese aber dennoch wie eigenständige Diagnosen (mit jeweils eigener Diagnosesicherheit oder -Lokalisation) zu kommunizieren.\n  Daher ist es in Deutschland nicht möglich, dem internationalen Usus zu folgen und verknüpfte Diagnosen als postkoordinierten Code *einer* Condition-Ressource aufzufassen.\n  Statt dessen müssen sie zwei eigenständige Condition-Ressourcen abgebildet werden, die mit Hilfe der `related`-Extension miteinander verknüpft werden.  \n  Die Sekundärdiagnose verweist jeweils auf die Primärdiagnose.",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/condition-related"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Condition.clinicalStatus",
                "path": "Condition.clinicalStatus",
                "short": "klinischer Status",
                "comment": "**Begründung MS:** Auch in Stufe 4 sind keine (client-seitigen) schreibenden Operationen für das Erstellen einer Condition-Ressource vorgesehen \n  (siehe CapabilityStatement). Das heißt, entweder führen KISe entsprechende Informationen und exponieren diese, \n  oder es gibt keinen pragmatischen Mechanismus (im ISIK-Kontext), um den Use Case einer zusätzlichen Annotation mittels Client zu erfüllen. \n  Da alle KIS-Hersteller, die sich zu Wort gemeldet haben, eine Befüllung von Condition.clinicalStatus NICHT unterstützen, \n  erscheint das MS nach übergreifender Definition und ein verpflichtender Testfall nicht angemessen.  \n  **Einschränkung der übergreifenden MS-Definition:** Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur \n  zur Hinterlegung des Status einer Diagnose, so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch `clinicalStatus` befüllen, sofern die entsprechende Information verfügbar ist.  \n  **Hinweis:** Für Diagnosen aus der *ambulanten* Versorgung können die Werte für `clinicalStatus` und `verificationStatus` aus dem \n  [ICD-10-Zusatzkennzeichen für die Diagnosesicherheit](https://www.bfarm.de/DE/Kodiersysteme/Services/Kodierfragen/ICD-10-GM/Allgemeine-Kodierfragen/icd-10-gm-1010.html) abgeleitet werden.\n  Das entsprechende Mapping kann den [Deutschen Basisprofilen](https://simplifier.net/guide/leitfaden-de-basis-r4/ig-markdown-Ressourcen-DiagnosenCondition?version=current) entnommen werden.",
                "mustSupport": true
            },
            {
                "id": "Condition.code",
                "path": "Condition.code",
                "short": "Diagnose-Code",
                "comment": "Diagnosen SOLLEN mindestens entweder mit einem der angebenen standardisierten Codier-Verfahren codiert werden. \n  Ist keine Codierung möglich, MUSS statt dessen eine textuelle Beschreibung der Prozedur angegeben werden.  \n   **Begründung Pflichtfeld:** Ist *weder* eine Codierung *noch* eine textuelle Beschreibung vorhanden, besitzt diese Ressource keine medizinische Aussagefähigkeit.",
                "min": 1,
                "constraint":  [
                    {
                        "key": "icd-text-1",
                        "severity": "error",
                        "human": "Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.",
                        "expression": "coding.exists().not() implies text.exists()",
                        "source": "https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose"
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding",
                "path": "Condition.code.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "$this"
                        }
                    ],
                    "rules": "open"
                },
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:ICD-10-GM",
                "path": "Condition.code.coding",
                "sliceName": "ICD-10-GM",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "https://gematik.de/fhir/isik/StructureDefinition/ISiKICD10GMCoding"
                        ]
                    }
                ],
                "patternCoding": {
                    "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm"
                },
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:ICD-10-GM.extension:Mehrfachcodierungs-Kennzeichen",
                "path": "Condition.code.coding.extension",
                "sliceName": "Mehrfachcodierungs-Kennzeichen",
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:ICD-10-GM.extension:Seitenlokalisation",
                "path": "Condition.code.coding.extension",
                "sliceName": "Seitenlokalisation",
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:ICD-10-GM.extension:Diagnosesicherheit",
