{
  "resourceType" : "Bundle",
  "id" : "BundleMammaNeoadjuvant",
  "language" : "en",
  "type" : "transaction",
  "entry" : [{
    "fullUrl" : "http://example.org/fhir/Patient/PatientinMamma",
    "resource" : {
      "resourceType" : "Patient",
      "id" : "PatientinMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "name" : [{
        "family" : "Baumann",
        "given" : ["Sabine"]
      }],
      "gender" : "female",
      "birthDate" : "1977-06-24"
    },
    "request" : {
      "method" : "POST",
      "url" : "Patient"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Practitioner/OnkologinMamma",
    "resource" : {
      "resourceType" : "Practitioner",
      "id" : "OnkologinMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "name" : [{
        "family" : "Musterarzt",
        "given" : ["Katrin"]
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Practitioner"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/TumorzentrumMamma",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "TumorzentrumMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "name" : "Zertifiziertes Brustzentrum Musterklinik"
    },
    "request" : {
      "method" : "POST",
      "url" : "Organization"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Organization/Tumorboard",
    "resource" : {
      "resourceType" : "Organization",
      "id" : "Tumorboard",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "identifier" : [{
        "system" : "https://www.musterklinik.de/fhir/sid/organisationen",
        "value" : "tumorboard-brust-001"
      }],
      "active" : true,
      "type" : [{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
          "code" : "team",
          "display" : "Organizational team"
        }]
      }],
      "name" : "Zertifiziertes Brustzentrum Musterklinik"
    },
    "request" : {
      "method" : "POST",
      "url" : "Organization"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestBiopsieMamma",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestBiopsieMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "intent" : "order",
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "44578009",
          "display" : "Core needle biopsy of breast (procedure)"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "authoredOn" : "2025-09-12",
      "requester" : {
        "reference" : "Practitioner/OnkologinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestPathologieMamma",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestPathologieMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "intent" : "order",
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "788124003",
          "display" : "Histopathology service (qualifier value)"
        }],
        "text" : "Histopathologische Untersuchung inkl. Rezeptor-/HER2-Status und Ki-67"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "authoredOn" : "2025-09-15",
      "requester" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "specimen" : [{
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestStagingMamma",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestStagingMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "intent" : "order",
      "code" : {
        "text" : "Klinische Ausbreitungsdiagnostik / TNM-Staging"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "authoredOn" : "2025-09-15",
      "requester" : {
        "reference" : "Practitioner/OnkologinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestGBRCAMamma",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestGBRCAMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "intent" : "order",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "21639-0",
          "display" : "BRCA1 gene mutations tested for in Blood or Tissue by Molecular genetics method Nominal"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "authoredOn" : "2025-09-18",
      "requester" : {
        "reference" : "Practitioner/OnkologinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/CarePlan/CarePlanMammaDiagnostik",
    "resource" : {
      "resourceType" : "CarePlan",
      "id" : "CarePlanMammaDiagnostik",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-diagnostic-care-plan"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "active",
      "intent" : "plan",
      "category" : [{
        "text" : "Tumordiagnostik"
      }],
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "author" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "goal" : [{
        "reference" : "Goal/DiagnosticGoal"
      }],
      "activity" : [{
        "outcomeReference" : [{
          "reference" : "Procedure/ProcedureBiopsieMamma"
        }],
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestBiopsieMamma"
        }
      },
      {
        "outcomeReference" : [{
          "reference" : "Observation/ObsHistologieMamma"
        },
        {
          "reference" : "Observation/ObsGradingMamma"
        },
        {
          "reference" : "Observation/ObsEstrogenrezeptorMamma"
        },
        {
          "reference" : "Observation/ObsProgesteronrezeptorMamma"
        },
        {
          "reference" : "Observation/ObsHER2Mamma"
        },
        {
          "reference" : "Observation/ObsKi67Mamma"
        }],
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestPathologieMamma"
        }
      },
      {
        "outcomeReference" : [{
          "reference" : "Observation/ObsTNMklinischMamma"
        }],
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestStagingMamma"
        }
      },
      {
        "outcomeReference" : [{
          "reference" : "Observation/ObsGBRCAMamma"
        }],
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestGBRCAMamma"
        }
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "CarePlan"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Goal/DiagnosticGoal",
    "resource" : {
      "resourceType" : "Goal",
      "id" : "DiagnosticGoal",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-goal"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "extension" : [{
