<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="spark1884" />
  <meta>
    <versionId value="spark2576" />
    <lastUpdated value="2016-01-22T08:23:40.939+00:00" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="3" />
  </extension>
  <url value="http://hl7.no/fhir/StructureDefinition/hncDiagnosticReport" />
  <name value="hncDiagnosticReport" />
  <status value="draft" />
  <date value="2015-09-22T20:02:49+10:00" />
  <description value="Base StructureDefinition for DiagnosticReport Resource" />
  <requirements value="To support reporting for any diagnostic report into a clinical data repository." />
  <fhirVersion value="1.0.1" />
  <mapping>
    <identity value="v2" />
    <uri value="http://hl7.org/v2" />
    <name value="HL7 v2" />
  </mapping>
  <mapping>
    <identity value="rim" />
    <uri value="http://hl7.org/v3" />
    <name value="RIM" />
  </mapping>
  <mapping>
    <identity value="w5" />
    <uri value="http://hl7.org/fhir/w5" />
    <name value="W5 Mapping" />
  </mapping>
  <kind value="resource" />
  <constrainedType value="DiagnosticReport" />
  <abstract value="false" />
  <base value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
  <differential>
    <element>
      <path value="DiagnosticReport" />
      <short value="A Diagnostic report - a combination of request information, atomic results, images, interpretation, as well as formatted reports" />
      <definition value="The findings and interpretation of diagnostic  tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports." />
      <comments value="This is intended to capture a single report, and is not suitable for use in displaying summary information that covers multiple reports.  For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing." />
      <alias value="Report" />
      <alias value="Test" />
      <alias value="Result" />
      <alias value="Results" />
      <alias value="Labs" />
      <alias value="Laboratory" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="DiagnosticReport" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="ORU -&gt; OBR" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Observation[classCode=OBS, moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="clinical.diagnostics" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.identifier" />
      <short value="Id for external references to this report" />
      <definition value="The local ID assigned to the report by the order filler, usually by the Information System of the diagnostic service provider." />
      <requirements value="Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context." />
      <alias value="ReportID" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Identifier" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-51" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="id" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="id" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.identifier.type" />
      <short value="Description of identifier" />
      <definition value="A coded type for the identifier that can be used to determine which identifier to use for a specific purpose." />
      <comments value="This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type." />
      <requirements value="Allows users to make use of identifiers when the identifier system is not known." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <strength value="extensible" />
        <description value="A coded type for an identifier that can be used to determine which identifier to use for a specific purpose." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/identifier-type" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="CX.5" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Role.code or implied by context" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.identifier.period" />
      <short value="Time period when id is/was valid for use" />
      <definition value="Time period during which identifier is/was valid for use." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="Period" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="CX.7 + CX.8" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="Role.effectiveTime or implied by context" />
      </mapping>
      <mapping>
        <identity value="servd" />
        <map value="./StartDate and ./EndDate" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.identifier.assigner" />
      <short value="Organization that issued id (may be just text)" />
      <definition value="Organization that issued/manages the identifier." />
      <comments value="The reference may be just a text description of the assigner." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Organization" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="CX.4 / (CX.4,CX.9,CX.10)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper" />
      </mapping>
      <mapping>
        <identity value="servd" />
        <map value="./IdentifierIssuingAuthority" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.status" />
      <short value="registered | partial | final | corrected | appended | cancelled | entered-in-error" />
      <definition value="The status of the diagnostic report as a whole." />
      <comments value="This is labeled as &quot;Is Modifier&quot; because applications need to take appropriate action if a report is withdrawn." />
      <requirements value="Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="code" />
      </type>
      <isModifier value="true" />
      <isSummary value="true" />
      <binding>
        <strength value="required" />
        <description value="Local Drelevant DIPS Codes indicating if this result is preliminary or pif paossibel partial" />
        <valueSetUri value="http://hl7.org/fhir/ValueSet/diagnostic-report-status" />
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBR-25 (not 1:1 mapping)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="statusCode  Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type &quot;revise&quot;" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="status" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.category" />
      <short value="Service category" />
      <definition value="A code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes." />
      <comments value="The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code." />
      <alias value="Department" />
      <alias value="Sub-department" />
      <alias value="service" />
      <alias value="discipline" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <isSummary value="true" />
      <binding>
