A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

bedingtes Pflichtfeld/bedingtes MS: Alle von einem Server bereitgestellten Ressourcen MÜSSEN über eine id verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine idverfügen.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Begründung Constraint: In ISiK existiert kein Use-Case für dieses Element. Da es sich um ein Modifying Element handelt, wird es daher ausgeschlossen. Darüber hinaus werden die Regeln als URI vorgehalten. Dies führt dazu, dass sich hinter der URI eine beliebige Menge an Regeln befinden kann; wodurch nicht sichergestellt werden kann, dass alle Clients die Regeln korrekt interpretieren können.

An Extension

Optional Extension Element - found in all resources.

Im ambulanten Kontext ist es üblich, abrechnungsrelevante Diagnosen und Prozeduren anzugeben, ohne sie in Haupt- und Nebendiagnosen aufzuteilen. Da dies in der praxis trotzdem teilweise passiert, ist die Nutzung dieser Extension hier nicht ausgeschlossen.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

An Extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

An Extension

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

Optional Extension Element - found in all resources.

Diese Extension ermöglicht es, Diagnosen und Prozeduren als abrechnungsrelevant im Abrechnungskontext zu kennzeichnen, unabhängig von der medizinischen Relevanz, die in Encounter.diagnosis erfolgt.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Über die mit MS gekennzeichneten Slices hinaus können weitere Identifier vorkommen, ohne, dass eine ISiK Inkompatibilität besteht. Verarbeitet werden müssen aber nur die folgenden Slices.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Im DRG-Kontext werden häufig sämtliche Besuche (Encounter), die unter einen gemeinsamen Abrechnungskontext zusammengefasst werden, unter einer 'Fallnummer' geführt. In dieser Konstellation sind die Begriffe 'Fallnummer' und 'Abrechnungsfallnummer' gleichbedeutend.
Dies ist insbesondere im Kontext des Mappings zwischen HL7 V2 und HL7 FHIR zu beachten, da es in V2 Usus ist, die Fallnummer (eigentlich Identifier des Abrechnungsfalles) im PV1-Segment (Patient Visit) zu übermitteln. Es handelt sich dabei jedoch nicht um den Identifier des Besuchs (Encounter) sondern den des Abrechnungsfalles (Account), da der Identifier oft für die Gruppierung mehrerer Besuche (z.B. vorstationär + stationär + nachstationär) mit gemeinsamem (DRG)-Kontext verwendet wird.
Die Abrechnungsfallnummer in Account.identifier muss identisch sein mit dem Identifier, der bei den Encountern, die unter diesem Account gruppiert werden, unter Encounter.account.identifier angegeben ist.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

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.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

A reference to a code defined by a terminology system.

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 labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

The identification of the code system that defines the meaning of the symbol in the code.

Hier ist stets der Wert http://terminology.hl7.org/CodeSystem/v2-0203 anzugeben.

Need to be unambiguous about the source of the definition of the symbol.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Hier ist stets der Wert AN anzugeben.

Need to refer to a particular code in the system.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Hier ist stets der eindeutige Name (URL) des Namensraums anzugeben, aus dem der Identifier stammt. Hinweise zur Festlegung der URLs für lokale Namensräume sind in den Deutschen Basisprofilen beschrieben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Enthält den eigentlichen Wert des Identifiers.
Begründung Pflichtfeld: Ist der Wert nicht bekannt, sollte der gesamte Slice weggelassen werden.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Die Scheinnummer ist eine Nummer, die in der ambulanten Versorgung in Deutschland verwendet wird. Da im Krankenhaus und in den zum Einsatz kommenden Primärsystemen auch ambulante Leistungen erbracht und dokumentieert werden, kann es also vorkommen, dass neben einer Fallnummer auch eine Scheinnummer vorliegt. Diese ist allerdings vom System selber vergeben und wie die Fall- bzw. Patientennummer nicht eindeutig über Systemgrenzen hinweg.

**Hinweis:**Im Kontext eines ambulanten BG Falls gibt es keine Scheinnummer.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

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.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

A reference to a code defined by a terminology system.

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 labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

The identification of the code system that defines the meaning of the symbol in the code.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

Need to be unambiguous about the source of the definition of the symbol.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Hier ist stets der Wert ASN anzugeben.

Need to refer to a particular code in the system.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Hier ist stets der eindeutige Name (URL) des Namensraums anzugeben, aus dem der Identifier stammt. Hinweise zur Festlegung der URLs für lokale Namensräume sind in den Deutschen Basisprofilen beschrieben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Enthält den eigentlichen Wert des Identifiers.
Begründung Pflichtfeld: Ist der Wert nicht bekannt, sollte der gesamte Slice weggelassen werden.