          "url" : "individual",
          "valueReference" : {
            "reference" : "Patient/PatientinMamma"
          }
        },
        {
          "url" : "status",
          "valueCode" : "agree"
        },
        {
          "url" : "priority",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
              "code" : "high-priority",
              "display" : "High Priority"
            }]
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-acceptance"
      }],
      "lifecycleStatus" : "active",
      "achievementStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-achievement",
          "code" : "in-progress",
          "display" : "In Progress"
        }]
      },
      "category" : [{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "261004008",
          "display" : "Diagnostic intent"
        }]
      }],
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
          "code" : "high-priority",
          "display" : "High Priority"
        }]
      },
      "description" : {
        "text" : "Diagnosesicherung für die Verdachtsdiagnose"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "startDate" : "2025-09-12",
      "target" : [{
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21905-5",
            "display" : "Primary tumor.clinical [Class] Cancer"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21906-3",
            "display" : "Regional lymph nodes.clinical [Class] Cancer"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21907-1",
            "display" : "Distant metastases.clinical [Class] Cancer"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21908-9",
            "display" : "Stage group.clinical Cancer"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "40556-3",
            "display" : "Estrogen receptor Ag [Presence] in Tissue by Immune stain"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "85339-0",
            "display" : "Progesterone receptor Ag [Presence] in Breast cancer specimen by Immune stain"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "48676-1",
            "display" : "HER2 Ag [Interpretation] in Tissue"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21855-2",
            "display" : "Primary site Cancer"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "44648-4",
            "display" : "Histologic grade [Score] in Breast cancer specimen by Nottingham"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "33732-9",
            "display" : "Histology grade [Identifier] in Cancer specimen"
          }]
        }
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "85347-3",
            "display" : "Sentinel lymph nodes examined [#] in Cancer specimen by Light microscopy"
          }]
        }
      }],
      "expressedBy" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "outcomeReference" : [{
        "reference" : "Observation/ObsDiseaseStatusMamma"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Goal"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Condition/ConditionMamma",
    "resource" : {
      "resourceType" : "Condition",
      "id" : "ConditionMamma",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-condition"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/condition-assertedDate",
        "valueDateTime" : "2025-09-15"
      }],
      "clinicalStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
          "code" : "active"
        }]
      },
      "verificationStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
          "code" : "confirmed"
        }]
      },
      "category" : [{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
          "code" : "encounter-diagnosis"
        }]
      }],
      "code" : {
        "coding" : [{
          "system" : "http://fhir.de/CodeSystem/bfarm/icd-10-gm",
          "version" : "2026",
          "code" : "C50.4",
          "display" : "Bösartige Neubildung: Oberer äußerer Quadrant der Brustdrüse"
        }],
        "text" : "Invasives Mammakarzinom links, oberer äußerer Quadrant (NST), triple-negativ"
      },
      "bodySite" : [{
        "text" : "Mamma links, oberer äußerer Quadrant"
      }],
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "onsetDateTime" : "2025-09-15",
      "recordedDate" : "2025-09-15"
    },
    "request" : {
      "method" : "POST",
      "url" : "Condition"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Procedure/ProcedureBiopsieMamma",
    "resource" : {
      "resourceType" : "Procedure",
      "id" : "ProcedureBiopsieMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "category" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "103693007",
          "display" : "Diagnostic procedure (procedure)"
        }]
      },
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "44578009",
          "display" : "Core needle biopsy of breast (procedure)"
        }],
        "text" : "Sonografisch gesteuerte Stanzbiopsie der Mamma links"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "performedDateTime" : "2025-09-15",
      "reasonReference" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "bodySite" : [{
        "text" : "Mamma links, oberer äußerer Quadrant"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Procedure"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Specimen/SpecimenBiopsieMamma",
    "resource" : {
      "resourceType" : "Specimen",
      "id" : "SpecimenBiopsieMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "available",
      "type" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "122737001",
          "display" : "Specimen from breast obtained by core needle biopsy"
        },
        {
          "system" : "http://snomed.info/sct",
          "code" : "119376003",
          "display" : "Tissue specimen (specimen)"
        }],
        "text" : "Stanzbiopsat (Gewebeprobe) Mamma links"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "collection" : {
        "collectedDateTime" : "2025-09-15",
        "method" : {
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "9911007",
            "display" : "Core needle biopsy"
