{
  "resourceType" : "ExampleScenario",
  "id" : "BiopsyProcedure",
  "language" : "en",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExampleScenario BiopsyProcedure</b></p><a name=\"BiopsyProcedure\"> </a><a name=\"hcBiopsyProcedure\"> </a><p><b>url</b>: <a href=\"ExampleScenario-BiopsyProcedure.html\">BiopsyProcedure</a></p><p><b>version</b>: 2.1.4</p><p><b>name</b>: BiopsyProcedure</p><p><b>status</b>: Draft</p><p><b>date</b>: 2026-07-24 08:52:06+0000</p><p><b>publisher</b>: NHS North West Genomics</p><p><b>contact</b>: <a href=\"https://www.nwgenomics.nhs.uk/contact-us\">https://www.nwgenomics.nhs.uk/contact-us</a></p><p><b>jurisdiction</b>: <span title=\"Codes:{urn:iso:std:iso:3166 GB}\">United Kingdom of Great Britain and Northern Ireland</span></p><blockquote><p><b>actor</b></p><p><b>actorId</b>: nurse</p><p><b>type</b>: System</p><p><b>name</b>: Nurse</p><p><b>description</b>: </p><div><p>TODO</p>\n</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: forms</p><p><b>type</b>: System</p><p><b>name</b>: Form Manager</p><p><b>description</b>: </p><div><p>This may be part of the EPR or be paper based</p>\n</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: epr</p><p><b>type</b>: System</p><p><b>name</b>: Electronic Patient Record</p><p><b>description</b>: </p><div><p><a href=\"ActorDefinition-ProviderInformationSource.html\">Provider Information Source</a></p>\n</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: patient</p><p><b>type</b>: System</p><p><b>name</b>: Patient/relative/carer</p><p><b>description</b>: </p><div><p>TODO</p>\n</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: consultant</p><p><b>type</b>: System</p><p><b>name</b>: Consultant</p><p><b>description</b>: </p><div><p>TODO</p>\n</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: laboratory</p><p><b>type</b>: System</p><p><b>name</b>: Diagnostic Testing</p><p><b>description</b>: </p><div><p>TODO</p>\n</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request1</p><p><b>resourceType</b>: Questionnaire</p><p><b>name</b>: Query Questionnaire</p><p><b>description</b>: </p><div><p>Query for Froms: <code>GET https://example.nhs.uk/FHIR/R4/Questionnaire</code></p>\n</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request2</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Query Observation and MedicationRequest</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request3</p><p><b>resourceType</b>: QuestionnaireResponse</p><p><b>name</b>: Create QuestionnaireResponse</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request4</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Create Observation and MedicationStatement from QuestionnaireResponse</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply1</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply3</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request5</p><p><b>resourceType</b>: Procedure</p><p><b>name</b>: Update Procedure -Biopsy</p><blockquote><p><b>version</b></p><p><b>R5: Label for instance version (new)</b>: Procedure Liver Biopsy</p><p><b>R5: Example instance version data (new)</b>: <a href=\"Procedure-13240a3b-d1db-4f1a-ad7d-b19f23967060.html\">Procedure Biopsy of liver</a></p><p><b>versionId</b>: 1</p><p><b>description</b>: </p><div><p>TODO</p>\n</div></blockquote></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request6</p><p><b>resourceType</b>: Specimen</p><p><b>name</b>: Update Specimen</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request7</p><p><b>resourceType</b>: Specimen</p><p><b>name</b>: Update Specimen with tracking number</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply5</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply6</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply7</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request8</p><p><b>resourceType</b>: Observation</p><p><b>name</b>: Create Observation - Vital Signs</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Request9</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Create Discharge Letter</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply8</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: Reply9</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Dummy</p></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Admission</p><p><b>description</b>: </p><div><p>Admit Patient. The process roughly follows <a href=\"https://build.fhir.org/ig/HL7/sdc\">FHIR Structured Data Capture</a></p>\n</div><p><b>preConditions</b>: </p><div><p>Test Order has been created (<a href=\"ExampleScenario-GenomicTestOrderProcess.html\">Genomic Test Order Process</a>)</p>\n</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: search-type</p><p><b>name</b>: Select Admission Forms</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: forms</p><p><b>description</b>: </p><div><p>This may be paper based</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request1</td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Reply1</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 2</p><p><b>type</b>: create</p><p><b>name</b>: Pre-populate Admission Form</p><p><b>initiator</b>: forms</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>If using electronic forms and their is a connection to an EPR or Health Information Exchange - the forms may be pre-populated</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request2</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 3</p><p><b>type</b>: read</p><p><b>name</b>: Complete Admission Form.