                "path": "Condition.code.coding.extension",
                "sliceName": "Diagnosesicherheit",
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:Alpha-ID",
                "path": "Condition.code.coding",
                "sliceName": "Alpha-ID",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/CodingAlphaID"
                        ]
                    }
                ],
                "patternCoding": {
                    "system": "http://fhir.de/CodeSystem/alpha-id"
                },
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:Alpha-ID.system",
                "path": "Condition.code.coding.system",
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:Alpha-ID.code",
                "path": "Condition.code.coding.code",
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:SNOMED-CT",
                "path": "Condition.code.coding",
                "sliceName": "SNOMED-CT",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "https://gematik.de/fhir/isik/StructureDefinition/ISiKSnomedCTCoding"
                        ]
                    }
                ],
                "patternCoding": {
                    "system": "http://snomed.info/sct"
                },
                "mustSupport": true,
                "binding": {
                    "strength": "required",
                    "valueSet": "https://gematik.de/fhir/isik/ValueSet/DiagnosesSCT"
                }
            },
            {
                "id": "Condition.code.coding:Orphanet",
                "path": "Condition.code.coding",
                "sliceName": "Orphanet",
                "min": 0,
                "max": "1",
                "patternCoding": {
                    "system": "http://www.orpha.net"
                },
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:Orphanet.system",
                "path": "Condition.code.coding.system",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Condition.code.coding:Orphanet.code",
                "path": "Condition.code.coding.code",
                "min": 1
            },
            {
                "id": "Condition.bodySite",
                "path": "Condition.bodySite",
                "comment": "**Begründung MS:** Harmonisierung mit KBV-Profil (KBV_PR_Base_Condition_Diagnosis)",
                "mustSupport": true
            },
            {
                "id": "Condition.bodySite.coding",
                "path": "Condition.bodySite.coding",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "pattern",
                            "path": "system"
                        }
                    ],
                    "rules": "open"
                },
                "mustSupport": true
            },
            {
                "id": "Condition.bodySite.coding:snomed-ct",
                "path": "Condition.bodySite.coding",
                "sliceName": "snomed-ct",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Coding",
                        "profile":  [
                            "https://gematik.de/fhir/isik/StructureDefinition/ISiKSnomedCTCoding"
                        ]
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Condition.subject",
                "path": "Condition.subject",
                "short": "Patientenbezug",
                "comment": "**Begründung Must-Support:** Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.",
                "mustSupport": true
            },
            {
                "id": "Condition.subject.reference",
                "path": "Condition.subject.reference",
                "short": "Patienten-Link",
                "comment": "Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation \n    zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Condition.encounter",
                "path": "Condition.encounter",
                "short": "Aufenthaltsbezug",
                "comment": "**Begründung Must-Support:** Ein Aufenthaltsbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.",
                "mustSupport": true
            },
            {
                "id": "Condition.encounter.reference",
                "path": "Condition.encounter.reference",
                "short": "Encounter-Link",
                "comment": "**Begründung Pflichtfeld:** Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt \n    und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.    \n    **WICHTIGER Hinweis für Implementierer:** Die Zuordnung MUSS auf auf einen Encounter der Ebene &quot;Abteilungskontakt&quot; (siehe hierzu {{pagelink:Fall}}) erfolgen. \n    Bei der Auswahl des Encounters ist zu beachten, dass unter einer (Abrechnungs-)&quot;Fallnummer&quot; (hier: `Encounter.account`) \n    unter Umständen mehrere Encounter gruppiert sein können (z.B. stationärer Besuch mit mehreren vor- und nachstationären Aufenthalten.)",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Condition.onset[x]",