          }]
        },
        "bodySite" : {
          "coding" : [{
            "system" : "http://snomed.info/sct",
            "code" : "76365002",
            "display" : "Structure of upper outer quadrant of breast"
          }],
          "text" : "Mamma links, oberer äußerer Quadrant"
        }
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Specimen"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsHistologieMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsHistologieMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "59847-4",
          "display" : "Histology and Behavior ICD-O-3 Cancer"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-15",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "82711006",
          "display" : "Infiltrating duct carcinoma"
        },
        {
          "system" : "urn:oid:2.16.840.1.113883.6.43.1",
          "code" : "8500/3",
          "display" : "Invasives duktales Karzinom / Karzinom ohne speziellen Typ (NST)"
        }],
        "text" : "Invasives Mammakarzinom, NST (ICD-O-3 8500/3)"
      },
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsGradingMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsGradingMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "44648-4",
          "display" : "Histologic grade [Score] in Breast cancer specimen by Nottingham"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-15",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "1155704001",
          "display" : "G3: Poorly differentiated"
        },
        {
          "system" : "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-grading",
          "code" : "3",
          "display" : "schlecht differenziert"
        }],
        "text" : "G3 – schlecht differenziert (Elston-Ellis)"
      },
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsTNMklinischMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsTNMklinischMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "21908-9",
          "display" : "Stage group.clinical Cancer"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-16",
      "valueCodeableConcept" : {
        "text" : "cT2 cN1 cM0 – UICC IIB"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsEstrogenrezeptorMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsEstrogenrezeptorMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "85337-4",
          "display" : "Estrogen receptor Ag [Presence] in Breast cancer specimen by Immune stain"
        },
        {
          "system" : "http://snomed.info/sct",
          "code" : "1234806008",
          "display" : "Observation using immunohistochemistry (observable entity)"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-17",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "LA6577-6",
          "display" : "Negative"
        }]
      },
      "note" : [{
        "text" : "Immunhistochemie: <1 % positive Kerne → ER-negativ."
      }],
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsProgesteronrezeptorMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsProgesteronrezeptorMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "85339-0",
          "display" : "Progesterone receptor Ag [Presence] in Breast cancer specimen by Immune stain"
        },
        {
          "system" : "http://snomed.info/sct",
          "code" : "1234806008",
          "display" : "Observation using immunohistochemistry (observable entity)"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-17",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "LA6577-6",
          "display" : "Negative"
        }]
      },
      "note" : [{
        "text" : "Immunhistochemie: <1 % positive Kerne → PR-negativ."
      }],
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsHER2Mamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsHER2Mamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "48676-1",
          "display" : "HER2 Ag [Interpretation] in Tissue"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-17",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "LA6577-6",
          "display" : "Negative"
        },
        {
          "system" : "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-mamma-her2neu-status-obds",
          "code" : "N",
          "display" : "negativ"
        },
        {
          "system" : "https://www.medizininformatik-initiative.de/fhir/ext/modul-onko/CodeSystem/mii-cs-onko-mamma-her2neu-status-leitlinie",
          "code" : "negativ",
          "display" : "HER2-negativ"
        }]
      },
      "note" : [{
        "text" : "Immunhistochemie 1+ → HER2-negativ; keine In-situ-Hybridisierung erforderlich."
      }],
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsKi67Mamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsKi67Mamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "85330-9",
          "display" : "Cells.Ki-67 nuclear Ag/cells in Breast cancer specimen by Immune stain"
        },
        {
          "system" : "http://snomed.info/sct",
          "code" : "1234806008",
          "display" : "Observation using immunohistochemistry (observable entity)"
        }],
        "text" : "Ki-67 Proliferationsindex (MIB-1)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-17",
      "valueQuantity" : {
        "value" : 70,
        "unit" : "%",
        "system" : "http://unitsofmeasure.org",
        "code" : "%"
      },
      "specimen" : {
        "reference" : "Specimen/SpecimenBiopsieMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsGBRCAMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsGBRCAMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "21639-0",
          "display" : "BRCA1 gene mutations tested for in Blood or Tissue by Molecular genetics method Nominal"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-09-25",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "260385009",
          "display" : "Negative"
        }]
      },
      "note" : [{
        "text" : "gBRCA1/2: keine (wahrscheinlich) pathogene Variante (Klasse 4/5) nachgewiesen."