Indicates whether the account is presently used/usable or not.

Zeigt den aktuellen Status der Ressource an.
WICHTIGER Hinweis für Implementierer:

• Alle server-seitigen Implementierungen MÜSSEN in der Lage sein, die systemintern möglichen Statuswerte korrekt in FHIR abzubilden, mindestens jedoch active und inactive.
• Alle client-seitigen Implementierungen MÜSSEN in der Lage sein, sämtliche Status-Codes zu interpretieren und dem Anwender in angemessener Form darstellen zu können, beispielsweise durch Ausblenden/Durchstreichen von Ressourcen mit dem status entered-in-error und Ausgrauen von Ressourcen, die einen Plan- oder Entwurfs-Status haben.

Indicates whether the account is available to be used.

Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account.

Begründung Pflichtfeld: Ein Patientenbezug des Falls muss stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Begründung Pflichtfeld: Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu ISiKPatient sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.

The date range of services associated with this account.

Begründung MS: Im Kontext der Abbildung von ambulanten Behandlungen im Krankenhaus ist die Angabe eines Gültigkeitszeitraum notwendig, da es sich hierbei um punktuelle Kontakte handelt und der Zeitraum der Gültigkeit nicht direkt aus den zugeordneten Encountern ableitbar ist.

The party(s) that are responsible for covering the payment of this account, and what order should they be applied to the account.

Auflistung aller Versicherungs- und oder (Selbst-/Fremd-)zahlerverhältnisse, die zur Abrechnung der in diesem Kontext erbrachten Leistungen herangezogen werden können.

An Extension

Optional Extension Element - found in all resources.

Art der Abrechnung, für die das Versicherungsverhältnis herangezogen wird. Die Abrechnungsart bezieht sich auf die Hauptversicherung über die der Fall abgerechnet wird. Bei initialen Fallanlage kann es vorkommen, dass die Abrechnungsart noch nicht bekannt ist (z.B. Unklare Versicherungszugehörigkeit, Rückfragen an den Kostenträger, Ungeklärte Zusatzleistungen). Sobald bekannt, SOLL angegeben werden, in welcher Abrechnungsart die Abrechnung erfolgt.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The party(s) that contribute to payment (or part of) of the charges applied to this account (including self-pay).

A coverage may only be responsible for specific types of charges, and the sequence of the coverages in the account could be important when processing billing.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Begründung Pflichtfeld: Die Verlinkung auf eine Coverage-Ressource dient der technischen Zuordnung zwischen Abrechnungsfall und Versicherungsverhältnis und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc.

The priority of the coverage in the context of this account.

Begründung des MS: Wenn ein Primärsystem mehrere Kostenträger angibt, sollte für lesende Systeme ersichtlich sein, welches der Hauptkostenträger ist.
Historie:
Diskussionstand der ISIK-Arbeitsgruppe vom 28.5.: Die Abbildung über einen Integer ist wünschenswert. Eine binäre Einteilung in Hauptkostenträger (1) und alle anderen (2) wird der Komplexität der Priorisierung zur Kostenträgerschaft nicht gerecht. Eine Ausdifferenzierung ist wünschenswert und sollte angestrebt werden.

Indicates the service area, hospital, department, etc. with responsibility for managing the Account.

Begründung MS: Bei einer ambulanten Behandlung im Krankenhaus ist es wichtig, die Ambulanz als verantwortliche Organisation zu dokumentieren. Aus diesem Grund wurde hier ein MS ergänzt.

Hinweis: Bei ambulanten Fällen steht nicht automatisch das Krankenhaus als abrechnende Organisation gegenüber dem Kostenträger auf der Rechnung. Deshlab ist es im ambulanten Kontext besonders wichtig, hier die Organisation anzugeben.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Hier sind verschiedene im ambulanten Kontext vorkommende Identifier denkbar. Zur Orientierung wird im ISiK Kontext auf die Identifier einer KBV Base Organization verwiesen, da diese bereits die relevanten Identifier für die ambulante Versorgung enthält.

Plain text narrative that identifies the resource in addition to the resource reference.

Hier ist der Name der managenden Organisation anzugeben, beispielsweise die Ambulanz, die für die Behandlung verantwortlich ist.

Im ambulanten Kontext ist es üblich, abrechnungsrelevante Diagnosen und Prozeduren anzugeben, ohne sie in Haupt- und Nebendiagnosen aufzuteilen. Da dies in der praxis trotzdem teilweise passiert, ist die Nutzung dieser Extension hier nicht ausgeschlossen.

