1.2.276.0.76.10.3044/static-2014-09-16T000000: Unterschied zwischen den Versionen

Version vom 19. April 2015, 18:14 Uhr

Template Vitalparameter / VitalSignsSection

Id 1.2.276.0.76.10.3044

Klassifikation CDA section level template

Kontext Elternknoten des Template-Element mit Id 1.2.276.0.76.10.3044

Version gültig ab 2014‑09‑16 Status In Entwicklung

Offen/Geschlossen Offen (auch andere als die definierten Elemente sind erlaubt)

Beschreibung Vitalparameter und Scores Section

Assoziiert mit

Assoziiert mit 1 Konzept

Id	Name	Datensatz
aktin-dataelement2014.1-10006	Vitalparameter und Scores	AKTIN-Datensatz

Benutzt von / Benutzt

Benutzt von / Benutzt 10 Templates

Benutzt von Template-Id	als	Name	Version
1.2.276.0.76.10.1015	Containment	EmergencymedicineNoteCDAdocument Emergency medicine Note CDA document	2014‑09‑18
Benutzt Template-Id	als	Name	Version
1.2.276.0.76.10.4030	Containment	RespiratoryRate	DYNAMIC
1.2.276.0.76.10.4031	Containment	OxygenSaturation	DYNAMIC
1.2.276.0.76.10.4032	Containment	Systolicbloodpressure	DYNAMIC
1.2.276.0.76.10.4033	Containment	HeartRate	DYNAMIC
1.2.276.0.76.10.4034	Containment	GlasgowComaScale	DYNAMIC
1.2.276.0.76.10.4046	Containment	Pupilsize	DYNAMIC
1.2.276.0.76.10.4047	Containment	Pupilreaction	DYNAMIC
1.2.276.0.76.10.4035	Containment	BodyTemperatureCore	DYNAMIC
1.2.276.0.76.10.4036	Containment	Painseverity	DYNAMIC

Beziehung Spezialisierung: Template 2.16.840.1.113883.10.12.201 (2005‑09‑07)
Adaptation: Template 2.16.840.1.113883.17.3.10.1.23 (DYNAMIC)

Beispiel <section classCode="DOCSECT"> <templateId root="2.16.840.1.113883.2.60.3.10.3.1"/> <code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Vital signs"/> <title>Vitalparameter</title> <text>...</text> <entry>  </entry></section>

Item DT Kard Konf Beschreibung Label

hl7:section

(VitalSignsSection)

@classCode

0 .. 1

F

DOCSECT

Ziel der Konzept Id(s):

aktin-dataelement2014.1-10006

Vitalparameter und Scores

hl7:templateId

II

1 .. 1

(VitalSignsSection)

@root

1 .. 1

F

1.2.276.0.76.10.3044

hl7:code

CD

1 .. 1

M

(VitalSignsSection)

@code

1 .. 1

F

8716-3

@codeSystem

1 .. 1

F

2.16.840.1.113883.6.1 (Logical Observation Identifier Names and Codes)

hl7:title

ST

1 .. 1

M

(VitalSignsSection)

hl7:text

SD.TEXT

1 .. 1

M

(VitalSignsSection)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4030 Atemfrequenz (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4031 Sauerstoffsättigung (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4032 Blutdruck systolisch (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4033 Herzfrequenz (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4034 Glasgow Coma Scale (DYNAMIC)

Schematron assert role error

test

count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4046']]

[hl7:targetSiteCode[@code='362503005']])<=1 and count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4046']

[hl7:targetSiteCode[@code='362502000']])<=1

Meldung Pupillenweite max 1x link und 1x rechts angeben

hl7:entry

0 .. 2

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4046 Pupillenweite (DYNAMIC)

Schematron assert role error

test

count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4047']]

[hl7:targetSiteCode[@code='362503005']])<=1 and count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4047']]

[hl7:targetSiteCode[@code='362502000']])<=1

Meldung Pupillenreaktion max 1x link und 1x rechts angeben

hl7:entry

0 .. 2

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4047 Pupillenreaktion (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4035 Körperkerntemperatur (DYNAMIC)

hl7:entry

0 .. 1

R

(VitalSignsSection)