        <strength value="example" />
        <description value="Codes for diagnostic service sections. ROS Rekvisisjonstype" />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/diagnostic-service-sections" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBR-24" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code &lt; LabService].code" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="class" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.category.coding" />
      <short value="Code defined by a terminology system" />
      <definition value="A reference to a code defined by a terminology system." />
      <comments value="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 labelled as UserSelected = true." />
      <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="Coding" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="C*E.1-8, C*E.10-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="union(., ./translation)" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.category.text" />
      <short value="Plain text representation of the concept" />
      <definition value="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." />
      <comments value="Very often the text is the same as a displayName of one of the codings." />
      <requirements value="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." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="string" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="C*E.9. But note many systems use C*E.2 for this" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="./originalText[mediaType/code=&quot;text/plain&quot;]/data" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.code.coding" />
      <short value="Code defined by a terminology system" />
      <definition value="A reference to a code defined by a terminology system." />
      <comments value="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 labelled as UserSelected = true." />
      <requirements value="Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Coding" />
      </type>
      <isSummary value="true" />
      <binding>
        <strength value="preferred" />
        <description value="Same as category" />
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="C*E.1-8, C*E.10-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="union(., ./translation)" />
      </mapping>
      <mapping>
        <identity value="orim" />
        <map value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.subject" />
      <short value="The subject of the report, usually, but not always, the patient" />
      <definition value="The subject of the report. Usually, but not always, this is a patient. However diagnostic services also perform analyses on specimens collected from a variety of other sources." />
      <requirements value="SHALL know the subject context." />
      <alias value="Patient" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.no/fhir/StructureDefinition/LabPatientNorway" />
        <aggregation value="contained" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PID-3 (no HL7 v2 mapping for Group or Device)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=SBJ]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.focus" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.encounter" />
      <short value="Health care event when test ordered" />
      <definition value="The link to the health care event (encounter) when the order was made." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PV1-19" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="context" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.effective[x]" />
      <short value="Clinically Relevant time/time-period for report. Sample time / samplingstidspunkt" />
      <definition value="The time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself." />
      <comments value="If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic." />
      <requirements value="Need to know where in the patient history to file/present this report." />
      <alias value="Observation time" />
      <alias value="Effective Time" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="dateTime" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-7" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="effectiveTime" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="when.done" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.issued" />
      <short value="DateTime this version was released, if no date is available use currentdatetime" />
      <definition value="The date and time that this version of the report was released from the source diagnostic service. " />
      <comments value="May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report." />
      <requirements value="Clinicians need to be able to check the date that the report was released." />
      <alias value="Date Created" />
      <alias value="Date published" />
      <alias value="Date Issued" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="instant" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBR-22" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=VRF or AUT].time" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="when.recorded" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.performer" />
      <short value="Responsible Diagnostic Service" />
      <definition value="The diagnostic service that is responsible for issuing the report." />
      <comments value="This is not necessarily the source of the atomic data items. It is the entity that takes responsibility for the clinical report." />
      <requirements value="Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis." />
      <alias value="Laboratory" />
      <alias value="Service" />
      <alias value="Practitioner" />
      <alias value="Department" />
      <alias value="Company" />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.no/fhir/StructureDefinition/hncOrganication" />
        <aggregation value="contained" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="PRT-8 (where this PRT-4-Participation = &quot;PO&quot;)" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=AUT].role[classCode=ASSIGN].scoper" />
      </mapping>
      <mapping>
        <identity value="w5" />
        <map value="who.witness" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.request" />
      <short value="Linc to request containing requstid" />
      <definition value="Details concerning a test or procedure requested." />
      <comments value="Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports." />