                "path": "Condition.onset[x]",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                },
                "short": "Erkrankungsbeginn",
                "comment": "Datum oder Alter/Lebensphase des Erkrankungsbeginns\n  **Begründung MS:** Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung.  \n  **Einschränkung der übergreifenden MS-Definition:** Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes,\n  so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist.",
                "type":  [
                    {
                        "code": "dateTime"
                    },
                    {
                        "code": "Age"
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Condition.onset[x]:onsetAge",
                "path": "Condition.onset[x]",
                "sliceName": "onsetAge",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Age"
                    }
                ]
            },
            {
                "id": "Condition.onset[x]:onsetAge.extension:Lebensphase-Beginn",
                "path": "Condition.onset[x].extension",
                "sliceName": "Lebensphase-Beginn",
                "short": "Lebensphase des Erkrankungsbeginns",
                "comment": "Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht möglich sind, insbesondere im Kontext anamnestischer Diagnosen",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/lebensphase"
                        ]
                    }
                ]
            },
            {
                "id": "Condition.abatement[x]",
                "path": "Condition.abatement[x]",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "type",
                            "path": "$this"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                },
                "short": "Erkrankungsende",
                "comment": "Datum oder Alter/Lebensphase des Erkrankungsendes  \n  **Begründung MS:** Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung.  \n  **Einschränkung der übergreifenden MS-Definition:** Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes,\n  so MUSS dieses System die Information NICHT abbilden. \n  Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist.",
                "type":  [
                    {
                        "code": "dateTime"
                    },
                    {
                        "code": "Age"
                    }
                ],
                "mustSupport": true
            },
            {
                "id": "Condition.abatement[x]:abatementAge",
                "path": "Condition.abatement[x]",
                "sliceName": "abatementAge",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Age"
                    }
                ]
            },
            {
                "id": "Condition.abatement[x]:abatementAge.extension:Lebensphase-Ende",
                "path": "Condition.abatement[x].extension",
                "sliceName": "Lebensphase-Ende",
                "short": "Lebensphase des Erkrankungsendes",
                "comment": "Alternative Angabe, wenn genauere Eingrenzungen des Zeitraums nicht möglich sind, insbesondere im Kontext anamnestischer Diagnosen",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://fhir.de/StructureDefinition/lebensphase"
                        ]
                    }
                ]
            },
            {
                "id": "Condition.recordedDate",
                "path": "Condition.recordedDate",
                "short": "Dokumentationsdatum",
                "comment": "Datum, an dem die Diagnose dokumentiert wurde.   \n  **Begründung Pflichtfeld:** Das Dokumentationsdatum der Diagnose MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, \n  nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein.  \n  **Hinweis:** Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden.",
                "min": 1,
                "mustSupport": true
            },
            {
                "id": "Condition.note",
                "path": "Condition.note",
                "short": "Notizen",
                "comment": "Ergänzende Hinweise und Anmerkungen zur Diagnose",
                "mustSupport": true
            }
        ]
    }
}

