{
  "resourceType": "StructureDefinition",
  "id": "zib-MUSTScore",
  "url": "http://nictiz.nl/fhir/StructureDefinition/zib-MUSTScore",
  "version": "1.0.2",
  "name": "Zib MUSTScore",
  "title": "HCIM MUSTScore",
  "status": "active",
  "publisher": "Nictiz",
  "contact": [
    {
      "name": "Nictiz",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.nictiz.nl",
          "use": "work"
        }
      ]
    }
  ],
  "description": "A Observation resource as defined by the Dutch HCIM MUSTScore-v3.0(2017EN). The Malnutrition Universal Screening Tool (MUST) is a (validated) diagnostic screening tool for determining the extent of a patient’s malnutrition. For this screening tool, every patient’s Body Mass Index (BMI) and weight loss percentage is calculated, after which the patient is assigned a disease factor. The MUST helps to recognize and treat malnutrition at an early stage. (Source: Guidelines for Screening and Treating Malnutrition.)",
  "purpose": "#Purpose\r\nThe MUST score is used to determine the extent of malnutrition or the risk of malnutrition. To treat malnutrition quickly and effectively, it is important to identify the malnutrition at an early stage.\r\n\r\n#Rationale\r\nHL7 uses observations for defining scores like APGAR, to stay consistent, Nictiz chose to the Observation resource too.",
  "copyright": "CC0",
  "fhirVersion": "3.0.2",
  "mapping": [
    {
      "identity": "hcim-MUSTscore-v3.0-2017EN",
      "uri": "https://zibs.nl/wiki/MUSTScore-v3.0(2017EN)",
      "name": "MUSTScore-v3.0(2017EN)"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://fhir.nl/fhir/StructureDefinition/nl-core-observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "MUSTScore",
        "definition": "The Malnutrition Universal Screening Tool (MUST) is a (validated) diagnostic screening tool for determining the extent of a patient’s malnutrition.  \r\nFor this screening tool, every patient’s Body Mass Index (BMI) and  \r\nweight loss percentage is calculated, after which the patient is assigned a disease factor. The MUST helps to recognize and treat malnutrition at an early stage. \r\n \r\n(Source: Guidelines for Screening and Treating Malnutrition.)",
        "alias": [
          "MUSTScore"
        ],
        "mapping": [
          {
            "identity": "hcim-MUSTscore-v3.0-2017EN",
            "map": "NL-CM:4.5.1",
            "comment": "MUSTScore"
          }
        ]
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.code.coding:MUSTScoreCode",
        "path": "Observation.code.coding",
        "sliceName": "MUSTScoreCode",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.code.coding:MUSTScoreCode.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "Observation.code.coding:MUSTScoreCode.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "fixedCode": "444297006"
      },
      {
        "id": "Observation.code.coding:MUSTScoreCode.display",
        "path": "Observation.code.coding.display",
        "defaultValueString": "Malnutrition universal screening tool"
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "short": "MUSTScoreDateTime",
        "definition": "The date and time at which the MUST score was determined.",
        "alias": [
          "MUSTScoreDatumTijd"
        ],
        "min": 1,
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.6",
            "comment": "MUSTScoreDateTime"
          }
        ]
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "short": "TotalScore",
        "definition": "The total score is the sum of all the individual scores. The total score has a range from 0 - 6.",
        "alias": [
          "TotaalScore"
        ],
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.2",
            "comment": "TotalScore"
          }
        ]
      },
      {
        "id": "Observation.value[x].value",
        "path": "Observation.value[x].value",
        "minValueDecimal": 0,
        "maxValueDecimal": 6
      },
      {
        "id": "Observation.comment",
        "path": "Observation.comment",
        "definition": "A comment on the circumstances during the measurement.",
        "alias": [
          "Toelichting"
        ],
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.7",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "code"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:WeightLossScore",
        "path": "Observation.component",
        "sliceName": "WeightLossScore",
        "max": "1"
      },
      {
        "id": "Observation.component:WeightLossScore.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "4.5.4"
            }
          ]
        }
      },
      {
        "id": "Observation.component:WeightLossScore.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Weight loss score"
      },
      {
        "id": "Observation.component:WeightLossScore.value[x]",
        "path": "Observation.component.value[x]",
        "short": "WeightLossScore",
        "definition": "The score based on undesired weight loss over the past month(s).",
        "alias": [
          "GewichtsverliesScore"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "example": [
          {
            "label": "Example of WeightLossScore",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.4.2",
                  "code": "G0",
                  "display": "LossLow"
                }
              ]
            }
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "MUSTGewichtsverliesScoreCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.5.2--20171231000000"
          }
        },
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.4",
            "comment": "WeightLossScore"
          }
        ]
      },
      {
        "id": "Observation.component:BMIScore",
        "path": "Observation.component",
        "sliceName": "BMIScore",
        "max": "1"
      },
      {
        "id": "Observation.component:BMIScore.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "4.5.3"
            }
          ]
        }
      },
      {
        "id": "Observation.component:BMIScore.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "BMI score"
      },
      {
        "id": "Observation.component:BMIScore.value[x]",
        "path": "Observation.component.value[x]",
        "short": "BMIScore",
        "definition": "A person’s Body Mass Index (BMI), also known as their Quetelet index (QI), is an index indicating the ratio between a person’s height and weight. This BMI is expressed in kg/m2.",
        "alias": [
          "BMIScore"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "example": [
          {
            "label": "Example of BMIScore",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.4.1",
                  "code": "B0",
                  "display": "BMIHigh"
                }
              ]
            }
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "BMIScoreCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.5.1--20171231000000"
          }
        },
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.3",
            "comment": "BMIScore"
          }
        ]
      },
      {
        "id": "Observation.component:IllnessScore",
        "path": "Observation.component",
        "sliceName": "IllnessScore",
        "max": "1"
      },
      {
        "id": "Observation.component:IllnessScore.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "4.5.5"
            }
          ]
        }
      },
      {
        "id": "Observation.component:IllnessScore.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Illness score"
      },
      {
        "id": "Observation.component:IllnessScore.value[x]",
        "path": "Observation.component.value[x]",
        "short": "IllnessScore",
        "definition": "Illness can result in reduced food intake, leading to a higher risk of malnutrition.\r\nThe IllnessScore concept is used to indicate that the patient is seriously ill and that the patient has not eaten for more than 5 days or that there is a chance that the patient has not eaten for more than 5 days.",
        "alias": [
          "ZiekteScore"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "example": [
          {
            "label": "Example of IllnessScore",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.4.3",
                  "code": "Z1",
                  "display": "Ziek"
                }
              ]
            }
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "ZiekteScoreCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.4.5.3--20171231000000"
          }
        },
        "mapping": [
          {
            "identity": "hcim-MUSTScore-v3.0-2017EN",
            "map": "NL-CM:4.5.5",
            "comment": "IllnessScore"
          }
        ]
      }
    ]
  }
}