<status value="active" /> <experimental value="false" /> <date value="2023-03-22T14:40:09+00:00" /> <contact> <name value="HL7 International Working Group" /> <telecom> <system value="url" /> <value value="http://www.hl7.org/Special/committees/" /> </telecom> </contact> <description value="Dokument Opći nalaz na internu uputnicu kreira se i šalje u CEZIH u slučajevima kada je pacijent završio u bolnici na obradi bez upućivanja preko crvene uputnice ili mimo hitnog bolničkog prijema i poslan je u obradu na temelju internih uputnica." /> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166" /> <code value="HR" /> <display value="Croatia" /> </coding> <text value="Croatia" /> </jurisdiction> <fhirVersion value="4.0.1" /> <mapping> <identity value="workflow" /> <uri value="http://hl7.org/fhir/workflow" /> <name value="Workflow Pattern" /> </mapping> <mapping> <identity value="rim" /> <uri value="http://hl7.org/v3" /> <name value="RIM Mapping" /> </mapping> <mapping> <identity value="cda" /> <uri value="http://hl7.org/v3/cda" /> <name value="CDA (R2)" /> </mapping> <mapping> <identity value="fhirdocumentreference" /> <uri value="http://hl7.org/fhir/documentreference" /> <name value="FHIR DocumentReference" /> </mapping> <mapping> <identity value="w5" /> <uri value="http://hl7.org/fhir/fivews" /> <name value="FiveWs Pattern Mapping" /> </mapping> <kind value="resource" /> <abstract value="false" /> <type value="Composition" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Composition" /> <derivation value="constraint" /> <differential> <element id="Composition.status"> <path value="Composition.status" /> <short value="Status kliničkog dokumenta" /> <definition value="Kod definira status kliničkog dokumenta logički definiranog kroz Composition resurs. Dopuštene vrijednosti su: preliminary | final | amended | entered-in-error." /> </element> <element id="Composition.type"> <path value="Composition.type" /> <short value="Vrsta kliničkog dokumenta" /> <definition value="Kod definira vrstu kliničkog dokumenta. Vrijednosti se uzimaju iz kodnog sustava http://fhir.cezih.hr/specifikacije/CodeSystem/document-type. Za Opći nalaz na internu uputnicu vrijednost je uvijek 004 - Opći nalaz na internu uputnicu" /> <fixedCodeableConcept> <coding> <system value="http://fhir.cezih.hr/specifikacije/CodeSystem/document-type" /> <code value="004" /> <display value="Opći nalaz na internu uputnicu" /> </coding> </fixedCodeableConcept> </element> <element id="Composition.subject"> <path value="Composition.subject" /> <short value="Pacijent" /> <definition value="Pacijent za koga je kreiran dokument." /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/hr-pacijent" /> </type> </element> <element id="Composition.encounter"> <path value="Composition.encounter" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/posjeta-hitna" /> </type> </element> <element id="Composition.date"> <path value="Composition.date" /> <label value="Datum i vrijeme kreiranja nalaza" /> <short value="Datum i vrijeme kreiranja nalaza" /> </element> <element id="Composition.author"> <path value="Composition.author" /> <slicing> <discriminator> <type value="profile" /> <path value="resolve()" /> </discriminator> <ordered value="false" /> <rules value="closed" /> </slicing> <min value="2" /> </element> <element id="Composition.author:djelatnik"> <path value="Composition.author" /> <sliceName value="djelatnik" /> <short value="Autor dokumenta" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/hr-practitioner" /> </type> </element> <element id="Composition.author:ustanova"> <path value="Composition.author" /> <sliceName value="ustanova" /> <short value="Ustanova u kojoj je dokument kreiran." /> <definition value="Ustanova u kojoj je dokument kreiran." /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/hr-organizacija" /> </type> <constraint> <key value="Ust1" /> <severity value="warning" /> <human value="Mora biti poslana HZZO šifra" /> <expression value="resolve().identifier.where(system='http://fhir.cezih.hr/specifikacije/identifikatori/HZZO-sifra-zdravstvene-organizacije').exists()" /> </constraint> </element> <element id="Composition.title"> <path value="Composition.title" /> <short value="Naslov dokumenta" /> <fixedString value="Opći nalaz na internu uputnicu" /> </element> <element id="Composition.attester"> <path value="Composition.attester" /> <slicing> <discriminator> <type value="profile" /> <path value="party.resolve()" /> </discriminator> <ordered value="false" /> <rules value="closed" /> </slicing> <short value="Odgovorni liječnik" /> <min value="2" /> <max value="2" /> </element> <element id="Composition.attester:djelatnik"> <path value="Composition.attester" /> <sliceName value="djelatnik" /> <min value="1" /> <max value="1" /> </element> <element id="Composition.attester:djelatnik.mode"> <path value="Composition.attester.mode" /> <fixedCode value="professional" /> </element> <element