ISiKDiagnose

Constraints/Invarianten

Name	Schweregrad	Beschreibung	Ausdruck
isik-con1	error	Falls eine kodierte Diagnose vorliegt muss angegeben werden durch welchen Kontakt diese Dokumentation erfolgte.	code.coding.exists() implies encounter.exists()
icd-text-1	error	Entweder MUSS eine kodierte Diagnose vorliegen oder eine textuelle Beschreibung. Stattdessen nur Extensions hinzuzufügen (vgl. https://www.hl7.org/fhir/element.html - ele-1), ist explizit nicht erlaubt.	coding.exists().not() implies text.exists()

Terminology-Bindings

Element	Staerke	ValueSet
Condition.code.coding:SNOMED-CT	required	https://gematik.de/fhir/isik/ValueSet/DiagnosesSCT

Anmerkungen zu Must-Support-Feldern

Feldname	Kurzbeschreibung	Hinweise
Condition.extension
Condition.extension:related	Verknüpfte Diagnose	Die Deutschen Kodierrichtlinien und die 'German Modification' ermöglichen es teilweise, ICD-10-Codierte Diagnosen miteinander zu verknüpfen ("Kreuz-Stern-Ausrufezeichen-Notation"), diese aber dennoch wie eigenständige Diagnosen (mit jeweils eigener Diagnosesicherheit oder -Lokalisation) zu kommunizieren. Daher ist es in Deutschland nicht möglich, dem internationalen Usus zu folgen und verknüpfte Diagnosen als postkoordinierten Code einer Condition-Ressource aufzufassen. Statt dessen müssen sie zwei eigenständige Condition-Ressourcen abgebildet werden, die mit Hilfe der `related`-Extension miteinander verknüpft werden. Die Sekundärdiagnose verweist jeweils auf die Primärdiagnose.
Condition.clinicalStatus	klinischer Status	Begründung MS: Auch in Stufe 4 sind keine (client-seitigen) schreibenden Operationen für das Erstellen einer Condition-Ressource vorgesehen (siehe CapabilityStatement). Das heißt, entweder führen KISe entsprechende Informationen und exponieren diese, oder es gibt keinen pragmatischen Mechanismus (im ISIK-Kontext), um den Use Case einer zusätzlichen Annotation mittels Client zu erfüllen. Da alle KIS-Hersteller, die sich zu Wort gemeldet haben, eine Befüllung von Condition.clinicalStatus NICHT unterstützen, erscheint das MS nach übergreifender Definition und ein verpflichtender Testfall nicht angemessen. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Status einer Diagnose, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch `clinicalStatus` befüllen, sofern die entsprechende Information verfügbar ist. Hinweis: Für Diagnosen aus der ambulanten Versorgung können die Werte für `clinicalStatus` und `verificationStatus` aus dem ICD-10-Zusatzkennzeichen für die Diagnosesicherheit abgeleitet werden. Das entsprechende Mapping kann den Deutschen Basisprofilen entnommen werden.
Condition.code	Diagnose-Code	Diagnosen SOLLEN mindestens entweder mit einem der angebenen standardisierten Codier-Verfahren codiert werden. Ist keine Codierung möglich, MUSS statt dessen eine textuelle Beschreibung der Prozedur angegeben werden. Begründung Pflichtfeld: Ist weder eine Codierung noch eine textuelle Beschreibung vorhanden, besitzt diese Ressource keine medizinische Aussagefähigkeit.
Condition.code.coding
Condition.code.coding:ICD-10-GM
Condition.code.coding:ICD-10-GM.extension:Mehrfachcodierungs-Kennzeichen
Condition.code.coding:ICD-10-GM.extension:Seitenlokalisation
Condition.code.coding:ICD-10-GM.extension:Diagnosesicherheit
Condition.code.coding:Alpha-ID
Condition.code.coding:Alpha-ID.system
Condition.code.coding:Alpha-ID.code
Condition.code.coding:SNOMED-CT
Condition.code.coding:Orphanet
Condition.code.coding:Orphanet.system
Condition.bodySite		Begründung MS: Harmonisierung mit KBV-Profil (KBV_PR_Base_Condition_Diagnosis)
Condition.bodySite.coding
Condition.bodySite.coding:snomed-ct
Condition.subject	Patientenbezug	Begründung Must-Support: Ein Patientenbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
Condition.subject.reference	Patienten-Link	Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.
Condition.encounter	Aufenthaltsbezug	Begründung Must-Support: Ein Aufenthaltsbezug der Diagnose MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
Condition.encounter.reference	Encounter-Link	Begründung Pflichtfeld: Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. WICHTIGER Hinweis für Implementierer: Die Zuordnung MUSS auf auf einen Encounter der Ebene "Abteilungskontakt" (siehe hierzu Abbildung des Konstrukts "Fall") erfolgen. Bei der Auswahl des Encounters ist zu beachten, dass unter einer (Abrechnungs-)"Fallnummer" (hier: `Encounter.account`) unter Umständen mehrere Encounter gruppiert sein können (z.B. stationärer Besuch mit mehreren vor- und nachstationären Aufenthalten.)
Condition.onset[x]	Erkrankungsbeginn	Datum oder Alter/Lebensphase des Erkrankungsbeginns Begründung MS: Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist.
Condition.abatement[x]	Erkrankungsende	Datum oder Alter/Lebensphase des Erkrankungsendes Begründung MS: Die Kenntnis des Erkrankungszeitraumes ist wichtig für die korrekte Einschätzung der medizinischen Relevanz einer Erkraknung. Einschränkung der übergreifenden MS-Definition: Verfügt ein bestätigungsrelevantes System nicht über die Datenstruktur zur Hinterlegung des Erkrankungszeitraumes, so MUSS dieses System die Information NICHT abbilden. Das System MUSS jedoch klinischen Status (`active`/`inactive`/`resolved`...) der Diagnose korrekt angeben, sofern die Information verfügbar ist.
Condition.recordedDate	Dokumentationsdatum	Datum, an dem die Diagnose dokumentiert wurde. Begründung Pflichtfeld: Das Dokumentationsdatum der Diagnose MUSS zu Qualitätssicherungszwecken angegeben werden. Dies ist das fachliche Dokumentationsdatum, nicht zu verwechseln mit der technischen Anlage des Datensatzes im Primärsystem. Diese beiden Daten können jedoch identisch sein. Hinweis: Das Recorded Date MUSS mindestens auf den Monat genau angegeben werden.
Condition.note	Notizen	Ergänzende Hinweise und Anmerkungen zur Diagnose