</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: patient</p><p><b>description</b>: </p><div><p>This includes enquiring about the patients medical history, such as conditions and medications. This also includes taking the patient vital signs - device data may be automatically uploaded into the EPR.</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request3</td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Reply3</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 4</p><p><b>type</b>: create</p><p><b>name</b>: Complete Admission Form.</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: forms</p><p><b>description</b>: </p><div><p>Enter answers to questions in the forms. The end of this process is likely to be signalled via a <strong>IHE Patient Administration</strong> HL7 v2 ADT Admission event.</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request4</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Perform Biopsy</p><p><b>description</b>: </p><div><p>Perform Biopsy Procedure</p>\n</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 5</p><p><b>type</b>: create</p><p><b>name</b>: Document Procedure - Record procedure details</p><p><b>initiator</b>: consultant</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>TODO</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request5</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 6</p><p><b>type</b>: update</p><p><b>name</b>: Document Procedure - Update specimen details</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>Ideally the updated specimen record should result in an update to the original order.</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request6</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 7</p><p><b>type</b>: create</p><p><b>name</b>: Send specimen</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: laboratory</p><p><b>description</b>: </p><div><p>If the specimen is being sent via a courier, then the specimen record should be updated with a tracking id</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request7</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Monitor and Discharge Patient</p><p><b>description</b>: </p><div><p>Monitor patient post procedure and Discharge Patient</p>\n</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 8</p><p><b>type</b>: update</p><p><b>name</b>: Monitor Patient - Update specimen details</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>This probably includes taking of vital signs to ensure the patient is stable</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request8</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 9</p><p><b>type</b>: update</p><p><b>name</b>: Discharge Patient</p><p><b>initiator</b>: nurse</p><p><b>receiver</b>: epr</p><p><b>description</b>: </p><div><p>This includes a <strong>IHE Patient Administration</strong> - HL7 v2 ADT Discharge event and may include clinical notes</p>\n</div><h3>Requests</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>ResourceId</b></td></tr><tr><td style=\"display: none\">*</td><td>Request9</td></tr></table></blockquote></blockquote></blockquote></div>"
  },
  "url" : "https://fhir.nwgenomics.nhs.uk/ExampleScenario/BiopsyProcedure",
  "version" : "2.1.4",
  "name" : "BiopsyProcedure",
  "status" : "draft",
  "date" : "2026-07-24T08:52:06+00:00",
  "publisher" : "NHS North West Genomics",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "https://www.nwgenomics.nhs.uk/contact-us"
    }]
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "GB",
      "display" : "United Kingdom of Great Britain and Northern Ireland"
    }]
  }],
  "actor" : [{
    "actorId" : "nurse",
    "type" : "entity",
    "name" : "Nurse",
    "description" : "TODO"
  },
  {
    "actorId" : "forms",
    "type" : "entity",
    "name" : "Form Manager",
    "description" : "This may be part of the EPR or be paper based"
  },
  {
    "actorId" : "epr",
    "type" : "entity",
    "name" : "Electronic Patient Record",
    "description" : " [Provider Information Source](ActorDefinition-ProviderInformationSource.html) "
  },
  {
    "actorId" : "patient",
    "type" : "entity",
    "name" : "Patient/relative/carer",
    "description" : "TODO"
  },
  {
    "actorId" : "consultant",
    "type" : "entity",
    "name" : "Consultant",
    "description" : "TODO"
  },
  {
    "actorId" : "laboratory",
    "type" : "entity",
    "name" : "Diagnostic Testing",
    "description" : "TODO"
  }],
  "instance" : [{
    "resourceId" : "Request1",
    "resourceType" : "Questionnaire",
    "name" : "Query Questionnaire",
    "description" : "Query for Froms: `GET https://example.nhs.uk/FHIR/R4/Questionnaire`"
  },
  {
    "resourceId" : "Request2",
    "resourceType" : "Observation",
    "name" : "Query Observation and MedicationRequest"
  },
  {
    "resourceId" : "Request3",
    "resourceType" : "QuestionnaireResponse",
    "name" : "Create QuestionnaireResponse"
  },
  {
    "resourceId" : "Request4",
    "resourceType" : "Observation",
    "name" : "Create Observation and MedicationStatement from QuestionnaireResponse"
  },
  {
    "resourceId" : "Reply1",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Reply3",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Request5",
    "resourceType" : "Procedure",
    "name" : "Update Procedure -Biopsy",
    "version" : [{
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.title",