Diese Extension ermöglicht es, Diagnosen und Prozeduren als abrechnungsrelevant im Abrechnungskontext zu kennzeichnen, unabhängig von der medizinischen Relevanz, die in Encounter.diagnosis erfolgt.

Die Scheinnummer ist eine Nummer, die in der ambulanten Versorgung in Deutschland verwendet wird. Da im Krankenhaus und in den zum Einsatz kommenden Primärsystemen auch ambulante Leistungen erbracht und dokumentieert werden, kann es also vorkommen, dass neben einer Fallnummer auch eine Scheinnummer vorliegt. Diese ist allerdings vom System selber vergeben und wie die Fall- bzw. Patientennummer nicht eindeutig über Systemgrenzen hinweg.

**Hinweis:**Im Kontext eines ambulanten BG Falls gibt es keine Scheinnummer.

Hier ist stets der Wert ASN anzugeben.

Hier ist stets der eindeutige Name (URL) des Namensraums anzugeben, aus dem der Identifier stammt. Hinweise zur Festlegung der URLs für lokale Namensräume sind in den Deutschen Basisprofilen beschrieben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

Enthält den eigentlichen Wert des Identifiers.
Begründung Pflichtfeld: Ist der Wert nicht bekannt, sollte der gesamte Slice weggelassen werden.

Begründung MS: Im Kontext der Abbildung von ambulanten Behandlungen im Krankenhaus ist die Angabe eines Gültigkeitszeitraum notwendig, da es sich hierbei um punktuelle Kontakte handelt und der Zeitraum der Gültigkeit nicht direkt aus den zugeordneten Encountern ableitbar ist.

Begründung MS: Bei einer ambulanten Behandlung im Krankenhaus ist es wichtig, die Ambulanz als verantwortliche Organisation zu dokumentieren. Aus diesem Grund wurde hier ein MS ergänzt.

Hinweis: Bei ambulanten Fällen steht nicht automatisch das Krankenhaus als abrechnende Organisation gegenüber dem Kostenträger auf der Rechnung. Deshlab ist es im ambulanten Kontext besonders wichtig, hier die Organisation anzugeben.

Hier sind verschiedene im ambulanten Kontext vorkommende Identifier denkbar. Zur Orientierung wird im ISiK Kontext auf die Identifier einer KBV Base Organization verwiesen, da diese bereits die relevanten Identifier für die ambulante Versorgung enthält.

Hier ist der Name der managenden Organisation anzugeben, beispielsweise die Ambulanz, die für die Behandlung verantwortlich ist.

A financial tool for tracking value accrued for a particular purpose. In the healthcare field, used to track charges for a patient, cost centers, etc.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

bedingtes Pflichtfeld/bedingtes MS: Alle von einem Server bereitgestellten Ressourcen MÜSSEN über eine id verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine idverfügen.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

Alle von einem Server bereitgestellten Ressourcen SOLLEN über eine versionID verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine versionIDverfügen.

When the resource last changed - e.g. when the version changed.

Alle von einem Server bereitgestellten Ressourcen SOLLEN über ein lastUpdate verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über ein lastUpdateverfügen.

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Begründung Constraint: In ISiK existiert kein Use-Case für dieses Element. Da es sich um ein Modifying Element handelt, wird es daher ausgeschlossen. Darüber hinaus werden die Regeln als URI vorgehalten. Dies führt dazu, dass sich hinter der URI eine beliebige Menge an Regeln befinden kann; wodurch nicht sichergestellt werden kann, dass alle Clients die Regeln korrekt interpretieren können.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

Optional Extension Element - found in all resources.

Im ambulanten Kontext ist es üblich, abrechnungsrelevante Diagnosen und Prozeduren anzugeben, ohne sie in Haupt- und Nebendiagnosen aufzuteilen. Da dies in der praxis trotzdem teilweise passiert, ist die Nutzung dieser Extension hier nicht ausgeschlossen.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

An Extension

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

An Extension

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

Optional Extension Element - found in all resources.

