{ "resourceType": "StructureDefinition", "id": "mii-pr-fall-kontakt-gesundheitseinrichtung", "extension": [ { "url": "https://www.medizininformatik-initiative.de/fhir/modul-meta/StructureDefinition/mii-ex-meta-license-codeable", "valueCodeableConcept": { "coding": [ { "code": "CC-BY-4.0", "system": "http://hl7.org/fhir/spdx-license", "display": "Creative Commons Attribution 4.0 International" } ] } } ], "url": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung", "version": "2025.0.1", "name": "MII_PR_Fall_KontaktGesundheitseinrichtung", "title": "MII PR Fall Kontakt mit einer Gesundheitseinrichtung", "_title": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fall - Kontakt mit einer Gesundheitseinrichtung" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Treatment case - Encounter with Health Care Facility" } ] } ] }, "status": "active", "date": "2024-12-10", "description": "Kontakt zu einer Einrichtung, Abteilung oder Versorgungsstelle", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "Encounter", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Encounter", "derivation": "constraint", "differential": { "element": [ { "id": "Encounter", "path": "Encounter", "constraint": [ { "key": "mii-enc-1", "severity": "error", "human": "Falls der Encounter abgeschlossen wurde, MUSS ein Enddatum bekannt sein", "expression": "status = 'finished' implies period.end.exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-2", "severity": "error", "human": "Abgeschlossene, stationäre Kontakte MÜSSEN einen Start- und End-Zeitpunkt angeben", "expression": "status = 'finished' and class = 'IMP' implies period.start.exists() and period.end.exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-3", "severity": "error", "human": "Geplante Kontakte DÜRFEN NICHT einen Start- oder End-Zeitpunkt angeben", "expression": "status = 'planned' implies period.exists().not()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-4", "severity": "warning", "human": "Geplante Kontakte SOLLTEN die Extensions für den geplanten Start- oder End-Zeitpunkt verwenden", "expression": "status = 'planned' implies extension.where(url = 'http://hl7.org/fhir/5.0/StructureDefinition/extension-Encounter.plannedStartDate').exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-5", "severity": "error", "human": "In-Durchführung befindliche Kontakte MÜSSEN einen Start-Zeitpunkt angeben", "expression": "status = 'in-progress' implies period.start.exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-6", "severity": "error", "human": "Kontakte mit Abwesenheitsstatus MÜSSEN einen Start-Zeitpunkt angeben", "expression": "status = 'onleave' implies period.start.exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" }, { "key": "mii-enc-7", "severity": "warning", "human": "Kontakte mit unbekannten Status SOLLTEN einen Start-Zeitpunkt angeben", "expression": "status = 'unknown' implies period.start.exists()", "source": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/StructureDefinition/KontaktGesundheitseinrichtung" } ] }, { "id": "Encounter.id", "path": "Encounter.id", "definition": "Angabe OPTIONAL, vom Server automatisch vergebene system-abhängige ID", "mustSupport": true }, { "id": "Encounter.meta", "path": "Encounter.meta", "definition": "Angabe OPTIONAL zur Provenance und zum Profil", "mustSupport": true }, { "id": "Encounter.meta.source", "path": "Encounter.meta.source", "mustSupport": true }, { "id": "Encounter.meta.profile", "path": "Encounter.meta.profile", "mustSupport": true }, { "id": "Encounter.extension:Aufnahmegrund", "path": "Encounter.extension", "sliceName": "Aufnahmegrund", "short": "Aufnahmegrund", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmegrund" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission reason" } ] } ] }, "definition": "OPTIONAL, Aufnahmegrund entsprechend Schlüssel 1 der Anlage 2 der Datenübermittlung nach § 301 Abs. 3 SGB V", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmegrund nach Schlüssel 1, Anlage 2, Datenübermittlung nach § 301 Abs. 3 SGB V" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission reason according to key 1, appendix 2, data transmission according to § 301 para. 3 SGB V" } ] } ] }, "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/Aufnahmegrund" ] } ], "mustSupport": true }, { "id": "Encounter.extension:Aufnahmegrund.extension:ErsteUndZweiteStelle", "path": "Encounter.extension.extension", "sliceName": "ErsteUndZweiteStelle", "short": "1. und 2. Stelle", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "1. und 2. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "1st and 2nd position" } ] } ] }, "definition": "OPTIONAL, Aufnahmegrund (1. und 2. Stelle), Datenübermittlung nach § 301 Abs. 3 SGB V.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmegrund 1. und 2. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission reason 1st and 2nd position" } ] } ] }, "mustSupport": true }, { "id": "Encounter.extension:Aufnahmegrund.extension:DritteStelle", "path": "Encounter.extension.extension", "sliceName": "DritteStelle", "short": "3. Stelle", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "3. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "3rd position" } ] } ] }, "definition": "OPTIONAL, Aufnahmegrund (3. Stelle), Datenübermittlung nach § 301 Abs. 3 SGB V.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmegrund 3. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission reason 3rd position" } ] } ] }, "mustSupport": true }, { "id": "Encounter.extension:Aufnahmegrund.extension:VierteStelle", "path": "Encounter.extension.extension", "sliceName": "VierteStelle", "short": "4. Stelle", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "4. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "4th position" } ] } ] }, "definition": "OPTIONAL, Aufnahmegrund (4. Stelle), Datenübermittlung nach § 301 Abs. 3 SGB V.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmegrund 4. Stelle" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission reason 4th position" } ] } ] }, "mustSupport": true }, { "id": "Encounter.extension:plannedStartDate", "path": "Encounter.extension", "sliceName": "plannedStartDate", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/5.0/StructureDefinition/extension-Encounter.plannedStartDate" ] } ] }, { "id": "Encounter.extension:plannedEndDate", "path": "Encounter.extension", "sliceName": "plannedEndDate", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://hl7.org/fhir/5.0/StructureDefinition/extension-Encounter.plannedEndDate" ] } ] }, { "id": "Encounter.identifier", "path": "Encounter.identifier", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "short": "Identifikator", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Identifikator" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Identifier" } ] } ] }, "definition": "Kennung/en, unter der/denen dieser Kontakt bekannt ist.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kennung/en, unter der/denen dieser Kontakt bekannt ist." } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Identifier/s by which this encounter is known." } ] } ] }, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer", "path": "Encounter.identifier", "sliceName": "Aufnahmenummer", "short": "Aufnahmenummer", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmenummer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission number" } ] } ] }, "definition": "OPTIONAL, Aufnahmenummer/Fallnummer, die Patient:innen bei der Planung einer Aufnahme oder bei der Aufnahme selbst bekommt. \nGenerell SOLLTE die Aufnahmenummer in allen Encounter-Ressourcen unabhängig von der Kontaktebene und dem Kontakttyp angegeben werden. \nAls Gründe würden dagegen sprechen, wenn die Aufnahmenummer nur in einem Encounter der Encounter-Hierarchie angegeben werden kann. \nIn diesem Fall SOLL auf die korrekte Encounter-Verlinkung über .partOf geachtet werden, \nsowie dass jeder Encounter einen eigenständigen Identifier mit unterschiedlichen Systemen enthält.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Aufnahmenummer/Fallnummer, die Patient:in bei einer Aufnahme bekommt." } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Admission number, the patient receives during an admission." } ] } ] }, "min": 0, "max": "1", "patternIdentifier": { "type": { "coding": [ { "code": "VN", "system": "http://terminology.hl7.org/CodeSystem/v2-0203" } ] } }, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer.type", "path": "Encounter.identifier.type", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "VN", "system": "http://terminology.hl7.org/CodeSystem/v2-0203" } ] }, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/ValueSet/identifier-type-codes" } }, { "id": "Encounter.identifier:Aufnahmenummer.type.coding", "path": "Encounter.identifier.type.coding", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "min": 1 }, { "id": "Encounter.identifier:Aufnahmenummer.type.coding:vn-type", "path": "Encounter.identifier.type.coding", "sliceName": "vn-type", "min": 