Interaktionen

Interaktion	Verbindlichkeit
read	SHALL
search-type	SHALL

Parameter	Typ	Verbindlichkeit	Hinweise
_id	token	SHALL	Beispiel: `GET [base]/[Resourcetype]?_id=103270` Anwendungshinweis: Der Parameter `_id` wird selten alleinstehend verwendet, da sich zum Abruf einer Ressource anhand der `id` die `READ`-Interaktion besser anbietet. Der Parameter kann jedoch verwendet werden, um den Abruf einer Ressource bspw. mit einem `_include` weiterer Ressourcen zu verbinden, z.B. zum Abruf eines Encounters in Verbindung mit dem zugehörigen Patienten: `GET [base]/Encounter?_id=103270&_include=Encounter:patient` Weitere Details siehe FHIR-Kernspezifikation, Abschnitt Parameters for all resources. Dieser Suchparameter ist für die Umsetzung des IHE PDQm Profils verpflichtend.
_tag	token	SHALL	Beispiel: `GET [base]/[Resourcetype]?_tag=https://example.org/codes\|needs-review` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation, Abschnitt Parameters for all resources sowie Abschnitt Tags.
_count	number	SHALL	Beispiel: `GET [base]/[Resourcetype]?_count=100` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation, Abschnitt Page Count.
_has	string	MAY	Beispiel: Suche nach allen Patienten, die eine Observation mit dem Code '1234-5' haben `GET [base]/Patient?_has:Observation:patient:code=1234-5` Beispiel: Suche nach allen Encountern, bei denen die Diagnose 'A12.3' gestellt wurde `GET [base]/Encounter?_has:Condition:encounter:code=A12.3` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation, Abschnitt Reverse Chaining.
clinical-status	token	SHALL	Beispiel: `GET [base]/Condition?clincial-status=active` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation.
patient	reference	SHALL	Beispiel: `GET [base]/Condition?patient=Patient/123` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation. Dieser Suchparameter ist für die Umsetzung des IHE QEDm Profils verpflichtend.
subject	reference	SHALL	Beispiel: `GET [base]/Condition?subject=Patient/123` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation.
encounter	reference	SHALL	Beispiel: `GET [base]/Condition?encounter=Patient/123` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation.
recorded-date	date	SHALL	Beispiel: `GET [base]/Condition?recorded-date=2015-01-01` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation.
related	reference	SHALL	Beispiel: `GET [base]/Condition?related=Condition/123` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation und Deutsche Basisprofile R4 - Doppel-/Mehrfachkodierte ICD-Codes.
category	token	MAY	Beispiel: `GET [base]/Condition?category=http://hl7.org/fhir/ValueSet/condition-category\|problem-list-item` Anwendungshinweis: Weitere Details siehe FHIR-Kernspezifikation. Dieser Suchparameter ist für die Umsetzung des IHE QEDm Profils verpflichtend.

