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Resultaatdocument MDL bevolkingsonderzoek darmkanker 2.16.840.1.113883.2.4.3.11.60.136.10.900836
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2023‑09‑22 12:00:00 |
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Template voor CDA document resultaten bevolkingsonderzoek darmkanker voor screeningsorganisatie
maag-, darm-, levercentrum (transactie T4)
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CDA document level template
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Resultaatdocument MDL bevolkingsonderzoek darmkanker 2.16.840.1.113883.2.4.3.11.60.136.10.900836
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2023‑09‑22 12:00:00 |
v2022 |
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Template voor CDA document resultaten bevolkingsonderzoek darmkanker voor screeningsorganisatie
maag-, darm-, levercentrum (transactie T4)
Nader...
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CDA header level template
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Aanvang verrichting 2.16.840.1.113883.2.4.3.11.60.136.10.900005
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Template: Aanvang verrichting |
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Burger Service Nummer 2.16.840.1.113883.2.4.3.11.60.136.10.900014
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Template: BurgerServiceNummer |
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CDA Assigned Entity Identification 2.16.840.1.113883.2.4.3.11.60.136.10.900829
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Identificatie van zorgverlener. Bijzonderheden bij pathologen: de identificatie voor
een patholoog is of een UZI nummer of een door Stichting PALGA uitgegeven identificatie.
De OID van PALGA is 2.16....
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CDA authenticator 2.16.840.1.113883.2.4.3.11.60.136.10.900812
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CDA author 2.16.840.1.113883.2.4.3.11.60.136.10.100
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Auteur van het document |
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CDA confidentialityCode 2.16.840.1.113883.2.4.3.11.60.136.10.900805
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CDA custodian 2.16.840.1.113883.2.4.3.11.60.136.10.900810
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CDA documentationOf (MDL) 2.16.840.1.113883.2.4.3.11.60.136.10.900815
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Documentatie van de verrichting, hier MDL |
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CDA effectiveTime 2.16.840.1.113883.2.4.3.11.60.136.10.900804
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Date report was created, precise to the second |
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CDA id 2.16.840.1.113883.2.4.3.11.60.136.10.900802
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The clinical document id element is an instance identifier data type. The root
attribute is an OID. The root uniquely identifies the scope of the extension. The
root and extension attributes uniquel...
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CDA informationRecipient 2.16.840.1.113883.2.4.3.11.60.136.10.900811
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Beoogde ontvanger(s) van het document |
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CDA languageCode 2.16.840.1.113883.2.4.3.11.60.136.10.900806
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CDA legalAuthenticator 2.16.840.1.113883.2.4.3.11.60.136.10.900813
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Ondertekenaar |
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CDA participant as verifier 2.16.840.1.113883.2.4.3.11.60.136.10.900817
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CDA realmCode 2.16.840.1.113883.2.4.3.11.60.136.10.900800
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Country specific context |
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CDA recordTarget MDL 2.16.840.1.113883.2.4.3.11.60.136.10.900830
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De burger/cliënt |
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CDA relatedDocument 2.16.840.1.113883.2.4.3.11.60.136.10.900814
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CDA represented organization 2.16.840.1.113883.2.4.3.11.60.136.10.900809
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Identificatie van zorginstelling. Bijzonderheden bij pathologie labs: de identificatie
voor een pathologie lab is of een URA nummer of een door Stichting PALGA uitgegeven
identificatie. De OID van PA...
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CDA setId and versionNumber 2.16.840.1.113883.2.4.3.11.60.136.10.900807
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Elementen setId en versionNumber moeten aanwezig zijn, zelfs als dit het eerste (originele)
document is. Let wel: In PA lab-verslagen is setId het T-nummer, in MDL verslagen
is setId NIET het T-nummer...
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CDA title 2.16.840.1.113883.2.4.3.11.60.136.10.900803
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CDA typeId 2.16.840.1.113883.2.4.3.11.60.136.10.900801
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The clinical document typeId identifies the constraints imposed by CDA R2 on the
content, essentially acting as a version identifier. The @root and @extension
values of this element are specifie...