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/EpisodeOfCare/TherapielinieChemo",
    "resource" : {
      "resourceType" : "EpisodeOfCare",
      "id" : "TherapielinieChemo",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-line"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "extension" : [{
          "url" : "hauptintention",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "373847000",
              "display" : "Neoadjuvant intent"
            }]
          }
        },
        {
          "url" : "phase",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "373808002",
              "display" : "Curative - procedure intent"
            }]
          }
        }],
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-intent"
      },
      {
        "extension" : [{
          "url" : "setting",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/enlist-lot-setting",
              "code" : "eLoT",
              "display" : "eLoT — frühes Setting"
            }]
          }
        },
        {
          "url" : "line",
          "valuePositiveInt" : 1
        },
        {
          "url" : "modification",
          "valueUnsignedInt" : 0
        },
        {
          "url" : "notation",
          "valueString" : "eLoT 1.0"
        },
        {
          "url" : "lineId",
          "valueIdentifier" : {
            "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/sid/enlist-line",
            "value" : "mamma-baumann-elot-1"
          }
        }],
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/enlist-lot"
      },
      {
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/enlist-countable",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/enlist-countable",
            "code" : "counted",
            "display" : "Zählt in der LoT-Zählung"
          }]
        }
      },
      {
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-line-medication-request",
        "valueReference" : {
          "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
        }
      }],
      "status" : "finished",
      "type" : [{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "385786002",
          "display" : "Chemotherapy care"
        }]
      }],
      "diagnosis" : [{
        "condition" : {
          "reference" : "Condition/ConditionMamma"
        },
        "role" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
            "code" : "CC",
            "display" : "Chief complaint"
          }]
        },
        "rank" : 1
      }],
      "patient" : {
        "reference" : "Patient/PatientinMamma"
      },
      "managingOrganization" : {
        "reference" : "Organization/Tumorboard"
      },
      "period" : {
        "start" : "2025-10-01",
        "end" : "2026-03-15"
      },
      "careManager" : {
        "reference" : "Practitioner/OnkologinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "EpisodeOfCare"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/EpisodeOfCare/TherapielinieOperation",
    "resource" : {
      "resourceType" : "EpisodeOfCare",
      "id" : "TherapielinieOperation",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-line"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "extension" : [{
          "url" : "hauptintention",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "373808002",
              "display" : "Curative - procedure intent"
            }]
          }
        }],
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-intent"
      },
      {
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/enlist-countable",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/enlist-countable",
            "code" : "not-counted",
            "display" : "Zählt nicht"
          }]
        }
      }],
      "status" : "finished",
      "type" : [{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "387713003",
          "display" : "Surgical procedure"
        }]
      }],
      "diagnosis" : [{
        "condition" : {
          "reference" : "Condition/ConditionMamma"
        },
        "role" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/diagnosis-role",
            "code" : "CC",
            "display" : "Chief complaint"
          }]
        },
        "rank" : 1
      }],
      "patient" : {
        "reference" : "Patient/PatientinMamma"
      },
      "managingOrganization" : {
        "reference" : "Organization/Tumorboard"
      },
      "period" : {
        "start" : "2026-03-20",
        "end" : "2026-04-06"
      },
      "referralRequest" : [{
        "reference" : "ServiceRequest/ServiceRequestProcedure"
      }],
      "careManager" : {
        "reference" : "Practitioner/OnkologinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "EpisodeOfCare"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Goal/TherapiezielMammaHeilung",
    "resource" : {
      "resourceType" : "Goal",
      "id" : "TherapiezielMammaHeilung",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-goal"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "extension" : [{
          "url" : "hauptintention",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://snomed.info/sct",
              "code" : "373808002",
              "display" : "Curative - procedure intent"
            }]
          }
        }],
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-intent"
      },
      {
        "extension" : [{
          "url" : "individual",
          "valueReference" : {
            "reference" : "Patient/PatientinMamma"
          }
        },
        {
          "url" : "status",
          "valueCode" : "agree"
        },
        {
          "url" : "priority",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
              "code" : "high-priority",
              "display" : "High Priority"
            }]
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-acceptance"
      },
      {
        "extension" : [{
          "url" : "type",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://hl7.org/fhir/goal-relationship-type",
              "code" : "predecessor",
              "display" : "Predecessor"
            }]
          }
        },
        {
          "url" : "target",
          "valueReference" : {
            "reference" : "Goal/DiagnosticGoal"
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-relationship"
      },
      {
        "extension" : [{
          "url" : "type",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://hl7.org/fhir/goal-relationship-type",
              "code" : "successor",
              "display" : "Successor"
            }]
          }
        },
        {
          "url" : "target",
          "valueReference" : {
            "reference" : "Goal/FollowUpGoal"
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-relationship"
      }],
      "lifecycleStatus" : "active",
      "achievementStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-achievement",
          "code" : "achieved",
          "display" : "Achieved"
        }]
      },
      "category" : [{
        "coding" : [{
          "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/onko-therapy-goal-type",
          "code" : "heilung",
          "display" : "Heilung"
        }]
      },
      {
        "coding" : [{
          "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/onko-therapy-goal-type",
          "code" : "funktionserhalt",
          "display" : "Funktionserhalt"
        }]
      }],
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
          "code" : "high-priority",
          "display" : "High Priority"
        }]
      },
      "description" : {
        "text" : "Kurative Behandlung des frühen triple-negativen Mammakarzinoms mittels neoadjuvanter Systemtherapie und brusterhaltender Operation; Erreichen einer pathologischen Komplettremission (pCR)."