id="Composition.attester:djelatnik.party"> <path value="Composition.attester.party" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/hr-practitioner" /> </type> </element> <element id="Composition.attester:organizacija"> <path value="Composition.attester" /> <sliceName value="organizacija" /> <min value="1" /> <max value="1" /> </element> <element id="Composition.attester:organizacija.mode"> <path value="Composition.attester.mode" /> <fixedCode value="official" /> </element> <element id="Composition.attester:organizacija.party"> <path value="Composition.attester.party" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/hr-organizacija" /> </type> </element> <element id="Composition.section"> <path value="Composition.section" /> <slicing> <discriminator> <type value="value" /> <path value="code" /> </discriminator> <ordered value="false" /> <rules value="closed" /> </slicing> <min value="1" /> </element> <element id="Composition.section:djelatnost"> <path value="Composition.section" /> <sliceName value="djelatnost" /> <short value="Medicinska djelatnost" /> <min value="1" /> <max value="1" /> </element> <element id="Composition.section:djelatnost.title"> <path value="Composition.section.title" /> <short value="Naziv sekcije" /> <min value="1" /> <fixedString value="Djelatnost" /> </element> <element id="Composition.section:djelatnost.code"> <path value="Composition.section.code" /> <fixedCodeableConcept> <coding> <system value="http://fhir.cezih.hr/specifikacije/CodeSystem/document-section" /> <code value="12" /> <display value="Djelatnost" /> </coding> </fixedCodeableConcept> </element> <element id="Composition.section:djelatnost.entry"> <path value="Composition.section.entry" /> <short value="Referenca na djelatnost" /> <definition value="Referenca na FHIR resurs HealthcareService u kojem je definirana mediinska djelatnost u kojoj je nastao dokument." /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/djelatnost" /> </type> </element> <element id="Composition.section:referencirani-dokumenti"> <path value="Composition.section" /> <sliceName value="referencirani-dokumenti" /> <short value="Referencirani dokumenti" /> <definition value="Dokument na koji se referencira nalaz kao odgovor." /> <max value="1" /> </element> <element id="Composition.section:referencirani-dokumenti.title"> <path value="Composition.section.title" /> <min value="1" /> <fixedString value="Referencirani dokumenti" /> </element> <element id="Composition.section:referencirani-dokumenti.code"> <path value="Composition.section.code" /> <min value="1" /> <fixedCodeableConcept> <coding> <system value="http://fhir.cezih.hr/specifikacije/CodeSystem/document-section" /> <code value="17" /> <display value="Referencirani dokumenti" /> </coding> </fixedCodeableConcept> </element> <element id="Composition.section:referencirani-dokumenti.entry"> <path value="Composition.section.entry" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/referencirani-dokument" /> </type> </element> <element id="Composition.section:prilozeni-dokumenti"> <path value="Composition.section" /> <sliceName value="prilozeni-dokumenti" /> <max value="1" /> </element> <element id="Composition.section:prilozeni-dokumenti.title"> <path value="Composition.section.title" /> <min value="1" /> <fixedString value="Priloženi dokumenti" /> </element> <element id="Composition.section:prilozeni-dokumenti.code"> <path value="Composition.section.code" /> <min value="1" /> <fixedCodeableConcept> <coding> <system value="http://fhir.cezih.hr/specifikacije/CodeSystem/document-section" /> <code value="16" /> <display value="Priloženi dokumenti" /> </coding> </fixedCodeableConcept> </element> <element id="Composition.section:prilozeni-dokumenti.entry"> <path value="Composition.section.entry" /> <min value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/prilog" /> </type> </element> <element id="Composition.section:medicinska-informacija"> <path value="Composition.section" /> <sliceName value="medicinska-informacija" /> <max value="1" /> </element> <element id="Composition.section:medicinska-informacija.title"> <path value="Composition.section.title" /> <min value="1" /> <fixedString value="Medicinska informacija" /> </element> <element id="Composition.section:medicinska-informacija.code"> <path value="Composition.section.code" /> <min value="1" /> <fixedCodeableConcept> <coding> <system value="http://fhir.cezih.hr/specifikacije/CodeSystem/document-section" /> <code value="18" /> <display value="Medicinska informacija" /> </coding> </fixedCodeableConcept> </element> <element id="Composition.section:medicinska-informacija.entry"> <path value="Composition.section.entry" /> <min value="1" /> <max value="1" /> <type> <code value="Reference" /> <targetProfile value="http://fhir.cezih.hr/specifikacije/StructureDefinition/tekstualni-nalaz" /> </type> </element> </differential> </StructureDefinition>