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CDA section level template
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Assessment Section 2.16.840.1.113883.2.4.3.11.60.136.10.205
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Assessment Section |
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Conclusion Colonoscopy Section 2.16.840.1.113883.2.4.3.11.60.136.10.208
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Conclusion Colonoscopy Section: overige bevindingen en eindconclusie |
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Plan of Care Section (dd) 2.16.840.1.113883.2.4.3.11.60.136.10.207
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Plan of Care Section |
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Procedure Description Section 2.16.840.1.113883.2.4.3.11.60.136.10.203
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Procedure Description Section |
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Procedure Findings Section 2.16.840.1.113883.2.4.3.11.60.136.10.204
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Procedure Findings Section |
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Procedure Indications Section 2.16.840.1.113883.2.4.3.11.60.136.10.202
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Procedure Indications Section |
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Salutation Section 2.16.840.1.113883.2.4.3.11.60.136.10.201
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Salutation Section |
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CDA entry level template
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Administration of sedative 2.16.840.1.113883.2.4.3.11.60.136.10.507
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Template: Level of consciousness |
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Assertion Colonoscopy Entry 2.16.840.1.113883.2.4.3.11.60.136.10.381
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Conclusion Colonoscopy Entry |
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Boston Bowel Preparation Scale 2.16.840.1.113883.2.4.3.11.60.136.10.310
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Template: Boston Bowel Preparation Scale |
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Boston Bowel Preparation Scale Left Colon 2.16.840.1.113883.2.4.3.11.60.136.10.313
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Template: Boston Bowel Preparation Scale Left Colon |
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Boston Bowel Preparation Scale Right Colon 2.16.840.1.113883.2.4.3.11.60.136.10.311
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Template: Boston Bowel Preparation Scale Right Colon |
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Boston Bowel Preparation Scale Transverse Colon 2.16.840.1.113883.2.4.3.11.60.136.10.312
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Template: Boston Bowel Preparation Scale Right Colon |
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Carcinoma passable 2.16.840.1.113883.2.4.3.11.60.136.10.427
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Template: Carcinoom is wel/niet te passeren |
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Carcinoom 2.16.840.1.113883.2.4.3.11.60.136.10.339
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Template: Carcinoom ja/nee en gegevens indien ja |
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CO2 insufflation 2.16.840.1.113883.2.4.3.11.60.136.10.322
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Template: CO2insufflatie |
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Conclusion Colonoscopy Entry 2.16.840.1.113883.2.4.3.11.60.136.10.380
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Conclusion Colonoscopy Entry |
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Diameter poliep 2.16.840.1.113883.2.4.3.11.60.136.10.900102
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Template: Diameterpoliep |
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Distance from anal verge 2.16.840.1.113883.2.4.3.11.60.136.10.344
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Template: Distance from anal verge |
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Distance from anal verge (laesie) 2.16.840.1.113883.2.4.3.11.60.136.10.348
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Template: Distance from anal verge |
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Distance of tumor from anal verge 2.16.840.1.113883.2.4.3.11.60.136.10.900120
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Template: Distance of tumor from anal verge |
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Dosage medication 2.16.840.1.113883.2.4.3.11.60.136.10.900028
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Template: Dosage sedation |
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Gloucester Comfort Score (GCS) 2.16.840.1.113883.2.4.3.11.60.136.10.328
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Template: Patiëntcomfort (GCS) |
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Indication 2.16.840.1.113883.2.4.3.11.60.136.10.382
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Template: Indicatie |
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Intubation of coecum 2.16.840.1.113883.2.4.3.11.60.136.10.329
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Template: Coecum intubatie |
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Klinische diagnose poliep 2.16.840.1.113883.2.4.3.11.60.136.10.900106
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Template: Klinische diagnose poliep |
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Lesions not obtained 2.16.840.1.113883.2.4.3.11.60.136.10.346
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Template: Aantal poliepen niet ingezonden / gegevens niet vastgelegd |
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Level of consciousness 2.16.840.1.113883.2.4.3.11.60.136.10.504
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Template: Level of consciousness |