(Reverse-)Include

Include	ReverseInclude
Condition:patient; Condition:subject; Condition:encounter	Encounter:diagnosis

CapabilityStatement

Beispiele

Beispiel einer Diagnose

Condition

id : Example-condition-kreuz-stern-primaer

meta

profile : https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose

clinicalStatus

coding

system : http://terminology.hl7.org/CodeSystem/condition-clinical

code : recurrence

code

coding

extension

url : http://fhir.de/StructureDefinition/icd-10-gm-mehrfachcodierungs-kennzeichen

value

system : http://fhir.de/CodeSystem/icd-10-gm-mehrfachcodierungs-kennzeichen

version : 2021

code : †

system : http://fhir.de/CodeSystem/bfarm/icd-10-gm

version : 2019

code : E10.30

display : Diabetes mellitus

subject

reference : Patient/PatientinMusterfrau

encounter

reference : Encounter/Fachabteilungskontakt

recordedDate : 2021-05-24

note

text : Beispiel für eine Anmerkung

<Condition xmlns="http://hl7.org/fhir">
    <id value="Example-condition-kreuz-stern-primaer" />
    <meta>
        <profile value="https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose" />
    </meta>
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/condition-clinical" />
            <code value="recurrence" />
        </coding>
    </clinicalStatus>
    <code>
        <coding>
            <extension url="http://fhir.de/StructureDefinition/icd-10-gm-mehrfachcodierungs-kennzeichen">
                <valueCoding>
                    <system value="http://fhir.de/CodeSystem/icd-10-gm-mehrfachcodierungs-kennzeichen" />
                    <version value="2021" />
                    <code value="†" />
                </valueCoding>
            </extension>
            <system value="http://fhir.de/CodeSystem/bfarm/icd-10-gm" />
            <version value="2019" />
            <code value="E10.30" />
            <display value="Diabetes mellitus" />
        </coding>
    </code>
    <subject>
        <reference value="Patient/PatientinMusterfrau" />
    </subject>
    <encounter>
        <reference value="Encounter/Fachabteilungskontakt" />
    </encounter>
    <recordedDate value="2021-05-24" />
    <note>
        <text value="Beispiel f&#252;r eine Anmerkung" />
    </note>
</Condition>

{
    "resourceType": "Condition",
    "id": "Example-condition-kreuz-stern-primaer",
    "meta": {
        "profile":  [
            "https://gematik.de/fhir/isik/StructureDefinition/ISiKDiagnose"
        ]
    },
    "clinicalStatus": {
        "coding":  [
            {
                "code": "recurrence",
                "system": "http://terminology.hl7.org/CodeSystem/condition-clinical"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "extension":  [
                    {
                        "url": "http://fhir.de/StructureDefinition/icd-10-gm-mehrfachcodierungs-kennzeichen",
                        "valueCoding": {
                            "version": "2021",
                            "code": "†",
                            "system": "http://fhir.de/CodeSystem/icd-10-gm-mehrfachcodierungs-kennzeichen"
                        }
                    }
                ],
                "version": "2019",
                "code": "E10.30",
                "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
                "display": "Diabetes mellitus"
            }
        ]
    },
    "subject": {
        "reference": "Patient/PatientinMusterfrau"
    },
    "encounter": {
        "reference": "Encounter/Fachabteilungskontakt"
    },
    "recordedDate": "2021-05-24",
    "note":  [
        {
            "text": "Beispiel für eine Anmerkung"
        }
    ]
}

Diabetes mellitus

Diagnose (Condition)

ISiKDiagnose

Motivation

Kompatibilität

Bestätigungsrelevanz

Metadaten

Inhalt

Constraints/Invarianten

Terminology-Bindings

Anmerkungen zu Must-Support-Feldern

Interaktionen

(Reverse-)Include

Beispiele