Diese Extension ermöglicht es, Diagnosen und Prozeduren als abrechnungsrelevant im Abrechnungskontext zu kennzeichnen, unabhängig von der medizinischen Relevanz, die in Encounter.diagnosis erfolgt.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Über die mit MS gekennzeichneten Slices hinaus können weitere Identifier vorkommen, ohne, dass eine ISiK Inkompatibilität besteht. Verarbeitet werden müssen aber nur die folgenden Slices.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Im DRG-Kontext werden häufig sämtliche Besuche (Encounter), die unter einen gemeinsamen Abrechnungskontext zusammengefasst werden, unter einer 'Fallnummer' geführt. In dieser Konstellation sind die Begriffe 'Fallnummer' und 'Abrechnungsfallnummer' gleichbedeutend.
Dies ist insbesondere im Kontext des Mappings zwischen HL7 V2 und HL7 FHIR zu beachten, da es in V2 Usus ist, die Fallnummer (eigentlich Identifier des Abrechnungsfalles) im PV1-Segment (Patient Visit) zu übermitteln. Es handelt sich dabei jedoch nicht um den Identifier des Besuchs (Encounter) sondern den des Abrechnungsfalles (Account), da der Identifier oft für die Gruppierung mehrerer Besuche (z.B. vorstationär + stationär + nachstationär) mit gemeinsamem (DRG)-Kontext verwendet wird.
Die Abrechnungsfallnummer in Account.identifier muss identisch sein mit dem Identifier, der bei den Encountern, die unter diesem Account gruppiert werden, unter Encounter.account.identifier angegeben ist.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

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.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A reference to a code defined by a terminology system.

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 labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The identification of the code system that defines the meaning of the symbol in the code.

Hier ist stets der Wert http://terminology.hl7.org/CodeSystem/v2-0203 anzugeben.

Need to be unambiguous about the source of the definition of the symbol.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Hier ist stets der Wert AN anzugeben.

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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.

Very often the text is the same as a displayName of one of the codings.

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.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Hier ist stets der eindeutige Name (URL) des Namensraums anzugeben, aus dem der Identifier stammt. Hinweise zur Festlegung der URLs für lokale Namensräume sind in den Deutschen Basisprofilen beschrieben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Enthält den eigentlichen Wert des Identifiers.
Begründung Pflichtfeld: Ist der Wert nicht bekannt, sollte der gesamte Slice weggelassen werden.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Unique identifier used to reference the account. Might or might not be intended for human use (e.g. credit card number).

Die Scheinnummer ist eine Nummer, die in der ambulanten Versorgung in Deutschland verwendet wird. Da im Krankenhaus und in den zum Einsatz kommenden Primärsystemen auch ambulante Leistungen erbracht und dokumentieert werden, kann es also vorkommen, dass neben einer Fallnummer auch eine Scheinnummer vorliegt. Diese ist allerdings vom System selber vergeben und wie die Fall- bzw. Patientennummer nicht eindeutig über Systemgrenzen hinweg.

**Hinweis:**Im Kontext eines ambulanten BG Falls gibt es keine Scheinnummer.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

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.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A reference to a code defined by a terminology system.

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 labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The identification of the code system that defines the meaning of the symbol in the code.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

Need to be unambiguous about the source of the definition of the symbol.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

Hier ist stets der Wert ASN anzugeben.

Need to refer to a particular code in the system.

A representation of the meaning of the code in the system, following the rules of the system.

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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.

Very often the text is the same as a displayName of one of the codings.

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.

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Hier ist stets der eindeutige Name (URL) des Namensraums anzugeben, aus dem der Identifier stammt. Hinweise zur Festlegung der URLs für lokale Namensräume sind in den Deutschen Basisprofilen beschrieben.
Begründung Pflichtfeld: system stellt in Kombination mit value die Eindeutigkeit eines Identifiers sicher.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Enthält den eigentlichen Wert des Identifiers.
Begründung Pflichtfeld: Ist der Wert nicht bekannt, sollte der gesamte Slice weggelassen werden.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Indicates whether the account is presently used/usable or not.

Zeigt den aktuellen Status der Ressource an.
WICHTIGER Hinweis für Implementierer:

• Alle server-seitigen Implementierungen MÜSSEN in der Lage sein, die systemintern möglichen Statuswerte korrekt in FHIR abzubilden, mindestens jedoch active und inactive.
• Alle client-seitigen Implementierungen MÜSSEN in der Lage sein, sämtliche Status-Codes zu interpretieren und dem Anwender in angemessener Form darstellen zu können, beispielsweise durch Ausblenden/Durchstreichen von Ressourcen mit dem status entered-in-error und Ausgrauen von Ressourcen, die einen Plan- oder Entwurfs-Status haben.

Indicates whether the account is available to be used.

Categorizes the account for reporting and searching purposes.

The usage type of this account, permits categorization of accounts.

Name used for the account when displaying it to humans in reports, etc.

Identifies the entity which incurs the expenses. While the immediate recipients of services or goods might be entities related to the subject, the expenses were ultimately incurred by the subject of the Account.

Begründung Pflichtfeld: Ein Patientenbezug des Falls muss stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Begründung Pflichtfeld: Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu ISiKPatient sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).