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "startDate" : "2025-09-22",
      "target" : [{
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21908-9",
            "display" : "Stage group.clinical Cancer"
          }]
        },
        "dueDate" : "2026-04-15"
      }],
      "expressedBy" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "outcomeReference" : [{
        "reference" : "Observation/ObsDiseaseStatusMamma"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Goal"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestProcedure",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestProcedure",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-tumorboard-service-request"]
      },
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "active",
      "intent" : "proposal",
      "category" : [{
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "85232-7",
          "display" : "Tumor board Consult note"
        }]
      },
      {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "387713003",
          "display" : "Surgical procedure"
        }]
      }],
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "392021009",
          "display" : "Lumpectomy of breast (procedure)"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma",
    "resource" : {
      "resourceType" : "MedicationRequest",
      "id" : "MedicationRequestPembroChemoNeoadjuvantMamma",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-tumorboard-medication-request"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/enlist-change",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/enlist-change-type",
            "code" : "new",
            "display" : "New LoT"
          }]
        }
      }],
      "status" : "completed",
      "intent" : "plan",
      "category" : [{
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "85232-7",
          "display" : "Tumor board Consult note"
        }]
      }],
      "medicationCodeableConcept" : {
        "text" : "Pembrolizumab + Carboplatin/Paclitaxel, gefolgt von Pembrolizumab + Epirubicin/Cyclophosphamid (KEYNOTE-522)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "MedicationRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma1",
    "resource" : {
      "resourceType" : "MedicationAdministration",
      "id" : "MedicationAdministrationPembroChemoNeoadjuvantMamma1",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "medicationCodeableConcept" : {
        "text" : "Pembrolizumab + Carboplatin (q3w), Paclitaxel wöchentlich begleitend (KEYNOTE-522, Phase 1)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-10-01",
      "request" : {
        "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
      },
      "note" : [{
        "text" : "Zyklus 1 von 4 (Pembro/Carbo q3w); begleitend wöchentliche Paclitaxel-Gaben, hier nicht einzeln erfasst"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "MedicationAdministration"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma2",
    "resource" : {
      "resourceType" : "MedicationAdministration",
      "id" : "MedicationAdministrationPembroChemoNeoadjuvantMamma2",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "medicationCodeableConcept" : {
        "text" : "Pembrolizumab + Carboplatin (q3w), Paclitaxel wöchentlich begleitend (KEYNOTE-522, Phase 1)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2025-11-01",
      "request" : {
        "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
      },
      "note" : [{
        "text" : "Zyklus 2 von 4 (Pembro/Carbo q3w); begleitend wöchentliche Paclitaxel-Gaben, hier nicht einzeln erfasst"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "MedicationAdministration"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma3",
    "resource" : {
      "resourceType" : "MedicationAdministration",
      "id" : "MedicationAdministrationPembroChemoNeoadjuvantMamma3",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "medicationCodeableConcept" : {
        "text" : "Pembrolizumab + Carboplatin (q3w), Paclitaxel wöchentlich begleitend (KEYNOTE-522, Phase 1)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2026-02-10",
      "request" : {
        "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
      },
      "note" : [{
        "text" : "Zyklus 3 von 4 (Pembro/Carbo q3w); begleitend wöchentliche Paclitaxel-Gaben, hier nicht einzeln erfasst"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "MedicationAdministration"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma4",
    "resource" : {
      "resourceType" : "MedicationAdministration",
      "id" : "MedicationAdministrationPembroChemoNeoadjuvantMamma4",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "medicationCodeableConcept" : {
        "text" : "Pembrolizumab + Carboplatin (q3w), Paclitaxel wöchentlich begleitend (KEYNOTE-522, Phase 1)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2026-03-15",
      "request" : {
        "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
      },
      "note" : [{