@typeCode

cs

1 .. 1

F

COMP

@contextConductionInd

bl

0 .. 1

F

true

Beinhaltet 1.2.276.0.76.10.4036 Schmerz (DYNAMIC)

@@ Zeile 5: / Zeile 5: @@
 .2.276.0.76.10.4033 <i xmlns="http://www.w3.org/1999/xhtml">Herzfrequenz</i> (DYNAMIC)</td></tr><tr style="background-color: #FFEAEA;"><td xmlns="" style="vertical-align: top;"><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>hl7:entry<br /></strong></tt></td></tr></table></td><td xmlns="" style="vertical-align: top;"><strong xmlns="http://www.w3.org/1999/xhtml"></strong></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>0 .. 1</strong></span></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>R</strong></span></td><td xmlns=""></td><td xmlns="" style="background-color: #FFEEEE">(VitalSignsSection)</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@typeCode<br /></strong></tt></td></tr></table></td><td xmlns="">cs</td><td xmlns="">1 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">COMP</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@context&#8203;Conduction&#8203;Ind<br /></strong></tt></td></tr></table></td><td xmlns="">bl</td><td xmlns="">0 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">true</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Beinhaltet</td><td xmlns="" style="background-color: #FFEEAA" colspan="3">
 .2.276.0.76.10.4034 <i xmlns="http://www.w3.org/1999/xhtml">Glasgow Coma Scale</i> (DYNAMIC)</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" rowspan="3" class="stron">Schematron assert</td><td xmlns="" style="background-color: #FFEEEE">role</td><td xmlns="" colspan="2">[[Datei:Reddot.gif]] error</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">test</td><td xmlns="" colspan="2">count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4046']]
-[hl7:targetSiteCode[@code='362503005']])&lt;=1 and count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4046']
+[hl7:targetSiteCode[@code='362503005']])&lt;=1 and
+count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4046']
 [hl7:targetSiteCode[@code='362502000']])&lt;=1</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Meldung</td><td xmlns="" colspan="2"><span xmlns="http://www.w3.org/1999/xhtml" class="pptext">Pupillenweite max 1x link und 1x rechts angeben</span></td></tr><tr style="background-color: #FFEAEA;"><td xmlns="" style="vertical-align: top;"><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>hl7:entry<br /></strong></tt></td></tr></table></td><td xmlns="" style="vertical-align: top;"><strong xmlns="http://www.w3.org/1999/xhtml"></strong></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>0 .. 2</strong></span></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>R</strong></span></td><td xmlns=""></td><td xmlns="" style="background-color: #FFEEEE">(VitalSignsSection)</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@typeCode<br /></strong></tt></td></tr></table></td><td xmlns="">cs</td><td xmlns="">1 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">COMP</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@context&#8203;Conduction&#8203;Ind<br /></strong></tt></td></tr></table></td><td xmlns="">bl</td><td xmlns="">0 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">true</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Beinhaltet</td><td xmlns="" style="background-color: #FFEEAA" colspan="3">
 .2.276.0.76.10.4046 <i xmlns="http://www.w3.org/1999/xhtml">Pupillenweite</i> (DYNAMIC)</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" rowspan="3" class="stron">Schematron assert</td><td xmlns="" style="background-color: #FFEEEE">role</td><td xmlns="" colspan="2">[[Datei:Reddot.gif]] error</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">test</td><td xmlns="" colspan="2">count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4047']]
-[hl7:targetSiteCode[@code='362503005']])&lt;=1 and count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4047']]
+[hl7:targetSiteCode[@code='362503005']])&lt;=1 and
+count(hl7:entry/hl7:observation[hl7:templateId[@root='1.2.276.0.76.10.4047']]
