Modifier

Partager via


Overview of ClinicalProcedure

CDM standard entities for 'ClinicalProcedure'

Entities

Name Description
ProcedureBasedOn A reference to a resource that contains details of the request for this procedure.
ProcedureBodySite Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
ProcedureCode
ProcedureComplication Any complications that occurred during the procedure, or in the immediate post-performance period.
ProcedureComplicationDetail Any complications that occurred during the procedure, or in the immediate post-performance period.
ProcedureDefinition A protocol, guideline, order set or other definition that was adhered to in whole or in part by this procedure.
ProcedureFocalDevice A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
ProcedureFollowUp If the procedure required specific follow up - e.g. removal of sutures. The followup may be represented as a simple note.
ProcedurePartOf A larger event of which this particular procedure is a component or step.
ProcedurePerformer Limited to 'real' people rather than equipment.
ProcedureReason The coded reason why the procedure was performed. This may be coded entity of some type, or may simply be present as text.
ProcedureReasonReference The condition that is the reason why the procedure was performed.
ProcedureReport Procedure report could represent histology result, pathology report, surgical report, etc.
ProcedureRequestBasedOn Plan/proposal/order fulfilled by this request.
ProcedureRequestBodySite Anatomic location where the procedure should be performed. This is the target site.
ProcedureRequestCategory A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
ProcedureRequestDefinition Protocol or definition followed by this request.
ProcedureRequestReasonCode An explanation or justification for why this diagnostic investigation is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in supp
ProcedureRequestReasonReference Indicates another resource that provides a justification for why this diagnostic investigation is being requested. May relate to the resources referred to in supporting Information.
ProcedureRequestRelevantHistory Key events in the history of the request.
ProcedureRequestReplace The request takes the place of the referenced completed or terminated request(s).
ProcedureRequestSpecimen One or more specimens that the laboratory procedure will use.
ProcedureRequestSupportingInformation Additional clinical information about the patient or specimen that may influence the procedure or diagnostics or their interpretations.
ProcedureUsedCode Identifies coded items that were used as part of the procedure.
ProcedureUsedReference Identifies medications, devices and any other substance used as part of the procedure.