1, "max": "1", "patternCoding": { "code": "VN", "system": "http://terminology.hl7.org/CodeSystem/v2-0203" }, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer.type.coding:vn-type.system", "path": "Encounter.identifier.type.coding.system", "min": 1, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer.type.coding:vn-type.code", "path": "Encounter.identifier.type.coding.code", "min": 1, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer.system", "path": "Encounter.identifier.system", "min": 1, "mustSupport": true }, { "id": "Encounter.identifier:Aufnahmenummer.value", "path": "Encounter.identifier.value", "min": 1, "mustSupport": true }, { "id": "Encounter.status", "path": "Encounter.status", "short": "Status", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Status" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "status" } ] } ] }, "definition": "VERPFLICHTEND, required Binding auf http://fhir.de/ValueSet/EncounterStatusDe", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "geplant | im Gange | beurlaubt | abgeschlossen | abgebrochen | fehlerhafte Eingabe | unbekannt" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "planned | in-progress | onleave | finished | cancelled | entered-in-error | unknown" } ] } ] }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/EncounterStatusDe" } }, { "id": "Encounter.class", "path": "Encounter.class", "short": "Kontaktklasse", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kontaktklasse" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Classification of patient encounter" } ] } ] }, "definition": "VERPFLICHTEND, Kontaktklasse. Required Binding auf http://fhir.de/ValueSet/EncounterClassDE. \nKlassifizierung des Kontaktes in stationär, ambulant, teilstationär oder andere.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "ambulant | stationär | vorstationär | virtuell | teilstationär | häusliche Pflege" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "ambulatory | inpatient encounter | pre-admission | virtual | short stay | home health" } ] } ] }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/EncounterClassDE" } }, { "id": "Encounter.type", "path": "Encounter.type", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "short": "Kontakttyp", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Typ des Kontaktes" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Type of encounter" } ] } ] }, "definition": "Spezifischer Typ des Kontaktes", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Spezifischer Typ des Kontaktes" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Specific type of encounter" } ] } ] }, "mustSupport": true }, { "id": "Encounter.type:Kontaktebene", "path": "Encounter.type", "sliceName": "Kontaktebene", "short": "Kontaktebene", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kontaktebene" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Level of encounter" } ] } ] }, "definition": "OPTIONAL, Unterscheidung der Kontakt-Hierarchieebenen Einrichtungskontakt, Abteilungskontakt, Versorgungsstellenkontakt. \nDie Gliederung gilt für stationäre Kontakte. Required Binding auf http://fhir.de/ValueSet/kontaktebene-de", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Unterscheidung der Kontakt-Hierarchieebenen: Einrichtungskontakt | Abteilungskontakt | Versorgungsstellenkontakt" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Differentiation of the encounter hierarchy levels: facility contact | department contact | care provider contact" } ] } ] }, "min": 0, "max": "1", "patternCodeableConcept": { "coding": [ { "system": "http://fhir.de/CodeSystem/Kontaktebene" } ] }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/kontaktebene-de", "description": "Kontaktebene" } }, { "id": "Encounter.type:KontaktArt", "path": "Encounter.type", "sliceName": "KontaktArt", "short": "Kontaktart", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kontaktart" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Type of encounter" } ] } ] }, "definition": "OPTIONAL, Differenzierung zwischen verschiedenen Arten von Kontakten (z.B. vorstationär, nachstationär, intensivstationär). \nRequired Binding auf http://fhir.de/ValueSet/kontaktart-de", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kontaktarten wie vorstationär | nachstationär | intensivstationär" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Type of encounter such as pre-admission | post-admission | intensive care" } ] } ] }, "min": 0, "max": "1", "patternCodeableConcept": { "coding": [ { "system": "http://fhir.de/CodeSystem/kontaktart-de" } ] }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/kontaktart-de" } }, { "id": "Encounter.serviceType", "path": "Encounter.serviceType", "short": "Fachabteilung", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fachabteilung" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Department" } ] } ] }, "definition": "Die Fachdisziplin bzw. Fachabteilung wird durch einen vierstelligen Fachabteilungsschlüssel klassifiziert.