      <requirements value="Need to be able to track completion of requests based on reports issued and also to report what diagnostic tests were requested (not always the same as what is delivered)." />
      <min value="1" />
      <max value="1" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/DiagnosticOrder" />
        <aggregation value="contained" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="ORC? OBR-2/3?" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=FLFS].target" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.specimen" />
      <short value="Specimens this report is based on" />
      <definition value="Details about the specimens on which this diagnostic report is based." />
      <comments value="If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per Observation or group." />
      <requirements value="Need to be able to report information about the collected specimens on which the report is based." />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.no/fhir/StructureDefinition/LabSpecimenNorway" />
        <aggregation value="contained" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="SPM" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="participation[typeCode=SBJ]" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.result" />
      <short value="Observations - simple, or complex nested groups" />
      <definition value="Observations that are part of this diagnostic report. Observations can be simple name/value pairs (e.g. &quot;atomic&quot; results), or they can be grouping observations that include references to other members of the group (e.g. &quot;panels&quot;)." />
      <requirements value="Need to support individual results, or report groups of results, where the result grouping is arbitrary, but meaningful. This structure is recursive - observations can contain observations." />
      <alias value="Data" />
      <alias value="Atomic Value" />
      <alias value="Result" />
      <alias value="Atomic result" />
      <alias value="Data" />
      <alias value="Test" />
      <alias value="Analyte" />
      <alias value="Battery" />
      <alias value="Organizer" />
      <min value="0" />
      <max value="*" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.no/fhir/StructureDefinition/LabObservationNorway" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBXs" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.result.display" />
      <short value="Text alternative for the resource" />
      <definition value="Plain text narrative that identifies the resource in addition to the resource reference." />
      <comments value="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." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="string" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="rim" />
        <map value="N/A" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.imagingStudy" />
      <short value="Reference to full details of imaging associated with the diagnostic report" />
      <definition value="One or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images." />
      <comments value="ImagingStudy and ImageObjectStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However each caters to different types of displays for different types of purposes. Neither, either, or both may be provided." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ImagingStudy" />
      </type>
      <type>
        <code value="Reference" />
        <profile value="http://hl7.org/fhir/StructureDefinition/ImagingObjectSelection" />
      </type>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.image" />
      <short value="Key images associated with this report" />
      <definition value="A list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest)." />
      <requirements value="Many diagnostic services include images in the report as part of their service." />
      <alias value="DICOM" />
      <alias value="Slides" />
      <alias value="Scans" />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="BackboneElement" />
      </type>
      <isSummary value="true" />
      <mapping>
        <identity value="v2" />
        <map value="OBX?" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="outboundRelationship[typeCode=COMP].target" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.conclusion" />
      <short value="Clinical Interpretation of test results" />
      <definition value="Concise and clinically contextualized narrative interpretation of the diagnostic report." />
      <comments value="Typically, a report is either [all data, no narrative (e.g. Core lab)] or [a mix of data with some concluding narrative (e.g. Structured Pathology Report, Bone Density)], or [all narrative (e.g. typical imaging report, histopathology)]. In all of these cases, the narrative goes in &quot;text&quot;." />
      <requirements value="Need to be able to provide a conclusion that is not lost among the basic result data." />
      <alias value="Report" />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="string" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=&quot;SPRT&quot;].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.codedDiagnosis" />
      <short value="Codes for the conclusion" />
      <definition value="Codes for the conclusion." />
      <min value="0" />
      <max value="0" />
      <type>
        <code value="CodeableConcept" />
      </type>
      <binding>
        <strength value="example" />
        <description value="Diagnoses codes provided as adjuncts to the report." />
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/clinical-findings" />
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)" />
      </mapping>
    </element>
    <element>
      <path value="DiagnosticReport.presentedForm" />
      <short value="Entire report as issued as PDF for other lab results than clinicalCehemical witch is al a list of observations" />
      <definition value="Rich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent." />
      <comments value="&quot;application/pdf&quot; is recommended as the most reliable and interoperable in this context." />
      <requirements value="Gives Laboratory the ability to provide its own fully formatted report for clinical fidelity." />
      <min value="0" />
      <max value="1" />
      <type>
        <code value="Attachment" />
      </type>
      <mapping>
        <identity value="v2" />
        <map value="OBX" />
      </mapping>
      <mapping>
        <identity value="rim" />
        <map value="text (type=ED)" />
      </mapping>
    </element>
  </differential>
</StructureDefinition>