        "valueString" : "Procedure Liver Biopsy"
      },
      {
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.content",
        "valueReference" : {
          "reference" : "Procedure/13240a3b-d1db-4f1a-ad7d-b19f23967060"
        }
      }],
      "versionId" : "1",
      "description" : " TODO "
    }]
  },
  {
    "resourceId" : "Request6",
    "resourceType" : "Specimen",
    "name" : "Update Specimen"
  },
  {
    "resourceId" : "Request7",
    "resourceType" : "Specimen",
    "name" : "Update Specimen with tracking number"
  },
  {
    "resourceId" : "Reply5",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Reply6",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Reply7",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Request8",
    "resourceType" : "Observation",
    "name" : "Create Observation - Vital Signs"
  },
  {
    "resourceId" : "Request9",
    "resourceType" : "Binary",
    "name" : "Create Discharge Letter"
  },
  {
    "resourceId" : "Reply8",
    "resourceType" : "Binary",
    "name" : "Dummy"
  },
  {
    "resourceId" : "Reply9",
    "resourceType" : "Binary",
    "name" : "Dummy"
  }],
  "process" : [{
    "title" : "Admission",
    "description" : "Admit Patient. The process roughly follows [FHIR Structured Data Capture](https://build.fhir.org/ig/HL7/sdc)",
    "preConditions" : "Test Order has been created ([Genomic Test Order Process](ExampleScenario-GenomicTestOrderProcess.html))",
    "step" : [{
      "operation" : {
        "number" : "1",
        "type" : "search-type",
        "name" : "Select Admission Forms",
        "initiator" : "nurse",
        "receiver" : "forms",
        "description" : "This may be paper based",
        "request" : {
          "resourceId" : "Request1"
        },
        "response" : {
          "resourceId" : "Reply1"
        }
      }
    },
    {
      "operation" : {
        "number" : "2",
        "type" : "create",
        "name" : "Pre-populate Admission Form",
        "initiator" : "forms",
        "receiver" : "epr",
        "description" : "If using electronic forms and their is a connection to an EPR or Health Information Exchange - the forms may be pre-populated ",
        "request" : {
          "resourceId" : "Request2"
        }
      }
    },
    {
      "operation" : {
        "number" : "3",
        "type" : "read",
        "name" : "Complete Admission Form.",
        "initiator" : "nurse",
        "receiver" : "patient",
        "description" : "This includes enquiring about the patients medical history, such as conditions and medications. This also includes taking the patient vital signs - device data may be automatically uploaded into the EPR. ",
        "request" : {
          "resourceId" : "Request3"
        },
        "response" : {
          "resourceId" : "Reply3"
        }
      }
    },
    {
      "operation" : {
        "number" : "4",
        "type" : "create",
        "name" : "Complete Admission Form.",
        "initiator" : "nurse",
        "receiver" : "forms",
        "description" : "Enter answers to questions in the forms. The end of this process is likely to be signalled via a **IHE Patient Administration** HL7 v2 ADT Admission event. ",
        "request" : {
          "resourceId" : "Request4"
        }
      }
    }]
  },
  {
    "title" : "Perform Biopsy",
    "description" : "Perform Biopsy Procedure",
    "step" : [{
      "operation" : {
        "number" : "5",
        "type" : "create",
        "name" : "Document Procedure - Record procedure details",
        "initiator" : "consultant",
        "receiver" : "epr",
        "description" : "TODO",
        "request" : {
          "resourceId" : "Request5"
        }
      }
    },
    {
      "operation" : {
        "number" : "6",
        "type" : "update",
        "name" : "Document Procedure - Update specimen details",
        "initiator" : "nurse",
        "receiver" : "epr",
        "description" : "Ideally the updated specimen record should result in an update to the original order.  ",
        "request" : {
          "resourceId" : "Request6"
        }
      }
    },
    {
      "operation" : {
        "number" : "7",
        "type" : "create",
        "name" : "Send specimen",
        "initiator" : "nurse",
        "receiver" : "laboratory",
        "description" : "If the specimen is being sent via a courier, then the specimen record should be updated with a tracking id ",
        "request" : {
          "resourceId" : "Request7"
        }
      }
    }]
  },
  {
    "title" : "Monitor and Discharge Patient",
    "description" : "Monitor patient post procedure and Discharge Patient",
    "step" : [{
      "operation" : {
        "number" : "8",
        "type" : "update",
        "name" : "Monitor Patient - Update specimen details",
        "initiator" : "nurse",
        "receiver" : "epr",
        "description" : "This probably includes taking of vital signs to ensure the patient is stable ",
        "request" : {
          "resourceId" : "Request8"
        }
      }
    },
    {
      "operation" : {
        "number" : "9",
        "type" : "update",
        "name" : "Discharge Patient",
        "initiator" : "nurse",
        "receiver" : "epr",
        "description" : "This includes a **IHE Patient Administration** - HL7 v2 ADT Discharge event and may include clinical notes",
        "request" : {
          "resourceId" : "Request9"
        }
      }
    }]
  }]
}