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fachabteilung Klassifizierung durch Fachabteilungsschlüssel" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Department classification by department key" } ] } ] }, "mustSupport": true }, { "id": "Encounter.serviceType.coding", "path": "Encounter.serviceType.coding", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "mustSupport": true }, { "id": "Encounter.serviceType.coding:Fachabteilungsschluessel", "path": "Encounter.serviceType.coding", "sliceName": "Fachabteilungsschluessel", "short": "Fachabteilungsschlüssel", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fachabteilungsschlüssel" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Department key" } ] } ] }, "definition": "OPTIONAL, required Binding auf http://fhir.de/ValueSet/dkgev/Fachabteilungsschluessel\nFachabteilungen gemäß Anhang 1 der BPflV in der am 31.12.2003 geltenden Fassung", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fachabteilungen gemäß Anhang 1 der Bundespflegesatzverordnung" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Departments according to appendix 1 of the Bundespflegesatzverordnung" } ] } ] }, "min": 0, "max": "1", "patternCoding": { "system": "http://fhir.de/CodeSystem/dkgev/Fachabteilungsschluessel" }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/dkgev/Fachabteilungsschluessel" } }, { "id": "Encounter.serviceType.coding:Fachabteilungsschluessel.system", "path": "Encounter.serviceType.coding.system", "min": 1, "mustSupport": true }, { "id": "Encounter.serviceType.coding:Fachabteilungsschluessel.code", "path": "Encounter.serviceType.coding.code", "min": 1, "mustSupport": true }, { "id": "Encounter.serviceType.coding:ErweiterterFachabteilungsschluessel", "path": "Encounter.serviceType.coding", "sliceName": "ErweiterterFachabteilungsschluessel", "short": "Erweiterter Fachabteilungsschlüssel", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Erweiterter Fachabteilungsschlüssel" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Extended department key" } ] } ] }, "definition": "OPTIONAL, required Binding auf http://fhir.de/ValueSet/dkgev/Fachabteilungsschluessel-erweitert\nFachabteilungen gemäß Anhang 1 der BPflV in der am 31.12.2003 geltenden Fassung inkl. Spezialisierungen.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Fachabteilungen gemäß Anhang 1 der Bundespflegesatzverordnung" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Departments according to appendix 1 of the Bundespflegesatzverordnung" } ] } ] }, "min": 0, "max": "1", "patternCoding": { "system": "http://fhir.de/CodeSystem/dkgev/Fachabteilungsschluessel-erweitert" }, "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/dkgev/Fachabteilungsschluessel-erweitert" } }, { "id": "Encounter.serviceType.coding:ErweiterterFachabteilungsschluessel.system", "path": "Encounter.serviceType.coding.system", "min": 1, "mustSupport": true }, { "id": "Encounter.serviceType.coding:ErweiterterFachabteilungsschluessel.code", "path": "Encounter.serviceType.coding.code", "min": 1, "mustSupport": true }, { "id": "Encounter.subject", "path": "Encounter.subject", "short": "Patientenidentifikator", "definition": "VERPFLICHTEND, Referenz auf Patient:in.", "min": 1, "mustSupport": true }, { "id": "Encounter.period", "path": "Encounter.period", "short": "Zeitraum des Kontaktes", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Zeitraum des Kontaktes" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Period of encounter" } ] } ] }, "definition": "Beginn- und Endzeitpunkt des Kontaktes. \n DARF NICHT vorhanden sein, kann OPTIONAL oder VERPFLICHTEND sein, \n abhängig vom Status des Kontaktes - siehe Invarianten auf Ebene Encounter.