        "text" : "Zyklus 4 von 4 (Pembro/Carbo q3w); begleitend wöchentliche Paclitaxel-Gaben, hier nicht einzeln erfasst"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "MedicationAdministration"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Procedure/ProcedureOperationMamma",
    "resource" : {
      "resourceType" : "Procedure",
      "id" : "ProcedureOperationMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "completed",
      "code" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "392021009",
          "display" : "Lumpectomy of breast (procedure)"
        }],
        "text" : "Brusterhaltende Operation (BET) links + Sentinel-Lymphknoten-Biopsie"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "performedDateTime" : "2026-04-02"
    },
    "request" : {
      "method" : "POST",
      "url" : "Procedure"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsTNMpathologischMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsTNMpathologischMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "21902-2",
          "display" : "Stage group.pathology Cancer"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2026-04-07",
      "valueCodeableConcept" : {
        "text" : "ypT0 ypN0 – pathologische Komplettremission (pCR)"
      }
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Observation/ObsDiseaseStatusMamma",
    "resource" : {
      "resourceType" : "Observation",
      "id" : "ObsDiseaseStatusMamma",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "final",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "97509-4",
          "display" : "Cancer disease progression"
        }]
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "effectiveDateTime" : "2026-04-07",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "260415000",
          "display" : "Not detected"
        }]
      },
      "note" : [{
        "text" : "Pathologische Komplettremission (pCR, ypT0 ypN0) nach neoadjuvanter Systemtherapie."
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Observation"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/CarePlan/CarePlanMammaNeoadjuvant",
    "resource" : {
      "resourceType" : "CarePlan",
      "id" : "CarePlanMammaNeoadjuvant",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-care-plan"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-careplan-custodian",
        "valueReference" : {
          "reference" : "Organization/TumorzentrumMamma"
        }
      }],
      "status" : "active",
      "intent" : "plan",
      "category" : [{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "736252007",
          "display" : "Cancer care plan"
        }]
      }],
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "period" : {
        "start" : "2025-09-22"
      },
      "author" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "goal" : [{
        "reference" : "Goal/TherapiezielMammaHeilung"
      }],
      "activity" : [{
        "outcomeReference" : [{
          "reference" : "MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma1"
        },
        {
          "reference" : "MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma2"
        },
        {
          "reference" : "MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma3"
        },
        {
          "reference" : "MedicationAdministration/MedicationAdministrationPembroChemoNeoadjuvantMamma4"
        }],
        "reference" : {
          "reference" : "MedicationRequest/MedicationRequestPembroChemoNeoadjuvantMamma"
        }
      },
      {
        "outcomeReference" : [{
          "reference" : "Procedure/ProcedureOperationMamma"
        }],
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestProcedure"
        }
      },
      {
        "reference" : {
          "reference" : "MedicationRequest/MedicationRequestPembroAdjuvantMamma"
        }
      },
      {
        "outcomeReference" : [{
          "reference" : "Observation/ObsDiseaseStatusMamma"
        }]
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "CarePlan"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/Goal/FollowUpGoal",
    "resource" : {
      "resourceType" : "Goal",
      "id" : "FollowUpGoal",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-therapy-goal"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "extension" : [{
          "url" : "individual",
          "valueReference" : {
            "reference" : "Patient/PatientinMamma"
          }
        },
        {
          "url" : "status",
          "valueCode" : "agree"
        },
        {
          "url" : "priority",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
              "code" : "high-priority",
              "display" : "High Priority"
            }]
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-acceptance"
      },
      {
        "extension" : [{
          "url" : "type",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://hl7.org/fhir/goal-relationship-type",
              "code" : "predecessor",
              "display" : "Predecessor"
            }]
          }
        },
        {
          "url" : "target",
          "valueReference" : {
            "reference" : "Goal/DiagnosticGoal"
