Release 4

Procedure-example-biopsy.json

Patient Care Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Encounter, Patient, Practitioner, RelatedPerson

Raw JSON (canonical form + also see JSON Format Specification)

Example of a Biopsy

{
  "resourceType": "Procedure",
  "id": "biopsy",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Biopsy of suspected melanoma L) arm</div>"
  },
  "status": "completed",
  "category": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "103693007",
        "display": "Diagnostic procedure (procedure)"
      }
    ],
    "text": "Diagnostic procedure"
  },
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "90105005",
        "display": "Biopsy of soft tissue of forearm (Procedure)"
      }
    ],
    "text": "Biopsy of suspected melanoma L) arm"
  },
  "subject": {
    "reference": "Patient/example"
  },
  "performedDateTime": "2014-02-03",
  "performer": [
    {
      "actor": {
        "reference": "Practitioner/example",
        "display": "Dr Bert Biopser"
      }
    }
  ],
  "reasonCode": [
    {
      "text": "Dark lesion l) forearm. getting darker last 3 months."
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "368225008",
          "display": "Entire Left Forearm"
        }
      ],
      "text": "Left forearm"
    }
  ],
  "complication": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "67750007",
          "display": "Ineffective airway clearance (finding)"
        }
      ],
      "text": "Ineffective airway clearance"
    }
  ],
  "followUp": [
    {
      "text": "Review in clinic"
    }
  ],
  "note": [
    {
      "text": "Standard Biopsy"
    }
  ],
  "usedCode": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "79068005",
          "display": "Needle, device (physical object)"
        }
      ],
      "text": "30-guage needle"
    }
  ]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.