procedure

A coded clinical procedure performed on a patient — and optionally tied to a specific encounter — sourced from the provider's clinical record.

Fields

Field	Type	Required	Description
identifiers	Identifier[]	no (defaults [])	Business identifiers for this procedure record.
patientRef	SourceRef	yes	The patient this procedure was performed on.
encounterRef	SourceRef	no	The encounter this procedure was performed during, if any.
code	CodeableConcept	yes	The coded procedure, e.g. an ICD-10-PCS or local procedure code.
status	string enum	yes	One of preparation, in-progress, completed, not-done, on-hold, stopped, unknown.
performedAt	IsoDatetime	no	When the procedure was performed.

Example payload

{
  "identifiers": [{ "system": "urn:michels:procedure", "value": "PROC-6001" }],
  "patientRef": {
    "sourceSystem": "michels",
    "resourceType": "patient",
    "sourceId": "pat-1"
  },
  "encounterRef": {
    "sourceSystem": "michels",
    "resourceType": "encounter",
    "sourceId": "enc-1"
  },
  "code": {
    "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
    "code": "1-208",
    "display": "Blood pressure measurement"
  },
  "status": "completed",
  "performedAt": "2026-07-05T08:00:00.000Z"
}

As a change-feed event

{
  "sequence": 84,
  "resourceType": "procedure",
  "canonicalId": "6c3e9a1b-4f7d-4c8a-9b3e-2f5a8c1d4b7e",
  "operation": "create",
  "version": 1,
  "occurredAt": "2026-07-05T08:00:05.000Z",
  "orgSlug": "default",
  "record": {
    "identifiers": [{ "system": "urn:michels:procedure", "value": "PROC-6001" }],
    "patientRef": {
      "sourceSystem": "michels",
      "resourceType": "patient",
      "sourceId": "pat-1"
    },
    "encounterRef": {
      "sourceSystem": "michels",
      "resourceType": "encounter",
      "sourceId": "enc-1"
    },
    "code": {
      "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
      "code": "1-208",
      "display": "Blood pressure measurement"
    },
    "status": "completed",
    "performedAt": "2026-07-05T08:00:00.000Z"
  }
}

From the Records API

curl -H "Authorization: Bearer $ROSETTA_SYNC_TOKEN" \
  "https://sync.example.com/api/v1/records/procedure/6c3e9a1b-4f7d-4c8a-9b3e-2f5a8c1d4b7e"

{
  "id": "6c3e9a1b-4f7d-4c8a-9b3e-2f5a8c1d4b7e",
  "resourceType": "procedure",
  "version": 1,
  "payload": {
    "identifiers": [{ "system": "urn:michels:procedure", "value": "PROC-6001" }],
    "patientRef": {
      "sourceSystem": "michels",
      "resourceType": "patient",
      "sourceId": "pat-1"
    },
    "encounterRef": {
      "sourceSystem": "michels",
      "resourceType": "encounter",
      "sourceId": "enc-1"
    },
    "code": {
      "system": "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
      "code": "1-208",
      "display": "Blood pressure measurement"
    },
    "status": "completed",
    "performedAt": "2026-07-05T08:00:00.000Z"
  },
  "updatedAt": "2026-07-05T08:00:05.000Z",
  "orgSlug": "default",
  "identifiers": [{ "system": "urn:michels:procedure", "value": "PROC-6001" }]
}

Consumption notes

• Match on code.system + code.code (see Coded concepts); treat code.display as convenience text only, not a matching key.
• encounterRef may be absent — not every procedure is tied to a specific visit.
• status is a lifecycle enum; handle not-done explicitly — it means the procedure was not performed (e.g. cancelled or declined) and must not be rendered as a completed procedure. Treat unknown and any unrecognized value defensively.
• performedAt is a normalized timestamp — always Z-suffixed UTC regardless of the offset the source system reported.
• patientRef/encounterRef are source references; correlate them to the canonical patient and encounter records whose identifiers contain the matching business identifier.