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-relationship"
      },
      {
        "extension" : [{
          "url" : "type",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://hl7.org/fhir/goal-relationship-type",
              "code" : "predecessor",
              "display" : "Predecessor"
            }]
          }
        },
        {
          "url" : "target",
          "valueReference" : {
            "reference" : "Goal/TherapiezielMammaHeilung"
          }
        }],
        "url" : "http://hl7.org/fhir/StructureDefinition/goal-relationship"
      }],
      "lifecycleStatus" : "planned",
      "achievementStatus" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-achievement",
          "code" : "in-progress",
          "display" : "In Progress"
        }]
      },
      "category" : [{
        "coding" : [{
          "system" : "https://bih-cei.de/fhir/therapieziele-onkologie/CodeSystem/onko-therapy-goal-type",
          "code" : "lebensqualitaet",
          "display" : "Lebensqualität"
        }]
      }],
      "priority" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/goal-priority",
          "code" : "high-priority",
          "display" : "High Priority"
        }]
      },
      "description" : {
        "text" : "Monitoring der Lebensqualität und des Krankheitsstatus nach der onkologischen Erkrankung und Therapie"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "startDate" : "2026-08-15",
      "target" : [{
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "21976-6",
            "display" : "Cancer outcome status"
          }]
        },
        "detailCodeableConcept" : {
          "text" : "Kein Hinweis auf Lokalrezidiv oder Fernmetastasen"
        },
        "dueDate" : "2026-11-15"
      },
      {
        "measure" : {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "24606-6",
            "display" : "Mammografie"
          }]
        },
        "detailCodeableConcept" : {
          "text" : "Unauffällige Nachsorge-Mammographie (jährlich), kein Rezidivnachweis"
        },
        "dueDate" : "2027-04-15"
      },
      {
        "measure" : {
          "text" : "Arm-/Schulterfunktion und Lymphödem-Status nach axillärem Eingriff"
        },
        "detailCodeableConcept" : {
          "text" : "Kein manifestes Lymphödem, erhaltene Schulterbeweglichkeit"
        }
      },
      {
        "measure" : {
          "text" : "Gesundheitsbezogene Lebensqualität (PROM, EORTC QLQ-C30 / BR23) – MII PRO-Modul"
        },
        "detailCodeableConcept" : {
          "text" : "Stabile bis verbesserte Lebensqualität im Verlauf"
        }
      }],
      "expressedBy" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "outcomeReference" : [{
        "reference" : "Observation/ObsDiseaseStatusMamma"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "Goal"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/ServiceRequest/ServiceRequestMammographieNachsorge",
    "resource" : {
      "resourceType" : "ServiceRequest",
      "id" : "ServiceRequestMammographieNachsorge",
      "language" : "en",
      "text" : {
        "status" : "generated"
      },
      "status" : "active",
      "intent" : "plan",
      "code" : {
        "coding" : [{
          "system" : "http://loinc.org",
          "code" : "24606-6",
          "display" : "Mammografie"
        }],
        "text" : "Nachsorge-Mammographie beidseits (jährlich)"
      },
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "occurrenceDateTime" : "2027-04-15",
      "requester" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "reasonReference" : [{
        "reference" : "Condition/ConditionMamma"
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "ServiceRequest"
    }
  },
  {
    "fullUrl" : "http://example.org/fhir/CarePlan/CarePlanMammaNachsorge",
    "resource" : {
      "resourceType" : "CarePlan",
      "id" : "CarePlanMammaNachsorge",
      "meta" : {
        "profile" : ["https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-care-plan"]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions"
      },
      "extension" : [{
        "url" : "https://bih-cei.de/fhir/therapieziele-onkologie/StructureDefinition/onko-careplan-custodian",
        "valueReference" : {
          "reference" : "Organization/TumorzentrumMamma"
        }
      }],
      "status" : "active",
      "intent" : "plan",
      "category" : [{
        "coding" : [{
          "system" : "http://snomed.info/sct",
          "code" : "736252007",
          "display" : "Cancer care plan"
        }]
      }],
      "subject" : {
        "reference" : "Patient/PatientinMamma"
      },
      "period" : {
        "start" : "2026-08-15"
      },
      "author" : {
        "reference" : "Practitioner/OnkologinMamma"
      },
      "addresses" : [{
        "reference" : "Condition/ConditionMamma"
      }],
      "goal" : [{
        "reference" : "Goal/FollowUpGoal"
      }],
      "activity" : [{
        "reference" : {
          "reference" : "ServiceRequest/ServiceRequestMammographieNachsorge"
        }
      }]
    },
    "request" : {
      "method" : "POST",
      "url" : "CarePlan"
    }
  }]
}