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Beginn- und Endzeitpunkt des Kontaktes." } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Start and end time of the encounter." } ] } ] }, "mustSupport": true }, { "id": "Encounter.period.start", "path": "Encounter.period.start", "short": "Beginndatum", "definition": "Start des Kontaktzeitraums. DARF NICHT vorhanden sein, kann OPTIONAL oder VERPFLICHTEND sein, \nabhängig vom Status des Kontaktes - siehe Invarianten auf Ebene Encounter.", "mustSupport": true }, { "id": "Encounter.period.end", "path": "Encounter.period.end", "short": "Enddatum", "definition": "Ende des Kontaktzeitraums. DARF NICHT vorhanden sein, kann OPTIONAL oder VERPFLICHTEND sein, \nabhängig vom Status des Kontaktes - siehe Invarianten auf Ebene Encounter.", "mustSupport": true }, { "id": "Encounter.diagnosis", "path": "Encounter.diagnosis", "short": "Diagnosen", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Diagnosen" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Diagnoses" } ] } ] }, "definition": "OPTIONAL, Angaben zu Diagnosen", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Angaben zu für den Kontakt relevanten Diagnosen" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Information about diagnoses relevant for the encounter" } ] } ] }, "mustSupport": true }, { "id": "Encounter.diagnosis.condition", "path": "Encounter.diagnosis.condition", "short": "Referenz zu Diagnose-Ressource", "definition": "VERPFLICHTEND, wenn Diagnosedaten angegeben werden, dann MUSS diese referenziert werden. \nEs SOLLTE nur die Primärdiagnose referenziert werden.", "mustSupport": true }, { "id": "Encounter.diagnosis.use", "path": "Encounter.diagnosis.use", "short": "Diagnosetyp", "definition": "Attribute wie Aufnahme- oder Entlassdiagnose sind immer im Kontext eines stationären Aufenthaltes zu betrachten\nund werden daher als Eigenschaft des Encounters modelliert. \nVERPFLICHTEND mindestens die Angabe eines Codings. EMPFOHLEN ist die Angabe mittels Diagnosetyp- und DiagnosesubTyp-Coding. \nWeitere Codings OPTIONAL. Extensible Binding auf `http://hl7.org/fhir/ValueSet/diagnosis-role`", "min": 1, "mustSupport": true, "binding": { "strength": "extensible", "valueSet": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/ValueSet/mii-vs-fall-diagnosis-use" } }, { "id": "Encounter.diagnosis.use.coding", "path": "Encounter.diagnosis.use.coding", "slicing": { "discriminator": [ { "type": "pattern", "path": "$this" } ], "rules": "open" }, "min": 1, "mustSupport": true }, { "id": "Encounter.diagnosis.use.coding:Diagnosetyp", "path": "Encounter.diagnosis.use.coding", "sliceName": "Diagnosetyp", "short": "Diagnosetyp", "definition": "Einweisungs-/Überweisungsdiagnose | Behandlungsrelevante Diagnosen", "min": 0, "max": "1", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/DiagnoseTyp" } }, { "id": "Encounter.diagnosis.use.coding:DiagnosesubTyp", "path": "Encounter.diagnosis.use.coding", "sliceName": "DiagnosesubTyp", "short": "Diagnosesubtyp", "definition": "Operationsdiagnose | Abteilung Hauptdiagnose | Todesursache | Infektionsschutzdiagnose +", "min": 0, "max": "1", "mustSupport": true, "binding": { "strength": "required", "valueSet": "http://fhir.de/ValueSet/Diagnosesubtyp" } }, { "id": "Encounter.diagnosis.rank", "path": "Encounter.diagnosis.rank", "short": "Rangfolge", "definition": "OPTIONAL, Rangfolge der Diagnose", "mustSupport": true }, { "id": "Encounter.hospitalization", "path": "Encounter.hospitalization", "short": "Klinikaufenthalt", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Klinikaufenthalt" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Hospitalization" } ] } ] }, "definition": "OPTIONAL, Details zur Aufnahme und Entlassung", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Details zur Aufnahme und Entlassung" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Details about admission and discharge" } ] } ] }, "mustSupport": true }, { "id": "Encounter.hospitalization.admitSource", "path": "Encounter.hospitalization.admitSource", "short": "Aufnahmeanlass", "definition": "VERPFLICHTEND, Aufnahmeanlass. Preferred Binding auf http://fhir.de/ValueSet/dgkev/Aufnahmeanlass", "min": 1, "mustSupport": true, "binding": { "strength": "preferred", "valueSet": "http://fhir.de/ValueSet/dgkev/Aufnahmeanlass" } }, { "id": "Encounter.hospitalization.dischargeDisposition", "path": "Encounter.hospitalization.dischargeDisposition", "short": "Entlassung", "definition": "OPTIONAL Daten zur Entlassung", "mustSupport": true }, { "id": "Encounter.hospitalization.dischargeDisposition.extension:Entlassungsgrund", "path": "Encounter.hospitalization.dischargeDisposition.extension", "sliceName": "Entlassungsgrund", "short": "Entlassungsgrund", "definition": "OPTIONAL, Entlassungs-/Verlegungsgrund nach § 301 Abs. 3 SGB V", "min": 0, "max": "1", "type": [ { "code": "Extension", "profile": [ "http://fhir.de/StructureDefinition/Entlassungsgrund" ] } ], "mustSupport": true }, { "id": "Encounter.location", "path": "Encounter.location", "slicing": { "discriminator": [ { "type": "pattern", "path": "physicalType" }, { "type": "pattern", "path": "status" } ], "rules": "open" }, "short": "Kontaktort", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Kontaktort" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Location" } ] } ] }, "definition": "OPTIONAL, Details zum Kontaktort wie Zimmer, Bett, Station", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Details zum Kontaktort wie Zimmer, Bett, Station" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Details about location such as room, bed, ward" } ] } ] } }, { "id": "Encounter.location.physicalType", "path": "Encounter.location.physicalType", "short": "Kontaktorttyp", "definition": "SOLL, extensible Binding auf https://www.medizininformatik-initiative.de/fhir/core/modul-fall/ValueSet/location-physical-type", "binding": { "strength": "extensible", "valueSet": "https://www.medizininformatik-initiative.de/fhir/core/modul-fall/ValueSet/location-physical-type" } }, { "id": "Encounter.location:Zimmer", "path": "Encounter.location", "sliceName": "Zimmer", "short": "Zimmer", "definition": "Von Patient oder Patientin während des Kontaktes belegtes Zimmer auf einer Station.", "min": 0, "max": "1" }, { "id": "Encounter.location:Zimmer.status", "path": "Encounter.location.status", "min": 1, "patternCode": "active", "mustSupport": true }, { "id": "Encounter.location:Zimmer.physicalType", "path": "Encounter.location.physicalType", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "ro", "system": "http://terminology.hl7.org/CodeSystem/location-physical-type" } ] } }, { "id": "Encounter.location:Bett", "path": "Encounter.location", "sliceName": "Bett", "short": "Bett", "definition": "Von Patient oder Patientin während des Kontaktes belegter Bettenstellplatz.", "min": 0, "max": "1" }, { "id": "Encounter.location:Bett.status", "path": "Encounter.location.status", "min": 1, "patternCode": "active", "mustSupport": true }, { "id": "Encounter.location:Bett.physicalType", "path": "Encounter.location.physicalType", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "bd", "system": "http://terminology.hl7.org/CodeSystem/location-physical-type" } ] } }, { "id": "Encounter.location:Station", "path": "Encounter.location", "sliceName": "Station", "short": "Station", "definition": "Die Station, auf welcher der Patient oder die Patientin während des Kontaktes behandelt wurde.", "min": 0, "max": "1" }, { "id": "Encounter.location:Station.status", "path": "Encounter.location.status", "min": 1, "patternCode": "active", "mustSupport": true }, { "id": "Encounter.location:Station.physicalType", "path": "Encounter.location.physicalType", "min": 1, "patternCodeableConcept": { "coding": [ { "code": "wa", "system": "http://terminology.hl7.org/CodeSystem/location-physical-type" } ] } }, { "id": "Encounter.serviceProvider", "path": "Encounter.serviceProvider", "short": "Leistungserbringer", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Leistungserbringer" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Service Provider" } ] } ] }, "definition": "OPTIONAL. Leistungserbringer, der für den Kontakt verantwortlich ist. \nReferenz auf eine Organisation", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Leistungserbringer, der für den Kontakt verantwortlich ist." } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Service provider responsible for the encounter." } ] } ] } }, { "id": "Encounter.partOf", "path": "Encounter.partOf", "short": "Teil von Kontakt", "_short": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Teil von Kontakt" } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Part of encounter" } ] } ] }, "definition": "OPTIONAL. Abbildung der Hierarchie zwischen Kontaktebenen durch Referenz auf weitere Kontakte, \nwenn bspw. ein Versorgungsstellenkontakt Teil eines Abteilungskontaktes \noder ein Abteilungskontakt Teil eines Einrichtungskontaktes ist.", "_definition": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "de-DE" }, { "url": "content", "valueString": "Abbildung der Hierarchie zwischen Kontaktebenen durch Referenz auf weitere Kontakte." } ] }, { "url": "http://hl7.org/fhir/StructureDefinition/translation", "extension": [ { "url": "lang", "valueCode": "en-US" }, { "url": "content", "valueString": "Hierarchy between encounter levels by referencing further encounters." } ] } ] }, "mustSupport": true } ] } }