 [hl7:targetSiteCode[@code='362502000']])&lt;=1</td></tr><tr style="vertical-align: top;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Meldung</td><td xmlns="" colspan="2"><span xmlns="http://www.w3.org/1999/xhtml" class="pptext">Pupillenreaktion max 1x link und 1x rechts angeben</span></td></tr><tr style="background-color: #FFEAEA;"><td xmlns="" style="vertical-align: top;"><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>hl7:entry<br /></strong></tt></td></tr></table></td><td xmlns="" style="vertical-align: top;"><strong xmlns="http://www.w3.org/1999/xhtml"></strong></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>0 .. 2</strong></span></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>R</strong></span></td><td xmlns=""></td><td xmlns="" style="background-color: #FFEEEE">(VitalSignsSection)</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@typeCode<br /></strong></tt></td></tr></table></td><td xmlns="">cs</td><td xmlns="">1 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">COMP</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@context&#8203;Conduction&#8203;Ind<br /></strong></tt></td></tr></table></td><td xmlns="">bl</td><td xmlns="">0 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">true</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Beinhaltet</td><td xmlns="" style="background-color: #FFEEAA" colspan="3">
 .2.276.0.76.10.4047 <i xmlns="http://www.w3.org/1999/xhtml">Pupillenreaktion</i> (DYNAMIC)</td></tr><tr style="background-color: #FFEAEA;"><td xmlns="" style="vertical-align: top;"><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>hl7:entry<br /></strong></tt></td></tr></table></td><td xmlns="" style="vertical-align: top;"><strong xmlns="http://www.w3.org/1999/xhtml"></strong></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>0 .. 1</strong></span></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>R</strong></span></td><td xmlns=""></td><td xmlns="" style="background-color: #FFEEEE">(VitalSignsSection)</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@typeCode<br /></strong></tt></td></tr></table></td><td xmlns="">cs</td><td xmlns="">1 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">COMP</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@context&#8203;Conduction&#8203;Ind<br /></strong></tt></td></tr></table></td><td xmlns="">bl</td><td xmlns="">0 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">true</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Beinhaltet</td><td xmlns="" style="background-color: #FFEEAA" colspan="3">
 .2.276.0.76.10.4035 <i xmlns="http://www.w3.org/1999/xhtml">Körperkerntemperatur</i> (DYNAMIC)</td></tr><tr style="background-color: #FFEAEA;"><td xmlns="" style="vertical-align: top;"><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>hl7:entry<br /></strong></tt></td></tr></table></td><td xmlns="" style="vertical-align: top;"><strong xmlns="http://www.w3.org/1999/xhtml"></strong></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>0 .. 1</strong></span></td><td xmlns="" style="vertical-align: top;"><span xmlns="http://www.w3.org/1999/xhtml" style="color: black;"><strong>R</strong></span></td><td xmlns=""></td><td xmlns="" style="background-color: #FFEEEE">(VitalSignsSection)</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@typeCode<br /></strong></tt></td></tr></table></td><td xmlns="">cs</td><td xmlns="">1 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">COMP</td></tr><tr><td xmlns=""><table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" cellpadding="1" style="background: transparent;"><tr><td xmlns="" style="vertical-align: top;">[[Datei:Treeblank.png|15px]]</td><td xmlns="" style="vertical-align: top;">[[Datei:Treetree.png|15px]]</td><td xmlns=""><tt xmlns="http://www.w3.org/1999/xhtml"><strong>@context&#8203;Conduction&#8203;Ind<br /></strong></tt></td></tr></table></td><td xmlns="">bl</td><td xmlns="">0 .. 1</td><td xmlns="">F</td><td xmlns="" colspan="2">true</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td xmlns="" style="background-color: white"> </td><td xmlns="" style="background-color: #FFEEEE">Beinhaltet</td><td xmlns="" style="background-color: #FFEEAA" colspan="3">
 .2.276.0.76.10.4036 <i xmlns="http://www.w3.org/1999/xhtml">Schmerz</i> (DYNAMIC)</td></tr></table></td></tr></table>

1.2.276.0.76.10.3044/static-2014-09-16T000000: Unterschied zwischen den Versionen

Version vom 19. April 2015, 18:14 Uhr

Navigationsmenü

Meine Werkzeuge

Namensräume

Varianten

Ansichten

Mehr

Suche

Hauptnavigation

Enzyklopädie

Best practice / Tipps

Interoperabilitätsforum

IHE

EBMF

Medizingeräte

Hilfe

Werkzeuge