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Max location reached 2.16.840.1.113883.2.4.3.11.60.136.10.330
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Template: Lokatie bereikt (maximale insertie) |
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Medication coloscopy 2.16.840.1.113883.2.4.3.11.60.136.10.900054
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Template: Medication coloscopy |
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Medication for preparation 2.16.840.1.113883.2.4.3.11.60.136.10.900088
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Template: Medication for preparation |
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Methodeverwijdering 2.16.840.1.113883.2.4.3.11.60.136.10.900121
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Template: Methode van verwijderen: in toto / piecemeal |
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Morfologie 2.16.840.1.113883.2.4.3.11.60.136.10.900109
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Template: Morfologie |
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Order placer number 2.16.840.1.113883.2.4.3.11.60.136.10.332
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Template: Order placer number, de opdrachtnummer uitgegeven door het MDL centrum |
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Overige klinische diagnose poliep 2.16.840.1.113883.2.4.3.11.60.136.10.900107
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Template: Overige klinische diagnose poliep |
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Pathology specimen submitted 2.16.840.1.113883.2.4.3.11.60.136.10.431
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Template: Pathology specimen submitted (procedure) |
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Patient counseling 2.16.840.1.113883.2.4.3.11.60.136.10.370
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Template: Patient counseling |
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Plan of treatment (dd) 2.16.840.1.113883.2.4.3.11.60.136.10.372
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Template: Planoftreatment (dd) |
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Preparation colonoscopy 2.16.840.1.113883.2.4.3.11.60.136.10.307
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Template: Preparation colonoscopy |
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Procedure time out 2.16.840.1.113883.2.4.3.11.60.136.10.342
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Template: Procedure time out |
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Reason cecum not reached 2.16.840.1.113883.2.4.3.11.60.136.10.343
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Template: Reason cecum not reached |
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Reason procedure not performed 2.16.840.1.113883.2.4.3.11.60.136.10.347
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Template: Reden poliep(en) niet ingezonden voor pathologie |
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Rectal retroflexion 2.16.840.1.113883.2.4.3.11.60.136.10.331
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Template: Retroflexie rectum |
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Reden afbreking coloscopie 2.16.840.1.113883.2.4.3.11.60.136.10.334
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Template: Reden afbreking coloscopie; dit wordt gebruikt in verband met een entryRelationship
typeCode SUBJ (suject) maar met inversionInd = true
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Resultaatverwijdering 2.16.840.1.113883.2.4.3.11.60.136.10.900122
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Template: Resultaatverwijdering |
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Results colonoscopy 2.16.840.1.113883.2.4.3.11.60.136.10.320
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Retraction time colonoscopy 2.16.840.1.113883.2.4.3.11.60.136.10.323
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Template: Retractiontime colonoscopy |
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Sedation management 2.16.840.1.113883.2.4.3.11.60.136.10.502
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Sedation management |
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Sedation/relaxation medication administration 2.16.840.1.113883.2.4.3.11.60.136.10.503
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Template: Sedation medication administration |
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Specimen Cluster (dd) 2.16.840.1.113883.2.4.3.11.60.136.10.383
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Template: Specimen Cluster (DD) |
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Specimen collection 2.16.840.1.113883.2.4.3.11.60.136.10.333
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Template: Specimen collection |
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Stenosis of colon 2.16.840.1.113883.2.4.3.11.60.136.10.424
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Template: Stenosis of colon |
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Tattooing 2.16.840.1.113883.2.4.3.11.60.136.10.900118
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Template: Tattooing |
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Total number of lesions 2.16.840.1.113883.2.4.3.11.60.136.10.345
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Template: Totaal aantal gedetecteerde poliepen |
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Type of preparation 2.16.840.1.113883.2.4.3.11.60.136.10.341
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Template: Type of preparation |
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Verslag identificatie pathologie 2.16.840.1.113883.2.4.3.11.60.136.10.338
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Template: Verslag identificatie pathologie Pathologieverslagen worden geïdentificeerd
met T-nummers of pa-nummers. Een verslag wordt normaal aangeduid met een pa-nummer:
Xjj-nnnnn (b.v. T12-60123). E...
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